Vascular Structure and Function Is Correlated to Cognitive Performance and White Matter Hyperintensities in Older Hypertensive Patients With Subjective Memory Complaints

Abstract

Background and Purpose-Arterial stiffening and thickening and endothelial dysfunction may be associated with cognitive decline or white matter hyperintensities (WMH) independently of blood pressure level. We aimed to investigate, using an integrative approach, the relative contributions of structural and functional vascular factors to the degree of cognitive impairment (primary outcome) and the severity of WMH (secondary outcome) in elderly hypertensive patients with subjective memory complaints, a group prone to dementia. Methods-A prospective, dedicated, cross-sectional population of 198 elderly hypertensive patients (mean age 69.3Ϯ6.2 years) with subjective memory complaints underwent a full set of cognitive function assessments, brain MRI with semiquantification of WMH, carotid ultrasonography, carotid-femoral pulse wave velocity, brachial endothelial function, and plasma von Willebrand Factor measurements. Results-After adjustment for the usual cardiovascular risk factors, increased arterial stiffness (as assessed by pulse wave velocity) was significantly and independently associated with memory impairment in men. The severity of WMH was independently associated with increased carotid intima media thickness and stiffness (as assessed by augmentation index) as well as with increased age and plasma levels of von Willebrand Factor, a biomarker of endothelial dysfunction. Conclusions-Our data suggest that vascular abnormalities, independently of blood pressure levels, may play a role in the setting of subjective memory complaints as well as of WMH in elderly hypertensive patients. Arterial thickness and stiffness as well as endothelial function should be assessed simultaneously and may represent additional targets for the prevention of subjective memory complaints and WMH.

Brain lesions, hypertension and cognitive ageing in the 1921 and 1936 Aberdeen birth cohorts

“…Magnetic resonance imaging (MRI)-detected white matter hyperintensities (WMH) (Young et al 2008) are associated with vascular risk factors (Murray et al 2005) and with reduced cognitive ability and dementia in older adults (Leaper et al 2001;Firbank et al 2007). We previously found that WMH contribute 14% of the variance in cognitive ability at age 78, that WMH are linked to hypertension , and it is now widely accepted that WMH are an imaging biomarker of vascular disease (Kearney-Schwartz et al 2009, Raz et al 2007, Fischer et al 2007). …”

Instruments of Active Search and Assessment of Memory Complaint. A Systematic Review

“…McNair questionnaire was also used in Wafta et al [32] and Kearney-Schwartz et al [33] studies, both of which addressed hypertensive older adults with MC investigating anti-hypertensive drug action on cognition. As a result, the studies showed that using drugs from the calcium channel blockers class was associated with better cognitive performance, regardless of blood pressure levels, usual cardiovascular risk factors and vessel structure, suggesting a protector effect from this pharmacological class.…”

Blood and CSF biomarkers in brain subcortical ischemic vascular disease: Involved pathways and clinical applicability

“…High plasma von Willebrand factor levels were associated with the presence, and number of SBI, with periventricular but not deep WMHs, and with WMH burden. [77][78][79][80] Renin-angiotensin-aldosterone system…”