Pulse Wave Velocity as a Marker of Cognitive Impairment in the Elderly

Abstract

Carotid-femoral pulse wave velocity (PWV), an index of large artery stiffness, is a good proxy of arterial aging and also an independent marker of cardiovascular disease. A consistently growing number of studies has shown a significant inverse association of arterial aging and cognitive function: the greater the PWV, the lower the cognitive performance (and the greater its decline over time)-regardless of heterogeneity in study populations, sample size, and measure of cognitive functions adopted in each study. Therefore the epidemiological evidence and the biological plausibility require adoption of strategies to foster the routine measurement of PWV and cognitive function measurements in each and every older subject, particularly those at higher cardiovascular risk. Consistently, limited available healthcare resources should be progressively shifted from a sterile differential diagnosis between Alzheimer-type and vascular dementia to interventions aimed to reduce PWV and, thus, to prevent dementia before its onset or to decrease its rate of progression.

Cerebral Small Vessel Disease and Arterial Stiffness: Tsunami Effect in the Brain

“…Cognitive impairment including dementia is also associated with arterial stiffness [8][9][10][11][12] . An ABI >1.30 and increased blood pressure variability are important predictors of cognitive impairment among patients without vascular diseases [13] .…”

“…Thus, an increased ABI indicates arterial calcification that leads to vessel sclerosis (advanced vessel stiffness). Increased PWV is also associated with cognitive impairment [12,14] , an independent predictor of cognitive decline [10,11] , and β-amyloid (Aβ) deposition in the brains of older patients [15] . More specifically, Hughes et al [15] showed the associations between arterial stiffness and Aβ deposition in the brain independent of blood pressure.…”

Cerebral Perfusion Enhancing Interventions: A New Strategy for the Prevention of Alzheimer Dementia

“…[58] Aside from contributing to systolic hypertension, the association involving arterial stiffness and high pulse waves can be considered to be a targets of therapeutic opportunity to prevent or treat cognitive impairment during advanced aging. [59] At present, there is an important focus in developing drugs that target the 20-HETE pathway for the treatment of hypertension due to the well-established evidence that CYP4F2 mutation is associated with increased 20-HETE urinary excretion and systolic hypertension. [60] A number of highly selective inhibitors of 20-HETE such as 17-ODYA (17-octadecynoic acid), HET0016 (N-hydroxy-N'-(4-butyl-2methylphenyl)formamidine) and TS011 (N-(3-Chloro-4-morpholin-4-yl)Phenyl-N'-hydroxyimido formamide) have been shown to be potential targets for hypertension and as safeguards of endothelial cell damage.…”

Preventive geriatrics the cross-talk between arterial and brain aging: A lifelong condition

“…As concept proof, several studies consistently reported that carotidfemoral Pulse Wave Velocity (PWV), a reliable proxy of aortic stiffness non-invasively and quickly measurable in humans (Najjar et al, 2005), is inversely associated with cognitive impairment, independently of traditional CV risk factors: the stiffer the arteries, the worse the cognitive performance (Scuteri and Wang, 2014c). In the well characterized cohort of Health ABC Study, it has been clearly shown that higher PWV was associated with a 59% higher odds of becoming cognitively impaired over 9 years as compared to older subjects with lower PWV (Al Hazzouri et al, 2013), after controlling for age, sex, ethnicity, and established CV risk factors levels.…”