Relation of Brain Natriuretic Peptide Levels to Cognitive Dysfunction in Adults >55 Years of Age With Cardiovascular Disease

Abstract

Cardiovascular disease (CVD) is associated with cognitive deficits long before the onset of stroke or dementia. Recent work has extended these findings and shown that patients with congestive heart failure also exhibit reduced cognitive performance. Brain natriuretic peptide (BNP) is used to help diagnose heart failure, but no study has examined whether BNP predicts cognitive dysfunction in older patients with CVD. BNP values and performance on the Dementia Rating Scale were assessed in 56 older adults with documented CVD. Forty-eight percent of the participants were women, and their average age was 70 ± 8 years. All participants had Mini-Mental State Examination scores greater than the cutoff for dementia and no histories of neurologic or severe psychiatric disorders. The average BNP level was 122 ± 202 pg/ml. Hierarchical regression analyses showed that logtransformed BNP levels predicted Dementia Rating Scale total score after adjusting for possible demographic and medical confounders (ΔR 2 = 0.09, F[1, 44] = 6.14, p = 0.017). Partial correlation analysis adjusting for these possible confounders showed a particularly strong relation to the conceptualization subtest (r = −0.44, p = 0.002), a measure of verbal and nonverbal abstraction abilities. In conclusion, the results of the present study provide the first evidence for an independent relation between BNP and cognitive dysfunction in older adults with CVD.We hypothesized that brain natriuretic peptide (BNP) levels might predict cognitive dysfunction and assessed BNP levels and cognitive performance in a sample of older adults with documented stable cardiovascular disease (CVD).The following methods were approved by the local institutional review board, and all participants provided written informed consent.Fifty-six participants enrolled in a larger, prospective study of the neurocognitive consequences of CVD were included in the present study. For inclusion into the parent study, all participants had to have documented histories of CVD, be between the ages of 55 and 85 years, have MiniMental State Examination total scores greater than the cutoff for dementia, 1 and have no histories of neurologic or severe psychiatric disorders (e.g., stroke, bipolar disorder). The demographic and medical characteristics of the sample are presented in Table 1. BNP levels were obtained on the same day as the neuropsychologic battery was conducted and <3 weeks after cardiac evaluation. BNP levels were quantified using the Bayer Advia Centaur (Bayer HealthCare, Tarrytown, New York). Blood samples were sent to the local laboratory for analysis. To promote comparison with past studies, BNP levels were log transformed before statistical analysis to adjust for the skewed distribution. 2 The Dementia Rating Scale (DRS) is a commonly used neuropsychologic measure that is sensitive to dementia and cognitive decrease in older adults. [3][4][5] In addition to the DRS total score, 5 subtests assess function in different cognitive domains, namely, attention, initiation and pers...

Association Between Subclinical Cardiac Biomarkers and Clinically Manifest Cardiac Diseases With Cortical Cerebral Microinfarcts

“…4,5 Hence, blood biomarkers of cardiovascular disease, such as N-terminal pro-brain natriuretic peptide (NT-proBNP) and high-sensitivity cardiac troponin T (hs-cTnT), have recently become of interest because of their upregulation not only in myocardial stress and injury but also in the early phases of cardiovascular disease. [6][7][8][9] Interestingly, higher levels of NT-proBNP and hs-cTnT were associated with cognitive impairment and dementia. 10 In addition to the traditional cerebral markers of vascular injury, such as lacunar infarcts and white matter hyperintensities, a novel marker of cerebrovascular diseases, cortical cerebral microinfarcts (CMIs), has recently gained attention because of its major role in cognitive impairment and dementia.…”

N-Terminal Pro-B-Type Natriuretic Peptide and Risk of Future Cognitive Impairment in the REGARDS Cohort

“…A study of 56 patients with dementia and cardiovascular disease showed cross sectional correlations of BNP with the conceptualization subtest of the Dementia Rating Scale score [21]. In 1066 elderly type 2 diabetics, those with higher NT-proBNP had lower scores on a cognitive battery, but this association was confounded by vascular and diabetes-related risk factors [22].…”

Vascular and cognitive functions associated with cardiovascular disease in the elderly

“…Yet, patients with severe cardiovascular disease frequently exhibit cognitive problems in the absence of clinically identified stroke (Moser et al, 1999;Paul et al, 2005), particularly in cases of heart failure (Bennett & Sauve, 2003;Bornstein, Starling, Myerowitz, & Haas, 1995), presumably reflecting the impact of reduced cardiac function on the aging brain (Roman, 2004). We have previously shown that both cognitive dysfunction and structural brain abnormalities on magnetic resonance imaging (MRI) are associated with reduced cardiac output among patients with severe cardiovascular disease (Jefferson, Poppas, Paul, & Cohen, 2007a;Jefferson et al, 2007b) and abnormalities of systemic vascular function (Gunstad et al, 2006a;Gunstad et al, 2005;Gunstad et al, 2006b;Haley et al, 2007a;Haley et al, 2007b;Hoth et al, 2007). …”