Cerebral white matter lesions, subjective cognitive failures, and objective neurocognitive functioning: A follow-up study in women after hypertensive disorders of pregnancy

Postma, Ineke R.; Bouma, Anke; Groot, Jan Cees de; Aukes, Annet M.; Aarnoudse, Jan G.; Zeeman, Gerda G.

doi:10.1080/13803395.2016.1143453

Cited by 44 publications

(51 citation statements)

References 39 publications

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“…White matter hyperintensities have been related to lower cognitive performance during middle-age in samples with high vascular risk (Nunley et al, 2015; Hawkins et al, 2017). However, this association has not been obtained in samples excluding vascular pathology (Postma et al, 2016), consistent with our study.…”

Section: Discussionsupporting

confidence: 91%

Cognitive Variability during Middle-Age: Possible Association with Neurodegeneration and Cognitive Reserve

Ferreira

Machado

Molina

et al. 2017

Front. Aging Neurosci.

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Objective: Increased variability in cognition with age has been argued as an indication of pathological processes. Focusing on early detection of neurodegenerative disorders, we investigated variability in cognition in healthy middle-aged adults. In order to understand possible determinants of this variability, we also investigated associations with cognitive reserve, neuroimaging markers, subjective memory complaints, depressive symptomatology, and gender.Method: Thirty-one 50 ± 2 years old individuals were investigated as target group and deviation was studied in comparison to a reference younger group of 30 individuals 40 ± 2 years old. Comprehensive neuropsychological and structural imaging protocols were collected. Brain regional volumes and cortical thickness were calculated with FreeSurfer, white matter hyperintensities with CASCADE, and mean diffusivity with FSL.Results: Across-individuals variability showed greater dispersion in lexical access, processing speed, executive functions, and memory. Variability in global cognition correlated with, reduced cortical thickness in the right parietal-temporal-occipital association cortex, and increased mean diffusivity in the cingulum bundle and right inferior fronto-occipital fasciculus. A trend was also observed for the correlation between global cognition and hippocampal volume and female gender. All these associations were influenced by cognitive reserve. No correlations were found with subjective memory complaints, white matter hyperintensities and depressive symptomatology. Across-domains and across-tasks variability was greater in several executive components and cognitive processing speed.Conclusion: Variability in cognition during middle-age is associated with neurodegeneration in the parietal–temporal–occipital association cortex and white matter tracts connecting this to the prefrontal dorsolateral cortex and the hippocampus. Moreover, this effect is influenced by cognitive reserve. Studying variability offers valuable information showing that differences do not occur in the same magnitude and direction across individuals, cognitive domains and tasks. These findings may have important implications for early detection of subtle cognitive impairment and clinical interpretation of deviation from normality.

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Section: Discussionsupporting

confidence: 91%

Cognitive Variability during Middle-Age: Possible Association with Neurodegeneration and Cognitive Reserve

Ferreira

Machado

Molina

et al. 2017

Front. Aging Neurosci.

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“…50 In further support that hypertensive pregnancy is an independent predictor of change in cognition and brain structure, women with a history of hypertensive pregnancy disorders have been shown to have smaller brain volumes than women with normotensive pregnancies decades later, even after adjusting for traditional cardiovascular risk factors, 51 in addition to increased risk of CAC. 14 A recent study found no relationship between white matter hyperintensities, objective cognitive performance, or subjective cognitive complaints in formerly preeclamptic women 40 years of age 6 years after pregnancy, 52 and we postulate that these women have not yet reached an age threshold that challenges cognitive reserve.…”

Section: Commentmentioning

confidence: 56%

Preeclampsia and cognitive impairment later in life

Fields

Garovic

Mielke

et al. 2017

American Journal of Obstetrics and Gynecology

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BACKGROUND Hypertension is a risk factor for cerebrovascular disease and cognitive impairment. Women who suffer hypertensive episodes during pregnancy report variable neurocognitive changes within the first decade following the affected pregnancy. However, long-term follow-up of these women into their post-menopausal years has not been conducted. OBJECTIVE The aim of this study was to examine whether women with a history of preeclampsia were at increased risk of cognitive decline 35–40 years after the affected pregnancy. STUDY DESIGN Women were identified and recruited through the medical linkage, population-based Rochester Epidemiologic Project. Forty women with a history of preeclampsia were age- and parity-matched to 40 women with a history of normotensive pregnancy. All women underwent comprehensive neuropsychological assessment and completed self-report inventories measuring mood, i.e., depression, anxiety, and other symptoms related to emotional state. Scores were compared between groups. In addition, individual cognitive scores were examined by neuropsychologists and a neurologist blinded to pregnancy status, and a clinical consensus diagnosis of normal, mild cognitive impairment, or dementia for each participant was conferred. RESULTS Age at time of consent did not differ between preeclampsia (59.2 years, range 50.9–71.5) and normotensive (59.6 years, range 52.1–72.2) groups, nor did time from index pregnancy (34.9 years, range 32.0–47.2 vs 34.5 years, range 32.0–46.4, respectively).There were no statistically significant differences in raw scores on tests of cognition and mood between women with histories of preeclampsia compared to women with histories of normotensive pregnancy. However, a consensus diagnosis of mild cognitive impairment or dementia trended towards greater frequency in women with histories of preeclampsia compared to those with normotensive pregnancies (20% versus 8%, p = 0.10) and affected more domains among the preeclampsia group (p = 0.03), most strongly related to executive dysfunction (d = 1.96) and verbal list learning impairment (d = 1.93). CONCLUSIONS These findings suggest a trend for women with a history of preeclampsia to exhibit more cognitive impairment later in life than those with a history of normotensive pregnancy. Furthermore, the pattern of cognitive changes is consistent with that observed with vascular disease/white matter pathology.

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“…It is important to recognize that neurocognitive impairment is a key feature associated with both AKI and CKD (106). Both hypertensive pregnancies and CKD are independently related to cognitive dysfunction (107)(108)(109)(110), it is important not to overlook the possible impact that they may have on the patient with a history of PR-AKI. The available data has led us to propose the following theory (Figure 3) suggesting that the increase in circulating inflammatory mediators (112) and oxidative stress (113) due to PR-AKI leads to impairment of the blood brain barrier during pregnancy which in turn contributes to neuroinflammation and neurocognitive impairment in the postpartum period and later in life; a situation that is only worsened in the presence of a hypertensive pregnancy.…”

Section: The Link Between Aki and Neurocognitionmentioning

confidence: 99%

Acute Kidney Injury in Pregnancies Complicated With Preeclampsia or HELLP Syndrome

et al. 2020

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Acute kidney injury that occurs during pregnancy or in the post-partum period (PR-AKI) is a serious obstetric complication with risk of significant associated maternal and fetal morbidity and mortality. Recent data indicates that the incidence of PR-AKI is increasing, although accurate calculation is limited by the lack of a uniform diagnostic criteria that is validated in pregnancy. Hypertensive and thrombotic microangiopathic disorders of pregnancy have been identified as major contributors to the burden of PR-AKI. As is now accepted regarding preeclampsia, HELLP syndrome and atypical hemolytic uremic syndrome, it is believed that PR-AKI may have long-term renal, cardiovascular and neurocognitive consequences that persist beyond the post-partum period. Further research regarding PR-AKI could be advanced by the development of a pregnancy-specific validated definition and classification system; and the establishment of refined animal models that would allow researchers to further elucidate the mechanisms and sequelae of the disorder.

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Cerebral white matter lesions, subjective cognitive failures, and objective neurocognitive functioning: A follow-up study in women after hypertensive disorders of pregnancy

Cited by 44 publications

References 39 publications

Cognitive Variability during Middle-Age: Possible Association with Neurodegeneration and Cognitive Reserve

Cognitive Variability during Middle-Age: Possible Association with Neurodegeneration and Cognitive Reserve

Preeclampsia and cognitive impairment later in life

Acute Kidney Injury in Pregnancies Complicated With Preeclampsia or HELLP Syndrome

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