Advertisement

Aortic stiffness and hypotension episodes are associated with impaired cognitive function in older subjects with subjective complaints of memory loss

Published:October 14, 2013DOI:https://doi.org/10.1016/j.ijcard.2013.09.009

      Abstract

      Objective

      Though CV risk factors and markers of arterial aging are recognized risky for cognition, no study has simultaneously investigated the impact of multiple cardiac, arterial (large and small vessels), and hemodynamic parameters on cognitive function in older subjects.

      Methods

      Two hundred eighty older subjects with subjective complaints of memory loss and no previous stroke (mean age 78.3 ± 6.3 years) were studied. Global cognitive function was evaluated with the Mini-Mental State Examination (MMSE). Cognitive impairment was defined as a MMSE <21. We measured: traditional CV risk factors; aorta stiffness (Pulse Wave Velocity, PWV); LV mass; presence of WML at neuroimaging; episodes of hypotension (SBP <100 mm Hg during 24 h Ambulatory Blood Pressure Monitoring).

      Results

      In both cross-sectional and longitudinal analyses PWV, WML, and episodes of hypotension were significantly associated with poorer cognitive function—controlling for age, sex, education, depression, traditional CV risk factors, and medications. LV mass was no longer associated with cognition in multiple regression. Older subjects with stiffer arteries or episodes of hypotension presented a 4-fold and an 11-fold, respectively, greater odds for progression from normal cognitive function to cognitive impairment. A synergistic effect between PWV, WML, and hypotension was observed: the occurrence of any two of PWV, WML, or hypotension was accompanied by lower MMSE; in the presence of all three factors, a further significant decline in cognitive function was observed.

      Interpretation

      Systemic hemodynamic parameters (higher PWV and hypotension) together with cerebral microvascular damage (WML) are significantly associated with poorer cognitive function and may identify older subjects with subjective complaints of memory loss at higher risk of cognitive decline.

      Keywords

      To read this article in full you will need to make a payment

      Purchase one-time access:

      Academic & Personal: 24 hour online accessCorporate R&D Professionals: 24 hour online access
      One-time access price info
      • For academic or personal research use, select 'Academic and Personal'
      • For corporate R&D use, select 'Corporate R&D Professionals'

      Subscribe:

      Subscribe to International Journal of Cardiology
      Already a print subscriber? Claim online access
      Already an online subscriber? Sign in
      Institutional Access: Sign in to ScienceDirect

      References

        • Scuteri A.
        • Palmieri L.
        • Lo Noce C.
        • Giampaoli S.
        Age-related changes in cognitive domains. A population-based study.
        Aging Clin Exp Res. 2005; 17: 367-373
        • Lobo A.
        • Launer L.J.
        • Fratiglioni L.
        • et al.
        Prevalence of dementia and major subtypes in Europe: A collaborative study of population-based cohorts. Neurologic Diseases in the Elderly Research Group.
        Neurology. 2000; 54: S4-S9
        • Reisberg B.
        • Shulman M.B.
        • Torossian C.
        • Leng L.
        • Zhu W.
        Outcome over seven years of healthy adults with and without subjective cognitive impairment.
        Alzheimers Dement. 2010; 6: 11-24
        • Gorelick P.B.
        • Scuteri A.
        • Black S.E.
        • et al.
        Vascular contributions to cognitive impairment and dementia. A statement for healthcare professionals from the American Heart Association/American Stroke Association.
        Stroke. 2011; 42: 2672-2713
        • Scuteri A.
        • Nilsson P.M.
        • Tzourio C.
        • Redon J.
        • Laurent S.
        Microvascular brain damage with aging and hypertension: pathophysiological consideration and clinical implications.
        J Hypertens. 2011; 29: 1469-1477
        • Kerola T.
        • Kettunen R.
        • Nieminen T.
        The complex interplay of cardiovascular system and cognition: how to predict dementia in the elderly?.
        Int J Cardiol. 2011; 150: 123-129
        • Scuteri A.
        • Brancati A.M.
        • Gianni W.
        • Assisi A.
        • Volpe M.
        Arterial stiffness is an independent risk factor for cognitive impairment in the elderly: a pilot study.
        J Hypertens. 2005; 23: 1211-1216
        • Poels M.M.
        • van Oijen M.
        • Mattace-Raso F.U.
        • et al.
        Arterial stiffness, cognitive decline, and risk of dementia: the Rotterdam Study.
        Stroke. 2007; 38: 888-892
        • Scuteri A.
        • Tesauro M.
        • Appolloni S.
        • Preziosi F.
        • Brancati A.M.
        • Volpe M.
        Arterial stiffness as an independent predictor of longitudinal changes in cognitive function in the older individual.
        J Hypertens. 2007; 25: 1035-1040
        • Vannorsdall T.D.
        • Waldstein S.R.
        • Kraut M.
        • Pearlson G.D.
        • Schretlen D.J.
        White matter abnormalities and cognition in a community sample.
        Arch Clin Neuropsychol. 2009; 24: 209-217
        • Joutel A.
        • Monet-Lepretre M.
        • Gosele C.
        • et al.
        Cerebrovascular dysfunction and microcirculation rarefaction precede white matter lesions in a mouse genetic model of cerebral ischemic small vessel disease.
        J Clin Invest. 2010; 120: 433-445
        • Muller M.
        • van der Graaf Y.
        • Visseren F.L.
        • et al.
        Blood pressure, cerebral blood flow, and brain volumes. The SMART-MR study.
        J Hypertens. 2010; 28: 1498-1505
        • Kim C.K.
        • Lee S.-H.
        • Kim B.J.
        • Ryu W.-S.
        • Yoon B.-W.
        Age-independent association of pulse pressure with cerebral white matter lesions in asymptomatic elderly individuals.
        J Hypertens. 2011; 29: 325-329
        • Nagai M.
        • Hoshide S.
        • Ishikawa J.
        • Shimada K.
        • Kario K.
        Visit-to-visit blood pressure variations: new independent determinants for cognitive function in the elderly at high risk of cardiovascular disease.
        J Hypertens. 2012; 30: 1556-1563
        • Scuteri A.
        • Coluccia R.
        • Castello L.
        • Nevola E.
        • Brancati A.M.
        • Volpe M.
        Left ventricular mass increase is associated with cognitive decline and dementia in the elderly independently of blood pressure.
        Eur Heart J. 2009; 30: 1525-1529
        • Suwa M.
        • Ito T.
        Correlation between cognitive impairment and left ventricular diastolic dysfunction in patients with cardiovascular diseases.
        Int J Cardiol. 2009; 136: 351-354
        • Najjar S.S.
        • Scuteri A.
        • Lakatta E.G.
        Arterial aging: is it an immutable cardiovascular risk factor?.
        Hypertension. 2005; 46: 454-462
        • Scuteri A.
        • Cacciafesta M.
        • Di Bernardo M.G.
        • et al.
        Pulsatile versus steady-state component of blood pressure in elderly females: an independent risk factor for cardiovascular disease?.
        J Hypertens. 1995; 13: 185-191
        • Saba P.S.
        • Ganau A.
        • Devereux R.B.
        • Pini R.
        • Pickering T.G.
        • Roman M.J.
        Impact of arterial elastance as a measure of vascular load on left ventricular geometry in hypertension.
        J Hypertens. 1999; 17: 1007-1015
        • Izzedine H.
        • Launay-Vacher V.
        • Deray G.
        Abnormal blood pressure circadian rhythm: a target organ damage?.
        Int J Cardiol. 2006; 107: 343-349
        • Henskens L.H.
        • Kroon A.A.
        • van Oostenbrugge R.J.
        • et al.
        Associations of ambulatory blood pressure levels with white matter hyperintensity volumes in hypertensive patients.
        J Hypertens. 2009; 27: 1446-1452
        • Kuo H.K.
        • Chen C.Y.
        • Liu H.M.
        • et al.
        Metabolic risks, white matter hyperintensities, and arterial stiffness in high-functioning healthy adults.
        Int J Cardiol. 2010; 143: 184-191
        • Sheik J.I.
        • Yesavge J.A.
        Geriatric Depression Scale (GDS): recent evidence and development of a shorter version.
        Clin Gerontol. 1986; 37: 819-820
        • Devereux R.B.
        • Alonso D.R.
        • Lutas E.M.
        • et al.
        Echocardiographic assessment of left ventricular hypertrophy: comparison to necropsy findings.
        Am J Cardiol. 1986; 57: 450-458
        • Scuteri A.
        • Modestino A.
        • Frattari A.
        • Di Daniele N.
        • Tesauro M.
        Occurrence of hypotension in older participants. Which 24-hour ABPM parameter better correlate with?.
        J Gerontol A Biol Sci Med Sci. 2012; 67: 804-810
        • Wahlund L.O.
        • Barkhof F.
        • Fazekas F.
        • et al.
        A new rating scale for age-related white matter changes applicable to MRI and CT.
        Stroke. 2001; 32: 1318-1322
        • Folstein M.F.
        • Folstein S.E.
        • McHugh P.R.
        Mini-mental state. A practical method for grading the state of patients for the clinician.
        J Psychiatr Res. 1975; 12: 189-198
        • Xuereb JH Brayne C.
        • Dufouil C.
        • Gertz H.
        • et al.
        Neuropathological findings in the very old. Results from the first 101 brains of a population-based longitudinal study of dementing disorders.
        Ann N Y Acad Sci. 2000; 903: 490-496
        • Laurent S.
        • Briet M.
        • Boutouyrie P.
        Large and small artery cross-talk and recent morbidity–mortality trials in hypertension.
        Hypertension. 2009; 54: 388-392
        • Dufouil C.
        • Godin O.
        • Chalmers J.
        • et al.
        Severe cerebral white matter hyperintensities predict severe cognitive decline in patients with cerebrovascular disease history.
        Stroke. 2009; 40: 2219-2221
        • Bakker S.L.
        • de Leeuw F.E.
        • De Groot J.C.
        • Hofman A.
        • Koudstaal P.J.
        • Breteler M.M.
        Cerebral vasomotor reactivity and cerebral white matter lesions in the elderly.
        Neurology. 1999; 52: 578-583
        • Marstrand J.R.
        • Garde E.
        • Rostrup E.
        • et al.
        Cerebral perfusion and cerebrovascular reactivity are reduced in white matter hyperintensities.
        Stroke. 2002; 33: 972-976
        • Scuteri A.
        • Spalletta G.
        • Cangelosi M.
        • et al.
        Decreased nocturnal systolic blood pressure fall in older subjects with depression.
        Aging Clin Exp Res. 2009; 21: 292-297
        • Scuteri A.
        • Modestino A.
        • Fedullo F.
        • Assisi A.P.
        • Gianni W.
        Depression treatment selectively modifies arterial stiffness in older subjects.
        J Gerontol A Biol Sci Med Sci. 2013; 68: 719-725
        • Terrera G.M.
        • Brayne C.
        • Matthews F.
        • the CC75C Study Collaboration Group2
        One size fits all? Why we need more sophisticated analytical methods in the explanation of trajectories of cognition in older age and their potential risk factors.
        Int Psychogeriatr. 2010; 22: 291-299
        • Nagai M.
        • Hoshide S.
        • Ishikawa J.
        • Shimada K.
        • Kario K.
        Ambulatory blood pressure as an independent determinant of brain atrophy and cognitive function in elderly hypertension.
        J Hypertens. 2008; 26: 1636-1641
        • Mattace-Raso F.U.
        • van der Cammen T.J.
        • Knetsch A.M.
        • et al.
        Arterial stiffness as the candidate underlying mechanism for postural blood pressure changes and orthostatic hypotension in older adults: the Rotterdam Study.
        J Hypertens. 2006; 24: 339-344
        • Eguchi K.
        • Kario K.
        • Hoshide S.
        • et al.
        Greater change of orthostatic blood pressure is related to silent cerebral infarct and cardiac overload in hypertensive subjects.
        Hypertens Res. 2004; 27: 235-241
        • Rose K.M.
        • Couper D.
        • Eigenbrodt M.L.
        • Mosley T.H.
        • Sharrett A.R.
        • Gottesman R.F.
        Orthostatic hypotension and cognitive function: the Atherosclerosis Risk in Communities Study.
        Neuroepidemiology. 2010; 34: 1-7
        • Mehrabian S.
        • Duron E.
        • Labouree F.
        • et al.
        Relationship between orthostatic hypotension and cognitive impairment in the elderly.
        J Neurol Sci. 2010; 299: 45-48
        • Pilleri M.
        • Facchini S.
        • Gasparoli E.
        • et al.
        Cognitive and MRI correlates of orthostatic hypotension in Parkinson's disease.
        J Neurol. 2013; 260: 253-259
        • Rogers T.K.
        • Bowman C.E.
        Cognitive impairment associated with beta-blockade in the elderly.
        Postgrad Med J. 1990; 66: 1050-1052
        • Lakatta EG Scuteri A.
        Bringing prevention in geriatrics: evidence from cardiovascular medicine supporting the new challenge.
        Exp Gerontol. 2013; 48: 64-68
        • Hachinski V.
        • Iadecola C.
        • Petersen R.C.
        • et al.
        National Institute of Neurological Disorders and Stroke-Canadian Stroke Network vascular cognitive impairment harmonization standards [published correction appears in Stroke. 2007;38:1118].
        Stroke. 2006; 37: 2220-2241
        • Scuteri A.
        Brain injury as end-organ damage in hypertension.
        Lancet Neurol. 2012; 11: 1015-1017
        • Scuteri A.
        • Cunha P.G.
        Decreasing arterial aging by controlling blood pressure levels and hypertension: a step forward.
        Curr Vasc Pharmacol. 2012; 10: 702-704