Blood Pressure Control in Aging Predicts Cerebral Atrophy Related to Small-Vessel White Matter Lesions

Abstract

Cerebral small-vessel damage manifests as white matter hyperintensities and cerebral atrophy on brain MRI and is associated with aging, cognitive decline and dementia. We sought to examine the interrelationship of these imaging biomarkers and the influence of hypertension in older individuals. We used a multivariate spatial covariance neuroimaging technique to localize the effects of white matter lesion load on regional gray matter volume and assessed the role of blood pressure control, age and education on this relationship. Using a case-control design matching for age, gender, and educational attainment we selected 64 participants with normal blood pressure, controlled hypertension or uncontrolled hypertension from the Northern Manhattan Study cohort. We applied gray matter voxel-based morphometry with the scaled subprofile model to (1) identify regional covariance patterns of gray matter volume differences associated with white matter lesion load, (2) compare this relationship across blood pressure groups, and (3) relate it to cognitive performance. In this group of participants aged 60–86 years, we identified a pattern of reduced gray matter volume associated with white matter lesion load in bilateral temporal-parietal regions with relative preservation of volume in the basal forebrain, thalami and cingulate cortex. This pattern was expressed most in the uncontrolled hypertension group and least in the normotensives, but was also more evident in older and more educated individuals. Expression of this pattern was associated with worse performance in executive function and memory. In summary, white matter lesions from small-vessel disease are associated with a regional pattern of gray matter atrophy that is mitigated by blood pressure control, exacerbated by aging, and associated with cognitive performance.

Hypertension-Induced Cerebral Small Vessel Disease Leading to Cognitive Impairment

“…[ 5 ] WML refers to the entire spectrum of such lesions from mild perivascular tissue damage surrounding the lipohyalinotic arterioles which result in minimal axonal loss, to more severe ischemic damage, which can cause extensive myelin and axonal loss. [ 6 ]…”

“…Moreover, WML-associated reductions in gray matter volume were significantly more substantial and executive function, and memory was worse in uncontrolled hypertensives than in normotensives. [ 6 ] In addition, cognitive decline was more associated with the degree of periventricular WML than that of subcortical WML. Intriguingly, the former may disrupt the long associative tracts that connect more distant cortical areas, whereas the latter may cause more limited damage to short cortico-cortical connections.…”

Interaction of Age and Self-reported Physical Sports Activity on White Matter Hyperintensity Volume in Healthy Older Adults

“…Future work to obtain quantitative segmentation of deep vs. periventricular WMH volumes is warranted to help evaluate potential differences in their relation to brain aging. There is also growing interest in understanding how WMH volumes interact with gray matter in healthy aging and with cerebrovascular risk factors, like hypertension (e.g., Kern et al, 2017 ). Future studies using multimodal neuroimaging methods are needed to evaluate how associations between WMH volume and gray or WM integrity are altered by PSA in the context of healthy and pathological aging.…”

Hypertriglyceridemia Is Associated with Reduced Leukoaraiosis Severity in Patients with a Small Vessel Stroke

“…We observed that hypertension increases the risk of severity of white matter hyperintensities in the SWML group, but not in the PVH group. Longitudinal investigations revealed that well-controlled blood pressure in patients with hypertension significantly reduces the risk of severe white matter hyperintensity lesions [ 18 ]. Our results from the subjects who had taken antihypertensive treatment (85%) might support this speculation.…”