# Behavioral and psychological symptoms of dementia and hypertension in nursing home residents

> **NIH NIH R21** · ICAHN SCHOOL OF MEDICINE AT MOUNT SINAI · 2020 · $358,585

## Abstract

PROJECT SUMMARY/ABSTRACT
This application aims to investigate the possibility that behavioral and psychological symptoms in dementia
(BPSD) increase blood pressure in nursing home (NH) residents with Alzheimer's Disease and related
dementias (ADRD), thereby complicating the management and treatment of hypertension in this group. BPSD
is common in NH residents with ADRD, affecting at least 80% of patients, and, by causing distress and
sympathetic nervous system activation, may increase blood pressure and blood pressure measurement
variability. The clinical implication is that NH clinicians may make antihypertensive prescribing decisions based
on suboptimal blood pressure measurements, and may intensify antihypertensive treatment of patients with
ADRD with unlikely benefit and possible harm. The aims of this study are exploratory and developmental in
that there are no large-scale studies on these questions and findings can inform the design of future studies to
examine interactions between BPSD exposures on outcomes in patients with ADRD and hypertension. Our
specific aims are to: 1) Explore the associations between behavioral and psychological symptoms in dementia
(BPSD), hypertension, and blood pressure readings in NH residents with ADRD, 2) Examine the association
between BPSD and intensity of antihypertensive medication treatment in NH residents with ADRD, and 3)
Examine the association between changes in antipsychotic use and blood pressure readings in NH residents
with ADRD, controlling for BPSD. We expect that, independent of other factors, BPSD will be associated with
increased variability of blood pressure and higher blood pressure in NH residents with ADRD. In addition, we
expect that NH residents with ADRD and more severe BPSD will receive more intense medication treatment
for high blood pressure. Finally, we expect that antipsychotic medication reduction will be associated with
changes in blood pressure that may affect antihypertensive medication management, but the direction of
association may differ from individual to individual. To achieve these aims we will utilize 2 cohorts of long-stay
NH residents with ADRD: 1) a cohort of veterans served in VA Community Living Centers (VA NHs); and 2)
Medicare-enrolled residents of U.S. NHs. Both cohorts will provide information on BPSD, hypertension, and
other diagnoses; cognitive and physical function; medication prescribing; and adverse drug effects in large
national representative groups. The VA cohort will provide information on blood pressure and will be used in
Aims 1, 2 and 3. The Medicare cohort will provide population estimates of antihypertensive and antipsychotic
medication treatment among all U.S. nursing home residents and will be used in Aims 2 and 3. We will
produce multivariable models that will enable us to test hypothesized relationships between behavioral and
psychological symptoms in dementia, blood pressure and blood pressure management.

## Key facts

- **NIH application ID:** 10040223
- **Project number:** 1R21AG068612-01
- **Recipient organization:** ICAHN SCHOOL OF MEDICINE AT MOUNT SINAI
- **Principal Investigator:** Kenneth S. Boockvar
- **Activity code:** R21 (R01, R21, SBIR, etc.)
- **Funding institute:** NIH
- **Fiscal year:** 2020
- **Award amount:** $358,585
- **Award type:** 1
- **Project period:** 2020-09-15 → 2023-08-31

## Primary source

NIH RePORTER: https://reporter.nih.gov/project-details/10040223

## Citation

> US National Institutes of Health, RePORTER application 10040223, Behavioral and psychological symptoms of dementia and hypertension in nursing home residents (1R21AG068612-01). Retrieved via AI Analytics 2026-05-22 from https://api.ai-analytics.org/grant/nih/10040223. Licensed CC0.

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