Treatment of hypertension and obstructive sleep apnea counteracts cognitive decline in common neurocognitive disorders in diagnosis-related patterns

Abstract

The aim of this study was to investigate the effect of arterial hypertension (AH) and of obstructive sleep apnea (OSA) on cognitive course in the neurocognitive disorder (NCD) cohort RIFADE which enrolled patients with NCD due to Alzheimer’s disease (AD), vascular NCD (vNCD), and mixed NCD (AD + vNCD = mNCD). Multiple risk factors (RF), including AH and OSA, that contribute to the development of various kinds of dementia have been identified in previous studies. Studies that observed AH lacked investigation of long-term effects and did not isolate it from other RF. Studies involving OSA as a risk factor did not include participants with all stages of NCD. 126 subjects were screened for AH and OSA. Repeated cognitive measurements were performed with the DemTect as primary outcome and the clock drawing test as secondary outcome measure. 90 patients had AH (71.4%) and 40 patients had OSA (31.7%). RF-status had a significant effect on cognitive outcome in models with RF as single factors (AH p = 0.027, OSA p < 0.001), a 2-factor analysis with AH × OSA (AH as main factor p = 0.027) as well as a model including the 3 factors AH × OSA × diagnosis (p = 0.038). Similarly, a 3-factor model was significant for the clock-drawing test, whereas single factor-models remained insignificant. AH and OSA appear to be risk factors in common NCD and cognitive decline can be mitigated by treatment of these RF.

Obstructive sleep apnea and attention deficits: A systematic review of magnetic resonance imaging biomarkers and neuropsychological assessments

“…CPAP can improve the quality of sleep, reduce daytime symptoms, and lower the risk of complications associated with OSA (Donovan et al., 2015 ; Spicuzza et al., 2015 ). The underlying mechanisms of attention impairment in OSA remain unclear (Ji et al., 2021 ), but several factors can contribute, such as excessive daytime sleepiness (EDS) (Steiropoulos et al., 2019 ), nocturnal hypoxia (Liu et al., 2020 ), oxidative stress (Angelelli et al., 2020 ), inflammation (Liu et al., 2020 ), and vascular damage (Kujovic et al., 2023 ). Additionally, structural and functional alterations in brain regions involved in attention processes have been observed in OSA patients using magnetic resonance imaging (MRI) techniques (Shin et al., 2013 ; Tahmasian et al., 2016 ; Volner et al., 2022 ).…”