Relationship Between Arterial Stiffness and Cognitive Function in Elderly Subjects With Complaints of Memory Loss

Hanon, Olivier; Haulon, S.; Lenoir, H.; Seux, Marie-Laure; Rigaud, Anne‐Sophie; Safar, Michel; Girerd, Xavier; Forette, Françoise

doi:10.1161/01.str.0000181771.82518.1c

Cited by 229 publications

(199 citation statements)

References 42 publications

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“…20 Arterial stiffness assessed by PWV has also been suggested to contribute to the progression of cognitive impairment. 5 Here, however, we found that although the baPWV of MCI subjects was significantly higher than that of normal controls, the significance of this association was lost on adjustment for age. Further, BP was found not to be an independent determinant for MCI.…”

Section: Discussioncontrasting

confidence: 67%

Abnormal nocturnal blood pressure profile is associated with mild cognitive impairment in the elderly: the J-SHIPP study

et al. 2009

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Mild cognitive impairment (MCI), a syndrome characteristic of the transition phase between normal cognitive function and dementia, has been shown to carry the risk of progression to dementia. Dysregulation of blood pressure (BP) is thought to be an indicator of cerebrovascular damage, including cognitive impairment. Here, we investigated the possible association of circadian BP variation with MCI in community-dwelling persons exhibiting no definitive dementia. Our study enrolled 144 persons (68 ± 7 years). Nocturnal BP profile was defined as dipper, with a 10-19% drop in nocturnal systolic BP; extreme dipper, X20% drop; non-dipper, 0-10% drop; and riser, any increase in nocturnal BP. MCI was assessed using the MCI screen, a cross-validated, staff-administered battery of tests. Subjects with MCI (n¼38) were significantly older (74±6, 67±6 years, Po0.001) and had higher frequency of apolipoprotein E e4 allele (36.8, 18.9%, P¼0.018). Although the ambulatory measured BP and the percent changes in nocturnal systolic BP (À10 ± 12% and À12 ± 8%, respectively; P¼0.291) did not differ between MCI subjects and normal controls, frequency of MCI was significantly higher in the extreme dippers (32.0%), non-dippers (30.0%) and risers (50.0%) than in dippers (13.2%, P¼0.018). Multiple logistic regression analysis identified a blunted nocturnal BP decline, non-dipping or increase in nocturnal BP and extreme drop in BP as potent determinants of MCI (odds ratio 3.062, P¼0.039), after adjustment for possible confounding factors, including apolipoprotein E e4 genotype. Abnormal nocturnal BP profile was found to be a strong indicator of MCI in otherwise apparently healthy community-dwelling elderly persons. Keywords: ambulatory blood pressure monitoring; mild cognitive impairment; nocturnal blood pressure INTRODUCTION Mild cognitive impairment (MCI) is a syndrome defined as cognitive decline greater than expected for an individual's age and education level that does not notably interfere with activities of daily life. 1 MCI is classified into four subtypes: amnestic MCI involving only memory impairment (single domain) or memory impairment along with deficits in another cognitive domain such as language function, visuospatial skills, or executive function (multiple domain) and non-amnestic MCI involving discrete cognitive impairments in single or multiple domains other than memory function. 2 MCI prevalence has been estimated to be between 6 and 10% based on community assessments, 3 a frequency about four times that of dementia. MCI also exhibits Alzheimer-type dementia-like neuropathology on autopsy, and at least half of those diagnosed with MCI, in particular amnestic MCI subtype, eventually progress into Alzheimer-type dementia (AD) with a smaller percentage progression to other forms of dementia,

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Section: Discussioncontrasting

confidence: 67%

Abnormal nocturnal blood pressure profile is associated with mild cognitive impairment in the elderly: the J-SHIPP study

et al. 2009

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“…In a recent study, Hanon et al 33 reported a significant association between the severity of the MMSE score decline and PWV in very old subjects with cognitive impairment. Our study shows that such a relationship does not exist in a younger asymptomatic population.…”

Section: Discussionmentioning

confidence: 97%

Determinants of arterial stiffness in an apparently healthy population over 60 years

et al. 2006

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Arterial stiffness assessed by the pulse wave velocity (PWV), a non-invasive and reproducible method, predicts cardiovascular morbidity and mortality. The main determinants of arterial stiffness are well established in younger and middle-aged populations, but much less in the elderly. The aim of this study was to describe the determinants of arterial stiffness in elderly apparently healthy subjects. The study included 221 voluntary subjects born before 1944 (mean age 67.475.0 years), who had a standard health check-up at the 'Centre de Mé decine Pré ventive' of Nancy. Arterial stiffness was evaluated by measuring the carotid-femoral PWV with the PulsePen automatic device. Clinical and biological parameters were evaluated at the same day. Measurements were valid and analysed in 207 subjects (94 women). Mean PWV was 9.3972.64 m/s. Men showed higher PWV values than women (9.9972.56 vs 8.6672.56, Po0.001). In univariate analysis, PWV was correlated with age (r ¼ 0.26, Po0.001) and mean arterial pressure (MAP) (r ¼ 0.40, Po0.001), and these relationships were similar in men and women. Subjects with hypertension (Po0.001), diabetes mellitus (Po0.001) and obesity (Po0.01) had higher values of PWV. In multiple regression analysis, PWV correlated positively and independently with age, male gender, MAP and diabetes mellitus. In conclusion, in an apparently healthy elderly population, the main determinants of arterial stiffness are the age, MAP, diabetes and gender. Our study also shows that the gender-related differences in arterial stiffness observed in middle-aged subjects are maintained in the elderly.

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“…36 This study was intended to describe blood pressure-dependent functional changes in neurotransmission before there are any signs of advanced atherosclerosis. Indeed, the mean AI 75 of 57.4% reflects normal age-adjusted arterial elasticity in the study population.…”

Section: Discussionmentioning

confidence: 99%

The impact of blood pressure on hippocampal glutamate and mnestic function

et al. 2010

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Hypertension is associated with an increased risk of cognitive decline, which is generally regarded as a consequence of advanced cerebral atherosclerosis. Many hypertensive patients, however, suffer from cognitive decline long before they have any signs of cerebrovascular disease. Therefore, this study examines direct effects of blood pressure on neurotransmitter status in the hippocampus, a vulnerable cerebral structure relevant for memory consolidation. Absolute glutamate concentration and N-acetylaspartate (NAA) concentration as an alternative marker of neuronal integrity were determined in the hippocampus and the cerebral cortex (anterior cingulate cortex; ACC) by 3-T proton magnetic resonance spectroscopy in 16 probands without any history of cerebrovascular disease. Memory function was tested by the auditory verbal learning test (AVLT) and the rivermead behavioural memory test (RBMT). Arterial stiffness was assessed by augmentation index (AI). Mean arterial pressure showed a significant negative age-adjusted correlation to absolute glutamate concentrations in the hippocampus (R ¼ À0.655, P ¼ 0.011), but not in the ACC. There was no significant correlation of mean arterial pressure and NAA in either hippocampus or ACC. AI did not affect hippocampal glutamate. Moreover, there was a significant negative correlation between mean arterial pressure and AVLT (r ¼ À0.558, P ¼ 0.025) and RBMT score (r ¼ À0.555, P ¼ 0.026). There is an inverse relation between blood pressure and the concentration of hippocampal glutamate. Glutamate is essential for long-term potentiation, the neurobiological correlate for memory formation in the hippocampus. Thus, hypertension-associated cognitive decline may not only be mediated by structural atherosclerotic wall changes, but also by functional changes in neurotransmission.

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Relationship Between Arterial Stiffness and Cognitive Function in Elderly Subjects With Complaints of Memory Loss

Cited by 229 publications

References 42 publications

Abnormal nocturnal blood pressure profile is associated with mild cognitive impairment in the elderly: the J-SHIPP study

Abnormal nocturnal blood pressure profile is associated with mild cognitive impairment in the elderly: the J-SHIPP study

Determinants of arterial stiffness in an apparently healthy population over 60 years

The impact of blood pressure on hippocampal glutamate and mnestic function

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