Blood pressure control has distinct effects on executive function, attention, memory and markers of cerebrovascular damage

Abstract

Hypertension causes cognitive impairment, involving mainly executive functions, but the effect of blood pressure (BP) control on the different cognitive domains is still debated. We correlated executive function, attention and memory with BP control and cerebrovascular damage in 60 undemented middle-aged hypertensives at baseline and after 6-year follow-up. At first evaluation, the patients with poor BP control had higher score of white matter lesions, reduced cerebrovascular reserve capacity and greater carotid intima-media thickness (IMT) than those with good BP control. Performance on executive tests correlated with IMT and with performance on attention tests, which was impaired by low diastolic BP. At long-term follow-up, performance in attention and executive tests improved in spite of the minor improvement of BP control, increased IMT and worse memory. Low diastolic BP has a negative effect on attention, which affects executive performance at first cross-sectional examination. This confounding effect has to be taken into consideration when planning studies on cognitive function. Longitudinal studies are required to unravel the effect of BP control on cognitive function, as only long-term antihypertensive treatment improves both attention and executive performance.

Vascular Risk Moderates Associations between Hippocampal Subfield Volumes and Memory

“…Declines in brain structure and selected cognitive abilities are exacerbated by ageassociated vascular risk factors such as essential hypertension (Brady, Spiro, & Gaziano, 2005;Singhmanoux & Marmot, 2005;Waldstein, Brown, Maier, & Katzel, 2005;Waldstein & Katzel, 2001;Harrington, Saxby, McKeith, Wesnes, & Ford, 2000), and the influence of vascular risk on brain and cognition varies across brain regions and cognitive domains (see Raz & Kennedy, 2009;Birns & Kaira, 2008, for reviews). Elevated arterial blood pressure has been linked to impaired psychomotor speed as well as Wayne State University, Detroit, MI poor fluid reasoning, working memory, and executive functions (Semplicini et al, 2010;Waldstein et al, 2005;Kuo et al, 2004;Raz, Rodrigue, & Acker, 2003;Saxby, Harrington, McKeith, Wesnes, & Ford, 2003;Knopman et al, 2001;Harrington et al, 2000;Elias, Robbins, Elias, & Streeten, 1998). Hypertension is also associated with reduced performance on various measures of episodic memory, including immediate and delayed recognition and free recall (Hannesdottir et al, 2009;Kuo et al, 2004;Saxby et al, 2003;Harrington et al, 2000).…”

Abnormal cerebral electrogenesis is associated with impaired cognitive performance in hypertensive patients

“…1 The electroencephalogram (EEG) is a cheap and noninvasive investigation, but virtually no information is available on the effects of high blood pressure, if any, on cerebral electrogenesis. Here, we show that low-amplitude EEG is considerably more common in hypertensive patients than in the general population, and associated with cognitive impairment.…”

“…Patients with chronic systemic hypertension also underwent formal, comprehensive assessment of their neuropsychiatric function (full protocol in Semplicini et al 1 ) and, where possible (n ¼ 26), cerebral magnetic resonance imaging (MRI). Paper and pencil neuropsychological tests were scored in relation to Italian normative data, and results were expressed as age-and education-adjusted z-scores.…”

Searching cerebrovascular risk indicators for hypertensive patients: Is Framingham Stroke Risk Profile “the magic bullet”?

“…The vascular alterations also disrupt cerebral blood flow autoregulation and make the brain more susceptible to hypoperfusion during occasional or chronic hypotension that may be caused by inappropriate or excessive antihypertensive therapy. Drug induced hypotension may affect attention and indirectly performance in executive functions . Finally, vascular lesions also have a permissive effect on the clinical expression of neurodegenerative dementia of the Alzheimer type …”