Treating the Heart, Protecting the Brain

Reviewed By: Sharyn Rossi, PhD, BrightFocus Foundation

BrightFocus Foundation Alzheimer's Disease Research grant recipient Brittany Butts, PhD, was always close with her grandmother. When she passed away from Alzheimer's, it had a major impact on Dr. Butts' life, and the experience steered her toward researching the disease that had taken her grandmother.

"She was my favorite person, and due to Alzheimer's disease, I lost her twice," Dr. Butts said. "The first time when her dementia progressed to the point that she was no longer herself, and again when she died."

Looking back, Dr. Butts can see several risk factors that may have ultimately contributed to her grandmother's dementia diagnosis, including cardiovascular disease. Although there is a strong link between cardiovascular disease and dementia, the reasons why aren't clear. Today, Dr. Butts is studying how the body's natural mechanisms for controlling blood pressure are linked to brain health, potentially finding a new avenue for treating Alzheimer's-or even preventing it before it happens.

Dr. Brittany Butts and her grandmother.

Her research focuses on the renin-angiotensin-aldosterone system(RAAS), which helps maintain blood pressure and fluid balance in the body. While the RAAS is essential for healthy cardiovascular function, if it becomes overactive, it can promote inflammation and lead to blood vessel problems. This can reduce blood flow to the brain, depriving it of oxygen and important nutrients. The combination of these factors may create an environment that increases the risk of neurodegenerative disease like Alzheimer's by contributing to the buildup of harmful disease proteins.

To study this, Dr. Butts is examining 80 middle-aged adults with heart failure and aims to recruit at least 50% Black and African American participants. These participants' RAAS can no longer effectively regulate blood pressure and fluid levels, and Dr. Butts believes they may start to show cognitive problems or even early warning signs of Alzheimer's. To look for these signs, she will run blood tests, conduct cognitive assessments, and examine artery stiffness-a sign of impaired brain blood flow.

"By putting all this information together, we hope to understand whether the RAAS system might be a key player in linking heart failure to brain health and Alzheimer's disease," Dr. Butts explained.

She says this research could help identify new risk factors for Alzheimer's in midlife-a topic that's gaining steam as research from The Lancet expanded recognized Alzheimer's risk factors. That study showed that factors including hearing loss, high cholesterol, and high blood pressure during mid-life had the biggest potential to contribute to Alzheimer's.

"Alzheimer's disease doesn't just happen overnight-it builds up slowly over many years," Dr. Butts said. "By the time most people show symptoms, a lot of damage has already been done. If we can spot these issues early, it might give doctors a new way to detect Alzheimer's risk long before symptoms appear."

If her research confirms RAAS plays a key role in brain health, it could lead to new treatments for neurological diseases. Some drugs for blood pressure and heart failure that fine-tune the RAAS are already on the market, so these medications could be repurposed to protect the brain.

The study also explores how changes in the RAAS and brain health are influenced by sex and race.

Dr. Brittany Butts, Alzheimer's Disease Research grant recipient.

"This research is important to me because it addresses some of the biggest health challenges that affect our communities, especially those that are often overlooked," Dr. Butts said. "Heart failure and Alzheimer's disease are both devastating conditions that take a heavy toll on individuals and their families."

Heart failure affects men and women differently, and older Black Americans are nearly twice as likely to have dementia as older white Americans. Black people are also 30% more likely to have high blood pressure and to die from heart disease than non-Hispanic whites. Dr. Butts' research suggests increased rates of both cardiovascular problems and dementia in the Black population may not be a coincidence, and her work aims to better understand and address the gaps in their care.

"What's really concerning is that certain groups, like Black Americans and women, seem to be hit even harder by these diseases," she said. "They're more likely to develop heart failure earlier in life and are at higher risk for Alzheimer's, yet they often receive less attention in research."

Dr. Butts hopes this research can help people like her grandmother detect signs of neurodegeneration early, before it's more difficult to treat. "This project is helping us get a step closer to understanding, detecting, and maybe even preventing Alzheimer's disease by focusing on a part of the body that most people don't immediately think of when it comes to brain health-the heart."

Through the generosity of our donors, Alzheimer's Disease Research, a BrightFocus Foundation program, is funding 112 innovative research studies around the world investigating the causes and potential prevention strategies, treatments, and a cure for Alzheimer's. Explore the research.

Additional resources:

• Medical Conditions That Can Mimic Dementia
• Diet and Alzheimer's Disease
• Alzheimer's and Inflammation

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