Cognitive impairment in preeclampsia complicated by eclampsia and pulmonary edema after delivery

Bergman, Lina; Thorgeirsdottir, Lilja; Elden, Helen; Hesselman, Susanne; Schell, Sonja; Ahlm, Evelina; Aukes, Annet M.; Cluver, Catherine

doi:10.1111/aogs.14100

Cited by 8 publications

(8 citation statements)

References 23 publications

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“…Women with hypertensive pregnancy disorders scored worse on all measures of speed processing (Digital Symbol Substitution Test mean score of hypertensive pregnancy = 41.2; normotensive pregnancy = 43.4), Trail Making Test mean seconds hypertensive (pregnancy = 45.1; normotensive pregnancy = 42.4) (Mielke et al, 2016). Furthermore, women with eclampsia or preeclampsia with pulmonary edema had lower scores on the MoCA cognitive test at the time of discharge compared to normotensive pregnant women or preeclampsia patients without severe symptoms (Bergman et al, 2021c). A recent study demonstrated that 15 years after a hypertensive pregnancy disorder (gestational hypertension or preeclampsia), significant impairments in working memory was observed in women with a history of hypertension during pregnancy (Adank et al, 2021).…”

Section: A History Of (Pre)eclampsia Is Associated With Cognitive Cha...mentioning

confidence: 99%

Preeclampsia history and postpartum risk of cerebrovascular disease and cognitive impairment: Potential mechanisms

2023

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Hypertensive disorders of pregnancy such as preeclampsia, eclampsia, superimposed preeclampsia, and gestational hypertension are major causes of fetal and maternal morbidity and mortality. Women with a history of hypertensive pregnancy disorders have increased risk of stroke and cognitive impairments later in life. Moreover, women with a history of preeclampsia have increased risk of mortality from diseases including stroke, Alzheimer’s disease, and cardiovascular disease. The underlying pathophysiological mechanisms are currently not fully known. Here, we present clinical, epidemiological, and preclinical studies focused on evaluating the long-term cerebrovascular and cognitive dysfunction that affect women with a history of hypertensive pregnancy disorders and discuss potential underlying pathophysiological mechanisms.

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Section: A History Of (Pre)eclampsia Is Associated With Cognitive Cha...mentioning

confidence: 99%

Preeclampsia history and postpartum risk of cerebrovascular disease and cognitive impairment: Potential mechanisms

2023

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“…attention from clinicians. Bergman et al (2021) suggested that PE patients had lower MoCA scores than normotensive pregnant women when they presented with symptoms of eclampsia or pulmonary edema, while they found no difference in MoCA score between PE women without severe features and normotensive women. Our study found that PE patients had already developed cognitive impairment before severe complications.…”

Section: Discussionmentioning

confidence: 97%

Correlation between cognitive impairment and serum phosphorylated tau181 protein in patients with preeclampsia

Wang

Guo

Zhao

et al. 2023

Front. Aging Neurosci.

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ObjectiveTo study the cognitive function status, serum phosphorylated tau181 (P-tau181) protein level, and total tau (T-tau) protein level in patients with preeclampsia (PE), pregnant healthy controls (PHCs), and non-pregnant healthy controls (NPHCs), and to research their feasibility as serum biomarkers for evaluating cognitive functional impairment in PE patients.MethodsSixty-eight patients with PE, 48 NPHCs, and 30 PHCs were included. Cognitive functional status was assessed using standardized Symbol Digit Modalities Test (SDMT) and Montreal Cognitive Assessment (MoCA) scales. Enzyme-linked immunosorbent assay (ELISA) was used to detect the level of serum P-tau181 and T-tau protein. The concentration of serum P-tau181 and T-tau protein were compared by one-way analysis of variance in the three groups of subjects. The correlation between P-tau181, T-tau, and SDMT was explore by multiple linear regression analysis. The areas under the receiver operating characteristic (ROC) curves of serum P-tau181 and SDMT were calculated to predict the cognitive level of subjects.ResultsPE patients significantly had lower scores on SDMT (47.97 ± 7.54) and MoCA (28.00 ± 2.00) than normotensive PHCs (30.00 ± 1.25, 54.73 ± 8.55, respectively). The significant difference was found in serum P-tau181 protein levels among the three groups [H(K) = 19.101, P < 0.001]. Serum P-tau181 was thicker in PE patients than PHCs or NPHCs (both P < 0.05). According to the ROC curve, T-tau had no statistical significance in predicting the ability of cognizance, while P-tau181 and SDMT had. The DeLong test showed that P-tau181 was better than T-tau in predicting the ability of cognizance (P < 0.05).ConclusionThe patients with PE have occurred the decline of cognitive function during pregnancy. The high level of serum P-tau181 can be used as a clinical laboratory indication for non-invasive assessment of cognitive functional impairment in PE patients.

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“…Pre‐eclampsia with severe features, such as eclampsia and HELLP syndrome, has been associated with poorer cognitive performance 54 . These severe features may be associated with greater BBB leakage.…”

Section: Discussionmentioning

confidence: 99%

Blood–brain barrier leakage years after pre‐eclampsia: dynamic contrast‐enhanced 7‐Tesla MRI study

Canjels

Jansen

Alers

et al. 2022

Ultrasound in Obstet & Gyne

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Objective Pre‐eclampsia is a hypertensive complication of pregnancy that is associated with an increased risk of long‐term cardiovascular and cerebrovascular disorders. Although the underlying mechanism of persistent susceptibility to cerebral complications after pre‐eclampsia remains largely unclear, impaired blood–brain barrier (BBB) integrity has been suggested to precede several cerebrovascular diseases. In this study, we aimed to investigate the integrity of the BBB years after pre‐eclampsia. Methods This was an observational study of premenopausal formerly pre‐eclamptic women and controls with a history of normotensive pregnancy who underwent cerebral magnetic resonance imaging (MRI) at ultra‐high field (7 Tesla) to assess the integrity of the BBB. Permeability of the BBB was determined by assessing leakage rate and fractional leakage volume of the contrast agent gadobutrol using dynamic contrast‐enhanced MRI. BBB leakage measures were determined for the whole brain and lobar white and gray matter. Multivariable analyses were performed, and odds ratios were calculated to compare women with and those without a history of pre‐eclampsia, adjusting for potential confounding effects of age, hypertension status at MRI and Fazekas score. Results Twenty‐two formerly pre‐eclamptic women (mean age, 37.8 ± 5.4 years) and 13 control women with a history of normotensive pregnancy (mean age, 40.8 ± 5.5 years) were included in the study. The time since the index pregnancy was 6.6 ± 3.2 years in the pre‐eclamptic group and 9.0 ± 3.7 years in controls. The leakage rate and fractional leakage volume were significantly higher in formerly pre‐eclamptic women than in controls in the global white (P = 0.001) and gray (P = 0.02) matter. Regionally, the frontal (P = 0.04) and parietal (P = 0.009) cortical gray matter, and the frontal (P = 0.001), temporal (P < 0.05) and occipital (P = 0.007) white matter showed higher leakage rates in formerly pre‐eclamptic women. The odds of a high leakage rate after pre‐eclampsia were generally higher in white‐matter regions than in gray‐matter regions. Conclusion This observational study demonstrates global impairment of the BBB years after a pre‐eclamptic pregnancy, which could be an early marker of long‐term cerebrovascular disorders. © 2022 The Authors. Ultrasound in Obstetrics & Gynecology published by John Wiley & Sons Ltd on behalf of International Society of Ultrasound in Obstetrics and Gynecology.

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Cognitive impairment in preeclampsia complicated by eclampsia and pulmonary edema after delivery

Abstract: This is an open access article under the terms of the Creative Commons Attribution-NonCommercial License, which permits use, distribution and reproduction in any medium, provided the original work is properly cited and is not used for commercial purposes.

Cited by 8 publications

References 23 publications

Preeclampsia history and postpartum risk of cerebrovascular disease and cognitive impairment: Potential mechanisms

Preeclampsia history and postpartum risk of cerebrovascular disease and cognitive impairment: Potential mechanisms

Correlation between cognitive impairment and serum phosphorylated tau181 protein in patients with preeclampsia

Blood–brain barrier leakage years after pre‐eclampsia: dynamic contrast‐enhanced 7‐Tesla MRI study

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