Central Arterial Stiffness Is Associated With Structural Brain Damage and Poorer Cognitive Performance: The ARIC Study

Abstract

Background Central arterial stiffening and increased pulsatility, with consequent cerebral hypoperfusion, may result in structural brain damage and cognitive impairment. Methods and Results We analyzed a cross‐sectional sample of ARIC ‐ NCS (Atherosclerosis Risk in Communities–Neurocognitive Study) participants (aged 67–90 years, 60% women) with measures of cognition (n=3703) and brain magnetic resonance imaging (n=1255). Central arterial hemodynamics were assessed as carotid‐femoral pulse wave velocity and pressure pulsatility (central pulse pressure). We derived factor scores for cognitive domains. Brain magnetic resonance imaging using 3‐Tesla scanners quantified lacunar infarcts; cerebral microbleeds; and volumes of white matter hyperintensities, total brain, and the Alzheimer disease signature region. We used logistic regression, adjusted for demographics, apolipoprotein E ɛ4, heart rate, mean arterial pressure, and select cardiovascular risk factors, to estimate the odds of lacunar infarcts or cerebral microbleeds. Linear regression, additionally adjusted for intracranial volume, estimated the difference in log‐transformed volumes of white matter hyperintensities , total brain, and the Alzheimer disease signature region. We estimated the mean difference in cognitive factor scores across quartiles of carotid‐femoral pulse wave velocity or central pulse pressure using linear regression. Compared with participants in the lowest carotid‐femoral pulse wave velocity quartile, participants in the highest quartile of carotid‐femoral pulse wave velocity had a greater burden of white matter hyperintensities ( P =0.007 for trend), smaller total brain volumes (−18.30 cm 3 ; 95% CI , −27.54 to −9.07 cm 3 ), and smaller Alzheimer disease signature region volumes (−1.48 cm 3 ; 95% CI , −2.27 to −0.68 cm 3 ). These participants also had lower scores in executive function/processing speed (β=−0.04 z score; 95% CI , −0.07 to −0.01 z score) and general cognition (β=−0.09 z score; 95% CI , −0.15 to −0.03 z score). Similar results were observed for central pulse pressure . Conclusions Central arterial hemodynamics were associated with structural brain damage and poorer cognitive performance among older adults.

Associations of Arterial Stiffness With Cognitive Performance, and the Role of Microvascular Dysfunction

“…2 Impairment of these processes may lead to neuronal dysfunction and ischemia, which may ultimately lead to lower cognitive performance. 3 In accordance, previous studies [4][5][6][7][8][9][10][11][12][13][14][15][16][17][18][19][20][21] have shown an association between greater arterial stiffness and worse cognitive performance and incident dementia. Most of these studies [4][5][6][7][8][9][10][11][14][15][16][17][18]21 focused on carotid-femoral pulse wave velocity (cfPWV), a measure of aortic stiffness, but only some [12][13][14][15][16][17]19,20 on carotid stiffness.…”

Assessment of the Willis circle flow changes and the severity of degenerative aortic stenosis and cognitive impairment

“…The other common believe is that CBF or cerebral flow velocity should correlate with cognitive status [30][31][32]. However, prior studies have only partially quantified the nature of the cognition-hemodynamic relationship [31,32].…”

“…The other common believe is that CBF or cerebral flow velocity should correlate with cognitive status [30][31][32]. However, prior studies have only partially quantified the nature of the cognition-hemodynamic relationship [31,32]. In Kidher et al study of 56 patients with severe DAS, aortic stiffness (assessed by measuring carotid-femoral pulse wave velocity) was an indicator for preoperative cognitive dysfunction [12].…”

Hypertension and arterial stiffness

“…In this regard, it is worth to notice that antihypertensive drugs that predominantly or exclusively affect diastolic or mean arterial pressure may not represent the best choice in patients with markedly raised systolic and pulse pressure and increased arterial stiffness, and some classes of BP‐lowering agents, including angiotensin receptor blockers and angiotensin‐converting enzyme inhibitors, can improve aortic stiffness . Nonpharmacological strategies, like physical activity, weight loss, and smoking cessation, have been also proposed as potentially effective “de‐stiffening” interventions …”

“…31 Nonpharmacological strategies, like physical activity, weight loss, and smoking cessation, have been also proposed as potentially effective "de-stiffening" interventions. 38…”