Background Research of hypertension‐related risk factors for Alzheimer's disease has typically focused on blood pressure (BP) levels, despite evidence that high blood pressure variability (BPV) over time may predict poorer cardiovascular, neuropathological, and neurocognitive outcomes. We evaluated associations between BPV and cognitive function in the Multi‐Ethnic Study of Atherosclerosis (MESA). Methods Multivariable linear and logistic regression analyses of BP data across six examinations were used to determine associations that BPV (average real variability [ARV], variability independent of the mean [VIM]) and group‐based latent BP trajectories have with cognitive function, decline, and impairment, measured by the Cognitive Abilities Screening Instrument (CASI), Digit Symbol Coding (DSC), and Digit Span tests. Results Participants ( N = 1314; mean baseline age = 57) were 50% female, and 48% White. Higher systolic ( β = −0.06, 95% confidence interval [CI]: −0.12, −0.0001) and diastolic ( β = −0.08, 95% CI: −0.14, −0.02) ARV predicted increased global cognitive decline after covariate adjustment. Stronger relationships between BPV and global cognition were in older, White and Black participants, apolipoprotein E ( APOE ) ε4 non‐carriers, male participants, and non‐antihypertensive medication users. Conclusion Results suggest that higher systolic and diastolic BPV is an independent risk factor for cognitive dysfunction and decline in this multi‐ethnic cohort. This relationship differs across demographic and clinical characteristics.
Background: Hypertension and diabetes are key modifiable risk factors for Alzheimer's disease and related dementias. Research has typically focused on blood pressure (BP) levels, despite evidence that high BP variability (BPV) over time may predict poorer cardiovascular, neuropathological, and neurocognitive outcomes. We assessed associations between BPV and global cognition in a cohort of participants from the Multi-Ethnic Study of Atherosclerosis (MESA), including 4 ethnoracial groups: White, African-American, Chinese, and Hispanic. Methods: Longitudinal BP data across 6 MESA examinations were used in multivariable linear and logistic regression analyses to determine the association BPV and cognitive function, decline, and incident impairment. Two measures of long-term BPV (Average Real Variability [ARV] and Variability Independent of the Mean [VIM]) and group-based latent BP trajectories were estimated over an average of 9.4 years. The Cognitive Abilities Screening Instrument (CASI), Digit Symbol Coding (DSC), and Digit Span (DS), were administered at MESA Exams 5 and 6, an average of 6.3 years apart. This enabled the assessment of cognitive function, decline, and cognitive impairment, defined as performance in the lowest 10% of groups stratified by age, education, and race. Results: Participants (N=1314) had a mean baseline age of 57 years, and were 50% female and 48% White. Increased systolic and diastolic BPV were associated with poorer performance across all measures and with increased global cognitive decline in unadjusted models. Higher systolic (β = -0.06, P=0.05) and diastolic (β = -0.08, P=0.005) ARV was predictive of increased CASI decline after adjustment for demographic and clinical characteristics, including mean BP. Significant interactions and subsequent stratified analyses indicated that the strongest relationships between BPV and global cognition were in participants older than age 65, White or Black, APOE ε4 non-carriers, males, and non-antihypertensive medication users. Higher and more variable latent systolic and diastolic BP trajectories predicted reduced performance on the CASI, DS, or DSC tests before and after adjustment for clinical and demographic characteristics.
The decline in physical and mental well-being is common with age. The negative impact of poor quality of sleep and depressive symptomatology contributes to the decline in well-being among middle to older adults. African Americans are more likely to report a decrease in well-being as they age. They are also disproportionately affected by poorer sleep quality and may be at greater risk for depressive symptomatology. Dispositional mindfulness is linked to improved well-being. Research has shown dispositional mindfulness is related to adaptive health behaviors, improved sleep quality, and reduced negative affect. Mindfulness allows engagement of early regulation of intense emotional responses because of nonjudgmental acceptance of thoughts and emotions. Therefore, this study aims to examine the impact of mindfulness on physical/mental well-being and depressive symptomatology through sleep. 131 African American participants were recruited for the study, with an average age of 58 years. The results showed a significant effect of mindfulness on well-being and depressive symptoms. Additionally, the impact of mindfulness on mental and physical well-being was mediated by sleep quality (B = .7920, CI [.1482, 1.6702]) and sleep disturbance (B = 2.874, CI [.1582, 6.335]). The results also showed an indirect effect of mindfulness on depressive symptoms through sleep quality (B = –6.139 CI [-12.871, -.5298]). This study demonstrates the positive impact of mindfulness on well-being and depressive symptomatology. Sleep quality also plays an important role in the relationship between dispositional mindfulness and physical/mental well-being and depressive symptomatology in middle to older African Americans.
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