101
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Lau KK, Pego P, Mazzucco S, Li L, Howard DP, Küker W, Rothwell PM. Age and sex-specific associations of carotid pulsatility with small vessel disease burden in transient ischemic attack and ischemic stroke. Int J Stroke 2018; 13:832-839. [PMID: 29966494 DOI: 10.1177/1747493018784448] [Citation(s) in RCA: 29] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/05/2023]
Abstract
Background Although large artery stiffness has been implicated in the pathogenesis of cerebral small vessel disease, whether carotid pulsatility, a convenient surrogate marker of arterial stiffness, is similarly associated with global burden of small vessel disease is unknown. Aims To determine the age and sex-specific associations of carotid pulsatility with global burden of small vessel disease. Methods We studied consecutive patients with transient ischemic attack or non-disabling ischemic stroke from the Oxford Vascular Study who had a brain MRI and carotid duplex ultrasound during 2002-2014. We determined clinical correlates of common carotid artery (CCA) and internal carotid artery (ICA) pulsatility index (PI) and their associations with the total small vessel disease score on MRI, stratified by age (median = 72). Results In 587 patients, correlates of CCA and ICA-PI were both independently associated with age, diabetes, and premorbid mean pulse pressure after adjustment for age, sex, and cardiovascular risk factors (all p < 0.05). ICA-PI was strongly associated with small vessel disease markers and burden, particularly lacunes, in patients aged<70 (age and sex-adjusted odds ratio of top vs. bottom pulsatility index quartile: 5.35, 1.95-14.70, p = 0.001; increasing small vessel disease score: 2.30, 1.01-5.25, p = 0.048), but not in patients aged ≥ 70 ( p > 0.05). No associations between CCA-PI with small vessel disease score were noted at any age. In 94 consecutive patients who also received transcranial Doppler ultrasound, strong associations between middle cerebral artery (MCA)-PI and an increasing small vessel disease score were noted (unadjusted OR-MCA: 4.26, 1.45-12.55, p = 0.009; ICA: 2.37, 0.81-6.87, p = 0.11; CCA: 1.33, 0.45-3.96, p=0.61). Conclusions ICA and MCA-PI are associated with global small vessel disease burden, especially in individuals aged<70 and may be causally related.
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Affiliation(s)
- Kui Kai Lau
- 1 Centre for Prevention of Stroke and Dementia, Nuffield Department of Clinical Neurosciences, University of Oxford, Oxford, UK
| | - Petra Pego
- 1 Centre for Prevention of Stroke and Dementia, Nuffield Department of Clinical Neurosciences, University of Oxford, Oxford, UK
| | - Sara Mazzucco
- 1 Centre for Prevention of Stroke and Dementia, Nuffield Department of Clinical Neurosciences, University of Oxford, Oxford, UK
| | - Linxin Li
- 1 Centre for Prevention of Stroke and Dementia, Nuffield Department of Clinical Neurosciences, University of Oxford, Oxford, UK
| | - Dominic Pj Howard
- 1 Centre for Prevention of Stroke and Dementia, Nuffield Department of Clinical Neurosciences, University of Oxford, Oxford, UK.,2 Department of Vascular Surgery, Oxford University Hospitals NHS Trust, Oxford, UK
| | - Wilhelm Küker
- 1 Centre for Prevention of Stroke and Dementia, Nuffield Department of Clinical Neurosciences, University of Oxford, Oxford, UK
| | - Peter M Rothwell
- 1 Centre for Prevention of Stroke and Dementia, Nuffield Department of Clinical Neurosciences, University of Oxford, Oxford, UK
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102
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DuBose LE, Boles Ponto LL, Moser DJ, Harlynn E, Reierson L, Pierce GL. Higher Aortic Stiffness Is Associated With Lower Global Cerebrovascular Reserve Among Older Humans. Hypertension 2018; 72:476-482. [PMID: 29915015 DOI: 10.1161/hypertensionaha.118.11143] [Citation(s) in RCA: 26] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/08/2018] [Revised: 03/20/2018] [Accepted: 05/23/2018] [Indexed: 12/13/2022]
Abstract
Greater aortic stiffness and pulse pressure are associated with cerebrovascular remodeling, reduced white matter microstructure, and cognitive performance with aging in humans. However, it is unclear whether aortic stiffness and pulse pressure are associated with reduced basal global cerebral blood flow (CBF) and cerebrovascular reserve among older adults. Global CBF was quantified in 205 adults (range, 19-87 years; mean±SE: 30.6±1.3 years) using quantitative [15O]water brain positron emission tomography imaging. In a subset of older adults (n=24; 70.0±2.0 years), aortic stiffness (carotid femoral pulse wave velocity) and cerebrovascular reserve (change in global CBF after intravenous infusion of acetazolamide) were assessed. In the entire cohort, global CBF was lower in older compared with young adults (36.5±1.1 versus 50.5±0.7 mL/min per 100 mL; P<0.001). Global CBF was higher in young women compared with young men (51.0±0.30 versus 47.4±0.03 mL/min per 100 mL; P<0.001) but did not differ between older women and men (P=0.63). In older adults, greater carotid femoral pulse wave velocity was associated with lower cerebrovascular reserve (r=-0.68; P=0.001 adjusted for age, sex, and mean arterial pressure) but not global CBF (r=0.13; P=0.60). Brachial pulse pressure was not associated with lower cerebrovascular reserve (r=-0.37; P=0.159) when adjusted for age and sex. These data indicate that the age-related increases in aortic stiffness may contribute, in part, to the brain's impaired ability to augment blood flow in response to a stimulus with aging in humans.
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Affiliation(s)
- Lyndsey E DuBose
- From the Departments of Health and Human Physiology (L.E.D., L.R., G.L.P.)
| | | | | | | | - Leah Reierson
- From the Departments of Health and Human Physiology (L.E.D., L.R., G.L.P.)
| | - Gary L Pierce
- From the Departments of Health and Human Physiology (L.E.D., L.R., G.L.P.) .,UI Healthcare Center for Hypertension Research (G.L.P.).,Abboud Cardiovascular Research Center (G.L.P.), University of Iowa
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103
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Impact of Aging on Endurance and Neuromuscular Physical Performance: The Role of Vascular Senescence. Sports Med 2018; 47:583-598. [PMID: 27459861 DOI: 10.1007/s40279-016-0596-8] [Citation(s) in RCA: 23] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/25/2022]
Abstract
The portion of society aged ≥60 years is the fastest growing population in the Western hemisphere. Aging is associated with numerous changes to systemic physiology that affect physical function and performance. We present a narrative review of the literature aimed at discussing the age-related changes in various metrics of physical performance (exercise economy, anaerobic threshold, peak oxygen uptake, muscle strength, and power). It also explores aging exercise physiology as it relates to global physical performance. Finally, this review examines the vascular contributions to aging exercise physiology. Numerous studies have shown that older adults exhibit substantial reductions in physical performance. The process of decline in endurance capacity is particularly insidious over the age of 60 years and varies considerably as a function of sex, task specificity, and individual training status. Starting at the age of 50 years, aging also implicates an impressive deterioration of neuromuscular function, affecting muscle strength and power. Muscle atrophy, together with minor deficits in the structure and function of the nervous system and/or impairments in intrinsic muscle quality, plays an important role in the development of neuromotor senescence. Large artery stiffness increases as a function of age, thus triggering subsequent changes in pulsatile hemodynamics and systemic endothelial dysfunction. For this reason, we propose that vascular senescence has a negative impact on cerebral, cardiac, and neuromuscular structure and function, detrimentally affecting physical performance.
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104
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Bruno RM, Stea F, Sicari R, Ghiadoni L, Taddei S, Ungar A, Bonuccelli U, Tognoni G, Cintoli S, Del Turco S, Sbrana S, Gargani L, D’Angelo G, Pratali L, Berardi N, Maffei L, Picano E, Andreassi M, Angelucci A, Baldacci F, Baroncelli L, Begenisic T, Bellinvia P, Biagi L, Bonaccorsi J, Bonanni E, Borghini A, Braschi C, Broccardi M, Caleo M, Carlesi C, Carnicelli L, Cartoni G, Cecchetti L, Cenni M, Ceravolo R, Chico L, Cioni G, Costa M, D’Ascanio P, De Nes M, Di Coscio E, Di Galante M, di Lascio N, Faita F, Falorni I, Faraguna U, Fenu A, Fortunato L, Franco R, Gargiulo R, Giorgi F, Iannarella R, Iofrida C, Kusmic C, Limongi F, Maestri M, Maffei M, Maggi S, Mainardi M, Mammana L, Marabotti A, Mariotti V, Melissari E, Mercuri A, Molinaro S, Narducci R, Navarra T, Noale M, Pagni C, Palumbo S, Pasquariello R, Pellegrini S, Pietrini P, Pizzorusso T, Poli A, Retico A, Ricciardi E, Rota G, Sale A, Scabia G, Scali M, Scelfo D, Siciliano G, Tonacci A, Tosetti M, Turchi S, Volpi L. Vascular Function Is Improved After an Environmental Enrichment Program. Hypertension 2018; 71:1218-1225. [DOI: 10.1161/hypertensionaha.117.10066] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/25/2017] [Revised: 08/09/2017] [Accepted: 03/15/2018] [Indexed: 11/16/2022]
Abstract
Environmental enrichment may slow cognitive decay possibly acting through an improvement in vascular function. Aim of the study was to assess the effects of a 7-month cognitive, social, and physical training program on cognitive and vascular function in patients with mild cognitive impairment. In a single-center, randomized, parallel-group study, 113 patients (age, 65–89 years) were randomized to multidomain training (n=55) or usual care (n=58). All participants underwent neuropsychological tests and vascular evaluation, including brachial artery flow-mediated dilation, carotid–femoral pulse wave velocity, carotid distensibility, and assessment of circulating hematopoietic CD34+ and endothelial progenitor cells. At study entry, an age-matched control group (n=45) was also studied. Compared with controls, patients had at study entry a reduced flow-mediated dilation (2.97±2.14% versus 3.73±2.06%;
P
=0.03) and hyperemic stimulus (shear rate area under the curve, 19.1±15.7 versus 25.7±15.1×10
−3
;
P
=0.009); only the latter remained significant after adjustment for confounders (
P
=0.03). Training improved Alzheimer disease assessment scale cognitive (training, 14.0±4.8 to 13.1±5.5; nontraining, 12.1±3.9 to 13.2±4.8;
P
for interaction visit×training=0.02), flow-mediated dilation (2.82±2.19% to 3.40±1.81%, 3.05±2.08% to 2.24±1.59%;
P
=0.006;
P
=0.023 after adjustment for diameter and shear rate area under the curve), and circulating hematopoietic CD34
+
cells and prevented the decline in carotid distensibility (18.4±5.3 to 20.0±6.6, 23.9±11.0 to 19.5±7.1 Pa
−1
;
P
=0.005). The only clinical predictor of improvement of cognitive function after training was established hypertension. There was no correlation between changes in measures of cognitive and vascular function. In conclusion, a multidomain training program slows cognitive decline, especially in hypertensive individuals. This effect is accompanied by improved systemic endothelial function, mobilization of progenitor CD34
+
cells, and preserved carotid distensibility.
Clinical Trial Registration—
URL:
http://www.clinicaltrials.gov
. Unique identifier: NCT01725178.
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Affiliation(s)
- Rosa Maria Bruno
- From the Department of Clinical and Experimental Medicine, University of Pisa, Italy (R.M.B., F.S., L.G., S.T., U.B.)
- Institute of Clinical Physiology of the National Research Council (CNR), Pisa, Italy (R.M.B., F.S., R.S., S.D.T., S.S., L.G., G.D., L.P., E.P.)
| | - Francesco Stea
- From the Department of Clinical and Experimental Medicine, University of Pisa, Italy (R.M.B., F.S., L.G., S.T., U.B.)
- Institute of Clinical Physiology of the National Research Council (CNR), Pisa, Italy (R.M.B., F.S., R.S., S.D.T., S.S., L.G., G.D., L.P., E.P.)
| | - Rosa Sicari
- Institute of Clinical Physiology of the National Research Council (CNR), Pisa, Italy (R.M.B., F.S., R.S., S.D.T., S.S., L.G., G.D., L.P., E.P.)
| | - Lorenzo Ghiadoni
- From the Department of Clinical and Experimental Medicine, University of Pisa, Italy (R.M.B., F.S., L.G., S.T., U.B.)
| | - Stefano Taddei
- From the Department of Clinical and Experimental Medicine, University of Pisa, Italy (R.M.B., F.S., L.G., S.T., U.B.)
| | | | - Ubaldo Bonuccelli
- From the Department of Clinical and Experimental Medicine, University of Pisa, Italy (R.M.B., F.S., L.G., S.T., U.B.)
| | - Gloria Tognoni
- Azienda Ospedaliero Universitaria Careggi, University of Florence, Italy (A.U.); Azienda Ospedaliero Universitaria Pisana, Italy (G.T., S.C.)
| | - Simona Cintoli
- Azienda Ospedaliero Universitaria Careggi, University of Florence, Italy (A.U.); Azienda Ospedaliero Universitaria Pisana, Italy (G.T., S.C.)
| | - Serena Del Turco
- Institute of Clinical Physiology of the National Research Council (CNR), Pisa, Italy (R.M.B., F.S., R.S., S.D.T., S.S., L.G., G.D., L.P., E.P.)
| | - Silverio Sbrana
- Institute of Clinical Physiology of the National Research Council (CNR), Pisa, Italy (R.M.B., F.S., R.S., S.D.T., S.S., L.G., G.D., L.P., E.P.)
| | - Luna Gargani
- Institute of Clinical Physiology of the National Research Council (CNR), Pisa, Italy (R.M.B., F.S., R.S., S.D.T., S.S., L.G., G.D., L.P., E.P.)
| | - Gennaro D’Angelo
- Institute of Clinical Physiology of the National Research Council (CNR), Pisa, Italy (R.M.B., F.S., R.S., S.D.T., S.S., L.G., G.D., L.P., E.P.)
| | - Lorenza Pratali
- Institute of Clinical Physiology of the National Research Council (CNR), Pisa, Italy (R.M.B., F.S., R.S., S.D.T., S.S., L.G., G.D., L.P., E.P.)
| | | | | | - Eugenio Picano
- Institute of Clinical Physiology of the National Research Council (CNR), Pisa, Italy (R.M.B., F.S., R.S., S.D.T., S.S., L.G., G.D., L.P., E.P.)
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105
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Gioscia-Ryan RA, Battson ML, Cuevas LM, Eng JS, Murphy MP, Seals DR. Mitochondria-targeted antioxidant therapy with MitoQ ameliorates aortic stiffening in old mice. J Appl Physiol (1985) 2018; 124:1194-1202. [PMID: 29074712 PMCID: PMC6008077 DOI: 10.1152/japplphysiol.00670.2017] [Citation(s) in RCA: 84] [Impact Index Per Article: 14.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/19/2017] [Revised: 10/10/2017] [Accepted: 10/20/2017] [Indexed: 12/21/2022] Open
Abstract
Aortic stiffening is a major independent risk factor for cardiovascular diseases, cognitive dysfunction, and other chronic disorders of aging. Mitochondria-derived reactive oxygen species are a key source of arterial oxidative stress, which may contribute to arterial stiffening by promoting adverse structural changes-including collagen overabundance and elastin degradation-and enhancing inflammation, but the potential for mitochondria-targeted therapeutic strategies to ameliorate aortic stiffening with primary aging is unknown. We assessed aortic stiffness [pulse-wave velocity (aPWV)], ex vivo aortic intrinsic mechanical properties [elastic modulus (EM) of collagen and elastin regions], and aortic protein expression in young (~6 mo) and old (~27 mo) male C57BL/6 mice consuming normal drinking water (YC and OC) or water containing mitochondria-targeted antioxidant MitoQ (250 µM; YMQ and OMQ) for 4 wk. Both baseline and postintervention aPWV values were higher in OC vs. YC (post: 482 ± 21 vs. 420 ± 5 cm/s, P < 0.05). MitoQ had no effect in young mice but decreased aPWV in old mice (OMQ, 426 ± 20, P < 0.05 vs. OC). MitoQ did not affect age-associated increases in aortic collagen-region EM, collagen expression, or proinflammatory cytokine expression, but partially attenuated age-associated decreases in elastin region EM and elastin expression. Our results demonstrate that MitoQ reverses in vivo aortic stiffness in old mice and suggest that mitochondria-targeted antioxidants may represent a novel, promising therapeutic strategy for decreasing aortic stiffness with primary aging and, possibly, age-related clinical disorders in humans. The destiffening effects of MitoQ treatment may be at least partially mediated by attenuation/reversal of age-related aortic elastin degradation. NEW & NOTEWORTHY We show that 4 wk of treatment with the mitochondria-specific antioxidant MitoQ in mice completely reverses the age-associated elevation in aortic stiffness, assessed as aortic pulse-wave velocity. The destiffening effects of MitoQ treatment may be at least partially mediated by attenuation of age-related aortic elastin degradation. Our results suggest that mitochondria-targeted therapeutic strategies may hold promise for decreasing arterial stiffening with aging in humans, possibly decreasing the risk of many chronic age-related clinical disorders.
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Affiliation(s)
- Rachel A Gioscia-Ryan
- Department of Integrative Physiology, University of Colorado, Boulder, Boulder, Colorado
| | - Micah L Battson
- Department of Integrative Physiology, University of Colorado, Boulder, Boulder, Colorado
| | - Lauren M Cuevas
- Department of Integrative Physiology, University of Colorado, Boulder, Boulder, Colorado
| | - Jason S Eng
- Department of Integrative Physiology, University of Colorado, Boulder, Boulder, Colorado
| | - Michael P Murphy
- MRC Mitochondrial Biology Unit, University of Cambridge , Cambridge , United Kingdom
| | - Douglas R Seals
- Department of Integrative Physiology, University of Colorado, Boulder, Boulder, Colorado
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106
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Abstract
OBJECTIVES To test the hypothesis that brain arterial diameters are associated with cognitive performance, particularly in arteries supplying domain-specific territories. METHODS Stroke-free participants in the Northern Manhattan Study were invited to have a brain MRI from 2003-2008. The luminal diameters of 13 intracranial arterial segments were obtained using time-of-flight magnetic resonance angiogram (MRA), and then averaged and normalized into a global score and region-specific arterial diameters. Z-Scores for executive function, semantic memory, episodic memory and processing speed were obtained at MRI and during follow-up. Adjusted generalized additive models were used to assess for associations. RESULTS Among the 1034 participants with neurocognitive testing and brain MRI, there were non-linear relationships between left anterior (ACA) and middle cerebral artery (MCA) diameter and semantic memory Z-scores (χ2=10.00; DF=3; p=.019), and left posterior cerebral artery (PCA) and posterior communicating artery (Pcomm) mean diameter and episodic memory Z-scores (χ2=9.88; DF=3; p=.020). Among the 745 participants who returned for 2nd neuropsychological testing, on average 5.0±0.4 years after their MRI, semantic memory change was associated non-linearly with the left PCA/Pcomm mean diameter (χ2=13.09; DF=3; p=.004) and with the right MCA/ACA mean diameter (χ2=8.43; DF=3; p=.03). In both cross-sectional and longitudinal analyses, participants with the larger brain arterial diameters had more consistently lower Z-scores and greater decline than the rest of the participants. CONCLUSIONS Brain arterial diameters may have downstream effects in brain function presenting as poorer cognition. Identifying the mechanisms and the directionality of such interactions may increase the understanding of the vascular contribution to cognitive impairment and dementia. (JINS, 2018, 24, 335-346).
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107
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Reddan JM, White DJ, Macpherson H, Scholey A, Pipingas A. Glycerophospholipid Supplementation as a Potential Intervention for Supporting Cerebral Structure in Older Adults. Front Aging Neurosci 2018; 10:49. [PMID: 29563868 PMCID: PMC5845902 DOI: 10.3389/fnagi.2018.00049] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/23/2017] [Accepted: 02/15/2018] [Indexed: 01/13/2023] Open
Abstract
Modifying nutritional intake through supplementation may be efficacious for altering the trajectory of cerebral structural decline evident with increasing age. To date, there have been a number of clinical trials in older adults whereby chronic supplementation with B vitamins, omega-3 fatty acids, or resveratrol, has been observed to either slow the rate of decline or repair cerebral tissue. There is also some evidence from animal studies indicating that supplementation with glycerophospholipids (GPL) may benefit cerebral structure, though these effects have not yet been investigated in adult humans. Despite this paucity of research, there are a number of factors predicting poorer cerebral structure in older humans, which GPL supplementation appears to beneficially modify or protect against. These include elevated concentrations of homocysteine, unbalanced activity of reactive oxygen species both increasing the risk of oxidative stress, increased concentrations of pro-inflammatory messengers, as well as poorer cardio- and cerebrovascular function. As such, it is hypothesized that GPL supplementation will support cerebral structure in older adults. These cerebral effects may influence cognitive function. The current review aims to provide a theoretical basis for future clinical trials investigating the effects of GPL supplementation on cerebral structural integrity in older adults.
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Affiliation(s)
- Jeffery M Reddan
- Centre for Human Psychopharmacology, Swinburne University of Technology, Melbourne, VIC, Australia
| | - David J White
- Centre for Human Psychopharmacology, Swinburne University of Technology, Melbourne, VIC, Australia
| | - Helen Macpherson
- Institute for Physical Activity and Nutrition, Deakin University, Melbourne, VIC, Australia
| | - Andrew Scholey
- Centre for Human Psychopharmacology, Swinburne University of Technology, Melbourne, VIC, Australia
| | - Andrew Pipingas
- Centre for Human Psychopharmacology, Swinburne University of Technology, Melbourne, VIC, Australia
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108
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Brant L, Bos D, Araujo LF, Ikram MA, Ribeiro AL, Barreto SM. Microvascular endothelial function and cognitive performance: The ELSA-Brasil cohort study. Vasc Med 2018; 23:212-218. [PMID: 29488440 DOI: 10.1177/1358863x18755004] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
Impaired microvascular endothelial function may be implicated in the etiology of cognitive decline. Yet, current data on this association are inconsistent. Our objective is to investigate the relation of microvascular endothelial function to cognitive performance in the ELSA-Brasil cohort study. A total of 1521 participants from ELSA-Brasil free of dementia underwent peripheral arterial tonometry (PAT) to quantify microvascular endothelial function (PAT-ratio and mean baseline pulse amplitude (BPA)) and cognitive tests that covered the domains of memory, verbal fluency, and executive function at baseline. Cognitive tests in participants aged 55 years old and above were repeated during the second examination (mean follow-up: 3.5 (0.3) years). Linear regression and generalized linear models were used to evaluate the association between endothelial function, global cognitive performance, and performance on specific cognitive domains. In unadjusted cross-sectional analyses, we found that BPA and PAT-ratio were associated with worse global cognitive performance (mean difference for BPA: -0.07, 95% CI: -0.11; -0.03, p<0.01; mean difference for PAT-ratio: 0.11, 95% CI: 0.01; 0.20, p=0.02), worse performance on learning, recall, and word recognition tests (BPA: -0.87, 95% CI: -1.21; -0.52, p<0.01; PAT-ratio: 1.58, 95% CI: 0.80; 2.36, p<0.01), and only BPA was associated with worse performance in verbal fluency tests (-0.70, 95% CI: -1.19; -0.21, p<0.01). Adjustments for age, sex, and level of education rendered the associations statistically non-significant. Longitudinally, there was no association between microvascular endothelial and cognitive functions. The associations between microvascular endothelial function and cognition are explained by age, sex, and educational level. Measures of microvascular endothelial function may be of limited value with regard to preclinical cognitive deficits.
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Affiliation(s)
- Luisa Brant
- 1 Hospital das Clínicas and School of Medicine, Universidade Federal de Minas Gerais, Belo Horizonte, Brazil
| | - Daniel Bos
- 2 Department of Radiology and Nuclear Medicine, Erasmus MC, Rotterdam, The Netherlands.,3 Department of Epidemiology, Erasmus MC, Rotterdam, The Netherlands.,4 Department of Epidemiology, Harvard TH Chan School of Public Health, Boston, MA, USA
| | - Larissa Fortunato Araujo
- 5 Department of Preventive and Social Medicine, Universidade Federal de Minas Gerais, Belo Horizonte, Brazil
| | - M Arfan Ikram
- 2 Department of Radiology and Nuclear Medicine, Erasmus MC, Rotterdam, The Netherlands.,3 Department of Epidemiology, Erasmus MC, Rotterdam, The Netherlands.,6 Department of Neurology, Erasmus MC, Rotterdam, The Netherlands
| | - Antonio Lp Ribeiro
- 1 Hospital das Clínicas and School of Medicine, Universidade Federal de Minas Gerais, Belo Horizonte, Brazil
| | - Sandhi M Barreto
- 5 Department of Preventive and Social Medicine, Universidade Federal de Minas Gerais, Belo Horizonte, Brazil
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109
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Thorin-Trescases N, de Montgolfier O, Pinçon A, Raignault A, Caland L, Labbé P, Thorin E. Impact of pulse pressure on cerebrovascular events leading to age-related cognitive decline. Am J Physiol Heart Circ Physiol 2018; 314:H1214-H1224. [PMID: 29451817 DOI: 10.1152/ajpheart.00637.2017] [Citation(s) in RCA: 80] [Impact Index Per Article: 13.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/11/2023]
Abstract
Aging is a modern concept: human life expectancy has more than doubled in less than 150 yr in Western countries. Longer life span, however, reveals age-related diseases, including cerebrovascular diseases. The vascular system is a prime target of aging: the "wear and tear" of large elastic arteries exposed to a lifelong pulsatile pressure causes arterial stiffening by fragmentation of elastin fibers and replacement by stiffer collagen. This arterial stiffening increases in return the amplitude of the pulse pressure (PP), its wave penetrating deeper into the microcirculation of low-resistance, high-flow organs such as the brain. Several studies have associated peripheral arterial stiffness responsible for the sustained increase in PP, with brain microvascular diseases such as cerebral small vessel disease, cortical gray matter thinning, white matter atrophy, and cognitive dysfunction in older individuals and prematurely in hypertensive and diabetic patients. The rarefaction of white matter is also associated with middle cerebral artery pulsatility that is strongly dependent on PP and artery stiffness. PP and brain damage are likely associated, but the sequence of mechanistic events has not been established. Elevated PP promotes endothelial dysfunction that may slowly develop in parallel with the accumulation of proinflammatory senescent cells and oxidative stress, generating cerebrovascular damage and remodeling, as well as brain structural changes. Here, we review data suggesting that age-related increased peripheral artery stiffness may promote the penetration of a high PP to cerebral microvessels, likely causing functional, structural, metabolic, and hemodynamic alterations that could ultimately promote neuronal dysfunction and cognitive decline.
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Affiliation(s)
| | - Olivia de Montgolfier
- Montreal Heart Institute, Research Center , Montreal, Quebec , Canada.,Department of Pharmacology, Faculty of Medicine, Université de Montréal , Montreal, Quebec , Canada
| | - Anthony Pinçon
- Montreal Heart Institute, Research Center , Montreal, Quebec , Canada.,Department of Pharmacology, Faculty of Medicine, Université de Montréal , Montreal, Quebec , Canada
| | - Adeline Raignault
- Montreal Heart Institute, Research Center , Montreal, Quebec , Canada
| | - Laurie Caland
- Montreal Heart Institute, Research Center , Montreal, Quebec , Canada.,Department of Pharmacology, Faculty of Medicine, Université de Montréal , Montreal, Quebec , Canada
| | - Pauline Labbé
- Montreal Heart Institute, Research Center , Montreal, Quebec , Canada.,Department of Pharmacology, Faculty of Medicine, Université de Montréal , Montreal, Quebec , Canada
| | - Eric Thorin
- Montreal Heart Institute, Research Center , Montreal, Quebec , Canada.,Department of Pharmacology, Faculty of Medicine, Université de Montréal , Montreal, Quebec , Canada.,Department of Surgery, Faculty of Medicine, Université de Montréal , Montreal, Quebec , Canada
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Brain Tissue Pulsatility is Increased in Midlife Depression: a Comparative Study Using Ultrasound Tissue Pulsatility Imaging. Neuropsychopharmacology 2017; 42:2575-2582. [PMID: 28585568 PMCID: PMC5686485 DOI: 10.1038/npp.2017.113] [Citation(s) in RCA: 21] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/03/2016] [Revised: 05/20/2017] [Accepted: 05/30/2017] [Indexed: 01/09/2023]
Abstract
Cerebrovascular disease (CVD) is consistently associated with late-life depression but poorly documented in midlife depression. It can be hypothesized that the relatively low sensitivity of conventional neuroimaging techniques does not allow the detection of subtle CVD in midlife depression. We used tissue pulsatility imaging (TPI), a novel ultrasound (US) neuroimaging technique that has demonstrated good sensitivity to detect changes in the pulsatility of small brain volumes, to identify early and subtle changes in brain vascular function in midlife depression. We compared the maximum and mean brain tissue pulsatility (MaxBTP and MeanBTP), as identified by TPI, between three groups of middle-aged females matched for age: patients with depression (n=25), patients with remitted depression (n=24) and community controls (n=25). MRI arterial spin labeling, white matter hyperintensities (WMHs) and transcranial doppler (TCD) were used as control conventional markers for CVD. We found no difference in the MRI and TCD measures among the three groups. In contrast, depressive patients showed an increased BTP related to the mean global brain pulsatility (MeanBTP) and no change related to large vessels (MaxBTP) in comparison with the remitted and control groups. US neuroimaging is a highly accurate method to detect brain pulsatility changes related to cerebrovascular functioning, and TPI identified an increased BTP in midlife depressed patients, suggesting early and subtle vascular impairments in this population at risk for CVD such as stroke or WMHs. Because high pulsatility could represent prodromal cerebrovascular changes that damage the brain over time, this paper provides a potential target for blocking the progression of CVD.
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Yano Y, Reis JP, Levine DA, Bryan RN, Viera AJ, Shimbo D, Tedla YG, Allen NB, Schreiner PJ, Bancks MP, Sidney S, Pletcher MJ, Liu K, Greenland P, Lloyd-Jones DM, Launer LJ. Visit-to-Visit Blood Pressure Variability in Young Adulthood and Hippocampal Volume and Integrity at Middle Age: The CARDIA Study (Coronary Artery Risk Development in Young Adults). Hypertension 2017; 70:1091-1098. [PMID: 28993449 PMCID: PMC5680098 DOI: 10.1161/hypertensionaha.117.10144] [Citation(s) in RCA: 33] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/07/2017] [Revised: 09/15/2017] [Accepted: 09/16/2017] [Indexed: 01/15/2023]
Abstract
The aims of this study are to assess the relationships of visit-to-visit blood pressure (BP) variability in young adulthood to hippocampal volume and integrity at middle age. We used data over 8 examinations spanning 25 years collected in the CARDIA study (Coronary Artery Risk Development in Young Adults) of black and white adults (age, 18-30 years) started in 1985 to 1986. Visit-to-visit BP variability was defined as by SDBP and average real variability (ARVBP, defined as the absolute differences of BP between successive BP measurements). Hippocampal tissue volume standardized by intracranial volume (%) and integrity assessed by fractional anisotropy were measured by 3-Tesla magnetic resonance imaging at the year-25 examination (n=545; mean age, 51 years; 54% women and 34% African Americans). Mean systolic BP (SBP)/diastolic BP levels were 110/69 mm Hg at year 0 (baseline), 117/73 mm Hg at year 25, and ARVSBP and SDSBP were 7.7 and 7.9 mm Hg, respectively. In multivariable-adjusted linear models, higher ARVSBP was associated with lower hippocampal volume (unstandardized regression coefficient [standard error] with 1-SD higher ARVSBP: -0.006 [0.003]), and higher SDSBP with lower hippocampal fractional anisotropy (-0.02 [0.01]; all P<0.05), independent of cumulative exposure to SBP during follow-up. Conversely, cumulative exposure to SBP and diastolic BP was not associated with hippocampal volume. There was no interaction by sex or race between ARVSBP or SDSBP with hippocampal volume or integrity. In conclusion, visit-to-visit BP variability during young adulthood may be useful in assessing the potential risk for reductions in hippocampal volume and integrity in midlife.
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Affiliation(s)
- Yuichiro Yano
- From the Department of Preventive Medicine, University of Mississippi Medical Center, Jackson (Y.Y.); Department of Preventive Medicine, Northwestern University Feinberg School of Medicine, Chicago, IL (Y.Y., Y.G.T., N.B.A., M.P.B., K.L., P.G., D.M.L.-J.); Division of Cardiovascular Sciences, National Heart, Lung, and Blood Institute, Bethesda, MD (J.P.R.); Division of General Medicine, University of Michigan, Ann Arbor (D.A.L.); Department of Radiology, University of Pennsylvania Health System, Philadelphia (R.N.B.); Department of Family Medicine, Hypertension Research Program, University of North Carolina at Chapel Hill (A.J.V.); Department of Medicine, Columbia University Medical Center, New York, NY (D.S.); Division of Epidemiology and Community Health, School of Public Health, University of Minnesota, Minneapolis (P.J.S.); Division of Research, Kaiser Permanente of Northern California, Oakland (S.S.); Department of Epidemiology and Biostatistics, University of California, San Francisco (M.J.P.); and Laboratory of Epidemiology and Population Sciences, National Institute on Aging, Bethesda, MD (L.J.L.).
| | - Jared P Reis
- From the Department of Preventive Medicine, University of Mississippi Medical Center, Jackson (Y.Y.); Department of Preventive Medicine, Northwestern University Feinberg School of Medicine, Chicago, IL (Y.Y., Y.G.T., N.B.A., M.P.B., K.L., P.G., D.M.L.-J.); Division of Cardiovascular Sciences, National Heart, Lung, and Blood Institute, Bethesda, MD (J.P.R.); Division of General Medicine, University of Michigan, Ann Arbor (D.A.L.); Department of Radiology, University of Pennsylvania Health System, Philadelphia (R.N.B.); Department of Family Medicine, Hypertension Research Program, University of North Carolina at Chapel Hill (A.J.V.); Department of Medicine, Columbia University Medical Center, New York, NY (D.S.); Division of Epidemiology and Community Health, School of Public Health, University of Minnesota, Minneapolis (P.J.S.); Division of Research, Kaiser Permanente of Northern California, Oakland (S.S.); Department of Epidemiology and Biostatistics, University of California, San Francisco (M.J.P.); and Laboratory of Epidemiology and Population Sciences, National Institute on Aging, Bethesda, MD (L.J.L.)
| | - Deborah A Levine
- From the Department of Preventive Medicine, University of Mississippi Medical Center, Jackson (Y.Y.); Department of Preventive Medicine, Northwestern University Feinberg School of Medicine, Chicago, IL (Y.Y., Y.G.T., N.B.A., M.P.B., K.L., P.G., D.M.L.-J.); Division of Cardiovascular Sciences, National Heart, Lung, and Blood Institute, Bethesda, MD (J.P.R.); Division of General Medicine, University of Michigan, Ann Arbor (D.A.L.); Department of Radiology, University of Pennsylvania Health System, Philadelphia (R.N.B.); Department of Family Medicine, Hypertension Research Program, University of North Carolina at Chapel Hill (A.J.V.); Department of Medicine, Columbia University Medical Center, New York, NY (D.S.); Division of Epidemiology and Community Health, School of Public Health, University of Minnesota, Minneapolis (P.J.S.); Division of Research, Kaiser Permanente of Northern California, Oakland (S.S.); Department of Epidemiology and Biostatistics, University of California, San Francisco (M.J.P.); and Laboratory of Epidemiology and Population Sciences, National Institute on Aging, Bethesda, MD (L.J.L.)
| | - R Nick Bryan
- From the Department of Preventive Medicine, University of Mississippi Medical Center, Jackson (Y.Y.); Department of Preventive Medicine, Northwestern University Feinberg School of Medicine, Chicago, IL (Y.Y., Y.G.T., N.B.A., M.P.B., K.L., P.G., D.M.L.-J.); Division of Cardiovascular Sciences, National Heart, Lung, and Blood Institute, Bethesda, MD (J.P.R.); Division of General Medicine, University of Michigan, Ann Arbor (D.A.L.); Department of Radiology, University of Pennsylvania Health System, Philadelphia (R.N.B.); Department of Family Medicine, Hypertension Research Program, University of North Carolina at Chapel Hill (A.J.V.); Department of Medicine, Columbia University Medical Center, New York, NY (D.S.); Division of Epidemiology and Community Health, School of Public Health, University of Minnesota, Minneapolis (P.J.S.); Division of Research, Kaiser Permanente of Northern California, Oakland (S.S.); Department of Epidemiology and Biostatistics, University of California, San Francisco (M.J.P.); and Laboratory of Epidemiology and Population Sciences, National Institute on Aging, Bethesda, MD (L.J.L.)
| | - Anthony J Viera
- From the Department of Preventive Medicine, University of Mississippi Medical Center, Jackson (Y.Y.); Department of Preventive Medicine, Northwestern University Feinberg School of Medicine, Chicago, IL (Y.Y., Y.G.T., N.B.A., M.P.B., K.L., P.G., D.M.L.-J.); Division of Cardiovascular Sciences, National Heart, Lung, and Blood Institute, Bethesda, MD (J.P.R.); Division of General Medicine, University of Michigan, Ann Arbor (D.A.L.); Department of Radiology, University of Pennsylvania Health System, Philadelphia (R.N.B.); Department of Family Medicine, Hypertension Research Program, University of North Carolina at Chapel Hill (A.J.V.); Department of Medicine, Columbia University Medical Center, New York, NY (D.S.); Division of Epidemiology and Community Health, School of Public Health, University of Minnesota, Minneapolis (P.J.S.); Division of Research, Kaiser Permanente of Northern California, Oakland (S.S.); Department of Epidemiology and Biostatistics, University of California, San Francisco (M.J.P.); and Laboratory of Epidemiology and Population Sciences, National Institute on Aging, Bethesda, MD (L.J.L.)
| | - Daichi Shimbo
- From the Department of Preventive Medicine, University of Mississippi Medical Center, Jackson (Y.Y.); Department of Preventive Medicine, Northwestern University Feinberg School of Medicine, Chicago, IL (Y.Y., Y.G.T., N.B.A., M.P.B., K.L., P.G., D.M.L.-J.); Division of Cardiovascular Sciences, National Heart, Lung, and Blood Institute, Bethesda, MD (J.P.R.); Division of General Medicine, University of Michigan, Ann Arbor (D.A.L.); Department of Radiology, University of Pennsylvania Health System, Philadelphia (R.N.B.); Department of Family Medicine, Hypertension Research Program, University of North Carolina at Chapel Hill (A.J.V.); Department of Medicine, Columbia University Medical Center, New York, NY (D.S.); Division of Epidemiology and Community Health, School of Public Health, University of Minnesota, Minneapolis (P.J.S.); Division of Research, Kaiser Permanente of Northern California, Oakland (S.S.); Department of Epidemiology and Biostatistics, University of California, San Francisco (M.J.P.); and Laboratory of Epidemiology and Population Sciences, National Institute on Aging, Bethesda, MD (L.J.L.)
| | - Yacob G Tedla
- From the Department of Preventive Medicine, University of Mississippi Medical Center, Jackson (Y.Y.); Department of Preventive Medicine, Northwestern University Feinberg School of Medicine, Chicago, IL (Y.Y., Y.G.T., N.B.A., M.P.B., K.L., P.G., D.M.L.-J.); Division of Cardiovascular Sciences, National Heart, Lung, and Blood Institute, Bethesda, MD (J.P.R.); Division of General Medicine, University of Michigan, Ann Arbor (D.A.L.); Department of Radiology, University of Pennsylvania Health System, Philadelphia (R.N.B.); Department of Family Medicine, Hypertension Research Program, University of North Carolina at Chapel Hill (A.J.V.); Department of Medicine, Columbia University Medical Center, New York, NY (D.S.); Division of Epidemiology and Community Health, School of Public Health, University of Minnesota, Minneapolis (P.J.S.); Division of Research, Kaiser Permanente of Northern California, Oakland (S.S.); Department of Epidemiology and Biostatistics, University of California, San Francisco (M.J.P.); and Laboratory of Epidemiology and Population Sciences, National Institute on Aging, Bethesda, MD (L.J.L.)
| | - Norrina B Allen
- From the Department of Preventive Medicine, University of Mississippi Medical Center, Jackson (Y.Y.); Department of Preventive Medicine, Northwestern University Feinberg School of Medicine, Chicago, IL (Y.Y., Y.G.T., N.B.A., M.P.B., K.L., P.G., D.M.L.-J.); Division of Cardiovascular Sciences, National Heart, Lung, and Blood Institute, Bethesda, MD (J.P.R.); Division of General Medicine, University of Michigan, Ann Arbor (D.A.L.); Department of Radiology, University of Pennsylvania Health System, Philadelphia (R.N.B.); Department of Family Medicine, Hypertension Research Program, University of North Carolina at Chapel Hill (A.J.V.); Department of Medicine, Columbia University Medical Center, New York, NY (D.S.); Division of Epidemiology and Community Health, School of Public Health, University of Minnesota, Minneapolis (P.J.S.); Division of Research, Kaiser Permanente of Northern California, Oakland (S.S.); Department of Epidemiology and Biostatistics, University of California, San Francisco (M.J.P.); and Laboratory of Epidemiology and Population Sciences, National Institute on Aging, Bethesda, MD (L.J.L.)
| | - Pamela J Schreiner
- From the Department of Preventive Medicine, University of Mississippi Medical Center, Jackson (Y.Y.); Department of Preventive Medicine, Northwestern University Feinberg School of Medicine, Chicago, IL (Y.Y., Y.G.T., N.B.A., M.P.B., K.L., P.G., D.M.L.-J.); Division of Cardiovascular Sciences, National Heart, Lung, and Blood Institute, Bethesda, MD (J.P.R.); Division of General Medicine, University of Michigan, Ann Arbor (D.A.L.); Department of Radiology, University of Pennsylvania Health System, Philadelphia (R.N.B.); Department of Family Medicine, Hypertension Research Program, University of North Carolina at Chapel Hill (A.J.V.); Department of Medicine, Columbia University Medical Center, New York, NY (D.S.); Division of Epidemiology and Community Health, School of Public Health, University of Minnesota, Minneapolis (P.J.S.); Division of Research, Kaiser Permanente of Northern California, Oakland (S.S.); Department of Epidemiology and Biostatistics, University of California, San Francisco (M.J.P.); and Laboratory of Epidemiology and Population Sciences, National Institute on Aging, Bethesda, MD (L.J.L.)
| | - Michael P Bancks
- From the Department of Preventive Medicine, University of Mississippi Medical Center, Jackson (Y.Y.); Department of Preventive Medicine, Northwestern University Feinberg School of Medicine, Chicago, IL (Y.Y., Y.G.T., N.B.A., M.P.B., K.L., P.G., D.M.L.-J.); Division of Cardiovascular Sciences, National Heart, Lung, and Blood Institute, Bethesda, MD (J.P.R.); Division of General Medicine, University of Michigan, Ann Arbor (D.A.L.); Department of Radiology, University of Pennsylvania Health System, Philadelphia (R.N.B.); Department of Family Medicine, Hypertension Research Program, University of North Carolina at Chapel Hill (A.J.V.); Department of Medicine, Columbia University Medical Center, New York, NY (D.S.); Division of Epidemiology and Community Health, School of Public Health, University of Minnesota, Minneapolis (P.J.S.); Division of Research, Kaiser Permanente of Northern California, Oakland (S.S.); Department of Epidemiology and Biostatistics, University of California, San Francisco (M.J.P.); and Laboratory of Epidemiology and Population Sciences, National Institute on Aging, Bethesda, MD (L.J.L.)
| | - Stephen Sidney
- From the Department of Preventive Medicine, University of Mississippi Medical Center, Jackson (Y.Y.); Department of Preventive Medicine, Northwestern University Feinberg School of Medicine, Chicago, IL (Y.Y., Y.G.T., N.B.A., M.P.B., K.L., P.G., D.M.L.-J.); Division of Cardiovascular Sciences, National Heart, Lung, and Blood Institute, Bethesda, MD (J.P.R.); Division of General Medicine, University of Michigan, Ann Arbor (D.A.L.); Department of Radiology, University of Pennsylvania Health System, Philadelphia (R.N.B.); Department of Family Medicine, Hypertension Research Program, University of North Carolina at Chapel Hill (A.J.V.); Department of Medicine, Columbia University Medical Center, New York, NY (D.S.); Division of Epidemiology and Community Health, School of Public Health, University of Minnesota, Minneapolis (P.J.S.); Division of Research, Kaiser Permanente of Northern California, Oakland (S.S.); Department of Epidemiology and Biostatistics, University of California, San Francisco (M.J.P.); and Laboratory of Epidemiology and Population Sciences, National Institute on Aging, Bethesda, MD (L.J.L.)
| | - Mark J Pletcher
- From the Department of Preventive Medicine, University of Mississippi Medical Center, Jackson (Y.Y.); Department of Preventive Medicine, Northwestern University Feinberg School of Medicine, Chicago, IL (Y.Y., Y.G.T., N.B.A., M.P.B., K.L., P.G., D.M.L.-J.); Division of Cardiovascular Sciences, National Heart, Lung, and Blood Institute, Bethesda, MD (J.P.R.); Division of General Medicine, University of Michigan, Ann Arbor (D.A.L.); Department of Radiology, University of Pennsylvania Health System, Philadelphia (R.N.B.); Department of Family Medicine, Hypertension Research Program, University of North Carolina at Chapel Hill (A.J.V.); Department of Medicine, Columbia University Medical Center, New York, NY (D.S.); Division of Epidemiology and Community Health, School of Public Health, University of Minnesota, Minneapolis (P.J.S.); Division of Research, Kaiser Permanente of Northern California, Oakland (S.S.); Department of Epidemiology and Biostatistics, University of California, San Francisco (M.J.P.); and Laboratory of Epidemiology and Population Sciences, National Institute on Aging, Bethesda, MD (L.J.L.)
| | - Kiang Liu
- From the Department of Preventive Medicine, University of Mississippi Medical Center, Jackson (Y.Y.); Department of Preventive Medicine, Northwestern University Feinberg School of Medicine, Chicago, IL (Y.Y., Y.G.T., N.B.A., M.P.B., K.L., P.G., D.M.L.-J.); Division of Cardiovascular Sciences, National Heart, Lung, and Blood Institute, Bethesda, MD (J.P.R.); Division of General Medicine, University of Michigan, Ann Arbor (D.A.L.); Department of Radiology, University of Pennsylvania Health System, Philadelphia (R.N.B.); Department of Family Medicine, Hypertension Research Program, University of North Carolina at Chapel Hill (A.J.V.); Department of Medicine, Columbia University Medical Center, New York, NY (D.S.); Division of Epidemiology and Community Health, School of Public Health, University of Minnesota, Minneapolis (P.J.S.); Division of Research, Kaiser Permanente of Northern California, Oakland (S.S.); Department of Epidemiology and Biostatistics, University of California, San Francisco (M.J.P.); and Laboratory of Epidemiology and Population Sciences, National Institute on Aging, Bethesda, MD (L.J.L.)
| | - Philip Greenland
- From the Department of Preventive Medicine, University of Mississippi Medical Center, Jackson (Y.Y.); Department of Preventive Medicine, Northwestern University Feinberg School of Medicine, Chicago, IL (Y.Y., Y.G.T., N.B.A., M.P.B., K.L., P.G., D.M.L.-J.); Division of Cardiovascular Sciences, National Heart, Lung, and Blood Institute, Bethesda, MD (J.P.R.); Division of General Medicine, University of Michigan, Ann Arbor (D.A.L.); Department of Radiology, University of Pennsylvania Health System, Philadelphia (R.N.B.); Department of Family Medicine, Hypertension Research Program, University of North Carolina at Chapel Hill (A.J.V.); Department of Medicine, Columbia University Medical Center, New York, NY (D.S.); Division of Epidemiology and Community Health, School of Public Health, University of Minnesota, Minneapolis (P.J.S.); Division of Research, Kaiser Permanente of Northern California, Oakland (S.S.); Department of Epidemiology and Biostatistics, University of California, San Francisco (M.J.P.); and Laboratory of Epidemiology and Population Sciences, National Institute on Aging, Bethesda, MD (L.J.L.)
| | - Donald M Lloyd-Jones
- From the Department of Preventive Medicine, University of Mississippi Medical Center, Jackson (Y.Y.); Department of Preventive Medicine, Northwestern University Feinberg School of Medicine, Chicago, IL (Y.Y., Y.G.T., N.B.A., M.P.B., K.L., P.G., D.M.L.-J.); Division of Cardiovascular Sciences, National Heart, Lung, and Blood Institute, Bethesda, MD (J.P.R.); Division of General Medicine, University of Michigan, Ann Arbor (D.A.L.); Department of Radiology, University of Pennsylvania Health System, Philadelphia (R.N.B.); Department of Family Medicine, Hypertension Research Program, University of North Carolina at Chapel Hill (A.J.V.); Department of Medicine, Columbia University Medical Center, New York, NY (D.S.); Division of Epidemiology and Community Health, School of Public Health, University of Minnesota, Minneapolis (P.J.S.); Division of Research, Kaiser Permanente of Northern California, Oakland (S.S.); Department of Epidemiology and Biostatistics, University of California, San Francisco (M.J.P.); and Laboratory of Epidemiology and Population Sciences, National Institute on Aging, Bethesda, MD (L.J.L.)
| | - Lenore J Launer
- From the Department of Preventive Medicine, University of Mississippi Medical Center, Jackson (Y.Y.); Department of Preventive Medicine, Northwestern University Feinberg School of Medicine, Chicago, IL (Y.Y., Y.G.T., N.B.A., M.P.B., K.L., P.G., D.M.L.-J.); Division of Cardiovascular Sciences, National Heart, Lung, and Blood Institute, Bethesda, MD (J.P.R.); Division of General Medicine, University of Michigan, Ann Arbor (D.A.L.); Department of Radiology, University of Pennsylvania Health System, Philadelphia (R.N.B.); Department of Family Medicine, Hypertension Research Program, University of North Carolina at Chapel Hill (A.J.V.); Department of Medicine, Columbia University Medical Center, New York, NY (D.S.); Division of Epidemiology and Community Health, School of Public Health, University of Minnesota, Minneapolis (P.J.S.); Division of Research, Kaiser Permanente of Northern California, Oakland (S.S.); Department of Epidemiology and Biostatistics, University of California, San Francisco (M.J.P.); and Laboratory of Epidemiology and Population Sciences, National Institute on Aging, Bethesda, MD (L.J.L.)
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112
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Pulse Pressure Is Associated With Early Brain Atrophy and Cognitive Decline: Modifying Effects of APOE-ε4. Alzheimer Dis Assoc Disord 2017; 30:210-5. [PMID: 27556935 DOI: 10.1097/wad.0000000000000127] [Citation(s) in RCA: 32] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
We investigated whether midlife pulse pressure is associated with brain atrophy and cognitive decline, and whether the association was modified by apolipoprotein-E ε4 (APOE-ε4) and hypertension. Participants (549 stroke-free and dementia-free Framingham Offspring Cohort Study participants, age range=55.0 to 64.9 y) underwent baseline neuropsychological and magnetic resonance imaging (subset, n=454) evaluations with 5- to 7-year follow-up. Regression analyses investigated associations between baseline pulse pressure (systolic-diastolic pressure) and cognition, total cerebral volume and temporal horn ventricular volume (as an index of smaller hippocampal volume) at follow-up, and longitudinal change in these measures. Interactions with APOE-ε4 and hypertension were assessed. Covariates included age, sex, education, assessment interval, and interim stroke. In the total sample, baseline pulse pressure was associated with worse executive ability, lower total cerebral volume, and greater temporal horn ventricular volume 5 to 7 years later, and longitudinal decline in executive ability and increase in temporal horn ventricular volume. Among APOE-ε4 carriers only, baseline pulse pressure was associated with longitudinal decline in visuospatial organization. Findings indicate arterial stiffening, indexed by pulse pressure, may play a role in early cognitive decline and brain atrophy in mid to late life, particularly among APOE-ε4 carriers.
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113
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Lin CH, Cheng HM, Chuang SY, Chen CH. Vascular Aging and Cognitive Dysfunction: Silent Midlife Crisis in the Brain. Pulse (Basel) 2017; 5:127-132. [PMID: 29761088 DOI: 10.1159/000481734] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/04/2017] [Accepted: 09/22/2017] [Indexed: 11/19/2022] Open
Abstract
Background Vascular aging may cause cerebral microvascular damage and cognitive dysfunction. There is incremental evidence that consistently implicates arterial stiffness being involved in the manifestation of cognitive impairment in the elderly. However, few investigations have examined the relationship between arterial stiffness and cognitive impairment in midlife. Summary Past studies inconsistently showed improved cognitive outcomes after antihypertensive therapy in elderly populations. Nevertheless, recent findings revealed that blood-pressure-lowering treatment in young adults might eliminate or halt the progression of the detrimental effects related to arterial stiffness, indicating that younger adults may have more favorable outcomes in cognition than their older counterparts if early intervention is conducted at the subclinical stage. Stiffening of the aorta may lead to an excessive flow pulsatility in the brain that may cause microvascular structural brain damage and worse cognitive performance. Recent investigations have suggested that arterial stiffness is likely to trigger initial silent brain damage, possibly preceding midlife, while the manifestation of cognitive decline and deterioration can be foreseen in the subsequent life span. Key Message Despite the recent novel findings, definite conclusions on causality between vascular aging and cognitive dysfunction cannot be drawn at present. Further well-powered longitudinal studies with superior neuroimaging indicator, vascular mechanical biomarkers, and sensitive cognitive assessment tools that examine a broad range of age populations may help extend our understanding of the association between vascular aging and cognitive dysfunction throughout the life span.
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Affiliation(s)
- Chen-Hua Lin
- Institute of Public Health, National Yang-Ming University, Taipei, ROC
| | - Hao-Min Cheng
- Institute of Public Health, National Yang-Ming University, Taipei, ROC.,Faculty of Medicine, National Yang-Ming University, Taipei, ROC.,Center for Evidence-Based Medicine, Taipei Veterans General Hospital, Taipei, ROC.,Department of Medical Education, Taipei Veterans General Hospital, Taipei, ROC.,Department of Internal Medicine, Taipei Veterans General Hospital, Taipei, ROC
| | | | - Chen-Huan Chen
- Institute of Public Health, National Yang-Ming University, Taipei, ROC.,Faculty of Medicine, National Yang-Ming University, Taipei, ROC.,Department of Medical Education, Taipei Veterans General Hospital, Taipei, ROC.,Department of Internal Medicine, Taipei Veterans General Hospital, Taipei, ROC
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114
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Xu X, Wang B, Ren C, Hu J, Greenberg DA, Chen T, Xie L, Jin K. Age-related Impairment of Vascular Structure and Functions. Aging Dis 2017; 8:590-610. [PMID: 28966804 PMCID: PMC5614324 DOI: 10.14336/ad.2017.0430] [Citation(s) in RCA: 174] [Impact Index Per Article: 24.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/07/2016] [Accepted: 04/30/2017] [Indexed: 12/12/2022] Open
Abstract
Among age-related diseases, cardiovascular and cerebrovascular diseases are major causes of death. Vascular dysfunction is a key characteristic of these diseases wherein age is an independent and essential risk factor. The present work will review morphological alterations of aging vessels in-depth, which includes the discussion of age-related microvessel loss and changes to vasculature involving the capillary basement membrane, intima, media, and adventitia as well as the accompanying vascular dysfunctions arising from these alterations.
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Affiliation(s)
- Xianglai Xu
- 1Zhongshan Hospital, Fudan University, Shanghai 200032, China.,2Department of Pharmacology and Neuroscience, University of North Texas Health Science Center at Fort Worth, TX 76107, USA
| | - Brian Wang
- 2Department of Pharmacology and Neuroscience, University of North Texas Health Science Center at Fort Worth, TX 76107, USA
| | - Changhong Ren
- 2Department of Pharmacology and Neuroscience, University of North Texas Health Science Center at Fort Worth, TX 76107, USA.,4Institute of Hypoxia Medicine, Xuanwu Hospital, Capital Medical University. Beijing, China
| | - Jiangnan Hu
- 2Department of Pharmacology and Neuroscience, University of North Texas Health Science Center at Fort Worth, TX 76107, USA
| | | | - Tianxiang Chen
- 6Department of Thoracic Surgery, Shanghai Chest Hospital, Shanghai Jiaotong University, Shanghai, China
| | - Liping Xie
- 3Department of Urology, the First Affiliated Hospital, Zhejiang University, Zhejiang Province, China
| | - Kunlin Jin
- 2Department of Pharmacology and Neuroscience, University of North Texas Health Science Center at Fort Worth, TX 76107, USA
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115
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Chung CP, Lee HY, Lin PC, Wang PN. Cerebral Artery Pulsatility is Associated with Cognitive Impairment and Predicts Dementia in Individuals with Subjective Memory Decline or Mild Cognitive Impairment. J Alzheimers Dis 2017; 60:625-632. [DOI: 10.3233/jad-170349] [Citation(s) in RCA: 23] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/22/2022]
Affiliation(s)
- Chih-Ping Chung
- Department of Neurology, Section of Cerebrovascular Disease, Neurological Institute, Taipei Veterans General Hospital, Taiwan
- School of Medicine, National Yang Ming University, Taipei, Taiwan
| | - Hsiang-Ying Lee
- Department of Neurology, Section of Cerebrovascular Disease, Neurological Institute, Taipei Veterans General Hospital, Taiwan
- School of Medicine, National Yang Ming University, Taipei, Taiwan
- Department of Neurology, Laboratory of Neurovascular Ultrasound, Neurological Institute, Taipei Veterans General Hospital, Taiwan
| | - Po-Chen Lin
- Department of Neurology, Section of Cerebrovascular Disease, Neurological Institute, Taipei Veterans General Hospital, Taiwan
- School of Medicine, National Yang Ming University, Taipei, Taiwan
| | - Pei-Ning Wang
- School of Medicine, National Yang Ming University, Taipei, Taiwan
- Department of Neurology, Laboratory of Neuropsychological Research, Neurological Institute, Taipei Veterans General Hospital, Taiwan
- Aging and Health Research Center, National Yang Ming University, Taipei, Taiwan
- Brain Research Center, National Yang Ming University, Taipei, Taiwan
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116
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Gregory MA, Boa Sorte Silva NC, Gill DP, McGowan CL, Liu-Ambrose T, Shoemaker JK, Hachinski V, Holmes J, Petrella RJ. Combined Dual-Task Gait Training and Aerobic Exercise to Improve Cognition, Mobility, and Vascular Health in Community-Dwelling Older Adults at Risk for Future Cognitive Decline1. J Alzheimers Dis 2017; 57:747-763. [PMID: 28304305 DOI: 10.3233/jad-161240] [Citation(s) in RCA: 32] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/01/2023]
Abstract
This 6-month experimental case series study investigated the effects of a dual-task gait training and aerobic exercise intervention on cognition, mobility, and cardiovascular health in community-dwelling older adults without dementia. Participants exercised 40 min/day, 3 days/week for 26 weeks on a Biodex GaitTrainer2 treadmill. Participants were assessed at baseline (V0), interim (V1: 12-weeks), intervention endpoint (V2: 26-weeks), and study endpoint (V3: 52-weeks). The study outcomes included: cognition [executive function (EF), processing speed, verbal fluency, and memory]; mobility: usual & dual-task gait (speed, step length, and stride time variability); and vascular health: ambulatory blood pressure, carotid arterial compliance, and intima-media thickness (cIMT). Fifty-six participants [age: 70(6) years; 61% female] were included in this study. Significant improvements following the exercise program (V2) were observed in cognition: EF (p = 0.002), processing speed (p < 0.001), verbal fluency [digit symbol coding (p < 0.001), phonemic verbal fluency (p < 0.001)], and memory [immediate recall (p < 0.001) and delayed recall (p < 0.001)]; mobility: usual & dual-task gait speed (p = 0.002 and p < 0.001, respectively) and step length (p = 0.001 and p = 0.003, respectively); and vascular health: cIMT (p = 0.002). No changes were seen in the remaining outcomes. In conclusion, 26 weeks of dual-task gait training and aerobic exercise improved performance on a number of cognitive outcomes, while increasing usual & dual-task gait speed and step length in a sample of older adults without dementia.
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Affiliation(s)
- Michael A Gregory
- Graduate Program in Health and Rehabilitation Sciences, Faculty of Health Sciences, Western University, London, ON, Canada.,Lawson Health Research Institute, London, ON, Canada
| | - Narlon C Boa Sorte Silva
- Lawson Health Research Institute, London, ON, Canada.,School of Kinesiology, Faculty of Health Sciences, Western University, London, ON, Canada
| | - Dawn P Gill
- Graduate Program in Health and Rehabilitation Sciences, Faculty of Health Sciences, Western University, London, ON, Canada.,Lawson Health Research Institute, London, ON, Canada.,Centre for Studies in Family Medicine, Department of Family Medicine, Schulich School of Medicine and Dentistry, Western University, London, ON, Canada.,School of Health Studies, Faculty of Health Sciences, Western University, London, ON, Canada
| | - Cheri L McGowan
- Lawson Health Research Institute, London, ON, Canada.,Centre for Studies in Family Medicine, Department of Family Medicine, Schulich School of Medicine and Dentistry, Western University, London, ON, Canada.,Department of Kinesiology, University of Windsor, Windsor, ON, Canada
| | - Teresa Liu-Ambrose
- Department of Physical Therapy, Faculty of Medicine, University of British Columbia, Vancouver, BC, Canada.,Djavad Mowafaghian Centre for Brain Health, Vancouver, BC, Canada
| | - J Kevin Shoemaker
- School of Kinesiology, Faculty of Health Sciences, Western University, London, ON, Canada
| | - Vladimir Hachinski
- Department of Clinical Neurological Sciences, London Health Sciences Centre, Western University, London, ON, Canada
| | - Jeff Holmes
- School of Occupational Therapy, Faculty of Health Sciences, Western University, London, ON, Canada
| | - Robert J Petrella
- Graduate Program in Health and Rehabilitation Sciences, Faculty of Health Sciences, Western University, London, ON, Canada.,Lawson Health Research Institute, London, ON, Canada.,School of Kinesiology, Faculty of Health Sciences, Western University, London, ON, Canada.,Centre for Studies in Family Medicine, Department of Family Medicine, Schulich School of Medicine and Dentistry, Western University, London, ON, Canada
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117
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Cooper LL, Himali JJ, Torjesen A, Tsao CW, Beiser A, Hamburg NM, DeCarli C, Vasan RS, Seshadri S, Pase MP, Mitchell GF. Inter-Relations of Orthostatic Blood Pressure Change, Aortic Stiffness, and Brain Structure and Function in Young Adults. J Am Heart Assoc 2017; 6:JAHA.117.006206. [PMID: 28862943 PMCID: PMC5586458 DOI: 10.1161/jaha.117.006206] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
BACKGROUND Relations of orthostatic change in blood pressure with brain structure and function have not been studied thoroughly, particularly in younger, healthier individuals. Elucidation of factors that contribute to early changes in brain integrity may lead to development of interventions that delay or prevent cognitive impairment. METHODS AND RESULTS In a sample of the Framingham Heart Study Third Generation (N=2119; 53% women; mean age±SD, 47±8 years), we assessed orthostatic change in mean arterial pressure (MAP), aortic stiffness (carotid-femoral pulse wave velocity), neuropsychological function, and markers of subclinical brain injury on magnetic resonance imaging. Multivariable regression analyses were used to assess relations between orthostatic change in MAP and brain structural and neuropsychological outcomes. Greater orthostatic increase in MAP on standing was related to better Trails B-A performance among participants aged <49 years (β±SE, 0.062±0.029; P=0.031) and among participants with carotid-femoral pulse wave velocity <6.9 m/s (β±SE, 0.063±0.026; P=0.016). This relation was not significant among participants who were older or had stiffer aortas. Conversely, greater orthostatic increase in MAP was related to larger total brain volume among older participants (β±SE, 0.065±0.029; P=0.023) and among participants with carotid-femoral pulse wave velocity ≥6.9 m/s (β±SE, 0.078±0.031; P=0.011). CONCLUSIONS Blunted orthostatic increase in MAP was associated with smaller brain volume among participants who were older or had stiffer aortas and with poorer executive function among persons who were younger or who had more-elastic aortas. Our findings suggest that the brain is sensitive to orthostatic change in MAP, with results dependent on age and aortic stiffness.
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Affiliation(s)
| | - Jayandra J Himali
- Boston University and NHLBI's Framingham Study, Framingham, MA.,Department of Biostatistics, Boston University School of Public Health, Boston, MA.,Department of Neurology, Boston University School of Medicine, Boston, MA
| | | | - Connie W Tsao
- Cardiovascular Division, Beth Israel Deaconess Medical Center and Harvard Medical School, Boston, MA
| | - Alexa Beiser
- Boston University and NHLBI's Framingham Study, Framingham, MA.,Department of Biostatistics, Boston University School of Public Health, Boston, MA.,Department of Neurology, Boston University School of Medicine, Boston, MA
| | - Naomi M Hamburg
- Evans Department of Medicine, Boston University School of Medicine, Boston, MA.,Whitaker Cardiovascular Institute, Boston University School of Medicine, Boston, MA
| | | | - Ramachandran S Vasan
- Boston University and NHLBI's Framingham Study, Framingham, MA.,Evans Department of Medicine, Boston University School of Medicine, Boston, MA.,Whitaker Cardiovascular Institute, Boston University School of Medicine, Boston, MA.,Cardiology and Preventive Medicine Sections, Department of Medicine, Boston University School of Medicine, Boston, MA.,Department of Epidemiology, Boston University School of Public Health, Hawthorn, Australia
| | - Sudha Seshadri
- Department of Neurology, Boston University School of Medicine, Boston, MA
| | - Matthew P Pase
- Boston University and NHLBI's Framingham Study, Framingham, MA.,Department of Neurology, Boston University School of Medicine, Boston, MA.,Centre for Human Psychopharmacology, Swinburne University of Technology, Hawthorn, Australia
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118
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Torjesen A, Cooper LL, Rong J, Larson MG, Hamburg NM, Levy D, Benjamin EJ, Vasan RS, Mitchell GF. Relations of Arterial Stiffness With Postural Change in Mean Arterial Pressure in Middle-Aged Adults: The Framingham Heart Study. Hypertension 2017; 69:685-690. [PMID: 28264924 DOI: 10.1161/hypertensionaha.116.08116] [Citation(s) in RCA: 21] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/04/2016] [Revised: 07/20/2016] [Accepted: 01/29/2017] [Indexed: 11/16/2022]
Abstract
Impaired regulation of blood pressure on standing can lead to adverse outcomes, including falls, syncope, and disorientation. Mean arterial pressure (MAP) typically increases on standing; however, an insufficient increase or a decline in MAP on standing may result in decreased cerebral perfusion. Orthostatic hypotension has been reported in older people with increased arterial stiffness, whereas the association between orthostatic change in MAP and arterial stiffness in young- to middle-aged individuals has not been examined. We analyzed orthostatic blood pressure response and comprehensive hemodynamic data in 3205 participants (1693 [53%] women) in the Framingham Heart Study Third Generation cohort. Participants were predominantly middle aged (mean age: 46±9 years). Arterial stiffness was assessed using carotid-femoral pulse wave velocity, forward pressure wave amplitude, and characteristic impedance of the aorta. Adjusting for standard cardiovascular disease risk factors, orthostatic change in MAP (6.9±7.7 mm Hg) was inversely associated with carotid-femoral pulse wave velocity (partial correlation, rp=-0.084; P<0.0001), forward wave amplitude (rp=-0.129; P<0.0001), and characteristic impedance (rp=-0.094; P<0.0001). The negative relation between forward wave amplitude and change in MAP on standing was accentuated in women (P=0.002 for sex interaction). Thus, higher aortic stiffness was associated with a blunted orthostatic increase in MAP, even in middle age. The clinical implications of these findings warrant further study.
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Affiliation(s)
- Alyssa Torjesen
- From the Cardiovascular Engineering, Inc, Norwood, MA (A.T., L.L.C., G.F.M.); Cardiovascular Research Center, Rhode Island Hospital, W. Alpert Medical School of Brown University, Providence (L.L.C.); National Heart, Lung, and Blood Institute's and Boston University's Framingham Heart Study, Framingham, MA (J.R., M.G.L., D.L., E.J.B., R.S.V.); Department of Biostatistics, Boston University School of Public Health, MA (M.G.L.); Evans Department of Medicine (N.M.H., E.J.B., R.S.V.), Whitaker Cardiovascular Institute (N.M.H., E.J.B., R.S.V.), and Preventive Medicine and Cardiology Sections (E.J.B., R.S.V.), Boston University School of Medicine, MA; and National Heart, Lung, and Blood Institute, Bethesda, MD (D.L.)
| | - Leroy L Cooper
- From the Cardiovascular Engineering, Inc, Norwood, MA (A.T., L.L.C., G.F.M.); Cardiovascular Research Center, Rhode Island Hospital, W. Alpert Medical School of Brown University, Providence (L.L.C.); National Heart, Lung, and Blood Institute's and Boston University's Framingham Heart Study, Framingham, MA (J.R., M.G.L., D.L., E.J.B., R.S.V.); Department of Biostatistics, Boston University School of Public Health, MA (M.G.L.); Evans Department of Medicine (N.M.H., E.J.B., R.S.V.), Whitaker Cardiovascular Institute (N.M.H., E.J.B., R.S.V.), and Preventive Medicine and Cardiology Sections (E.J.B., R.S.V.), Boston University School of Medicine, MA; and National Heart, Lung, and Blood Institute, Bethesda, MD (D.L.)
| | - Jian Rong
- From the Cardiovascular Engineering, Inc, Norwood, MA (A.T., L.L.C., G.F.M.); Cardiovascular Research Center, Rhode Island Hospital, W. Alpert Medical School of Brown University, Providence (L.L.C.); National Heart, Lung, and Blood Institute's and Boston University's Framingham Heart Study, Framingham, MA (J.R., M.G.L., D.L., E.J.B., R.S.V.); Department of Biostatistics, Boston University School of Public Health, MA (M.G.L.); Evans Department of Medicine (N.M.H., E.J.B., R.S.V.), Whitaker Cardiovascular Institute (N.M.H., E.J.B., R.S.V.), and Preventive Medicine and Cardiology Sections (E.J.B., R.S.V.), Boston University School of Medicine, MA; and National Heart, Lung, and Blood Institute, Bethesda, MD (D.L.)
| | - Martin G Larson
- From the Cardiovascular Engineering, Inc, Norwood, MA (A.T., L.L.C., G.F.M.); Cardiovascular Research Center, Rhode Island Hospital, W. Alpert Medical School of Brown University, Providence (L.L.C.); National Heart, Lung, and Blood Institute's and Boston University's Framingham Heart Study, Framingham, MA (J.R., M.G.L., D.L., E.J.B., R.S.V.); Department of Biostatistics, Boston University School of Public Health, MA (M.G.L.); Evans Department of Medicine (N.M.H., E.J.B., R.S.V.), Whitaker Cardiovascular Institute (N.M.H., E.J.B., R.S.V.), and Preventive Medicine and Cardiology Sections (E.J.B., R.S.V.), Boston University School of Medicine, MA; and National Heart, Lung, and Blood Institute, Bethesda, MD (D.L.)
| | - Naomi M Hamburg
- From the Cardiovascular Engineering, Inc, Norwood, MA (A.T., L.L.C., G.F.M.); Cardiovascular Research Center, Rhode Island Hospital, W. Alpert Medical School of Brown University, Providence (L.L.C.); National Heart, Lung, and Blood Institute's and Boston University's Framingham Heart Study, Framingham, MA (J.R., M.G.L., D.L., E.J.B., R.S.V.); Department of Biostatistics, Boston University School of Public Health, MA (M.G.L.); Evans Department of Medicine (N.M.H., E.J.B., R.S.V.), Whitaker Cardiovascular Institute (N.M.H., E.J.B., R.S.V.), and Preventive Medicine and Cardiology Sections (E.J.B., R.S.V.), Boston University School of Medicine, MA; and National Heart, Lung, and Blood Institute, Bethesda, MD (D.L.)
| | - Daniel Levy
- From the Cardiovascular Engineering, Inc, Norwood, MA (A.T., L.L.C., G.F.M.); Cardiovascular Research Center, Rhode Island Hospital, W. Alpert Medical School of Brown University, Providence (L.L.C.); National Heart, Lung, and Blood Institute's and Boston University's Framingham Heart Study, Framingham, MA (J.R., M.G.L., D.L., E.J.B., R.S.V.); Department of Biostatistics, Boston University School of Public Health, MA (M.G.L.); Evans Department of Medicine (N.M.H., E.J.B., R.S.V.), Whitaker Cardiovascular Institute (N.M.H., E.J.B., R.S.V.), and Preventive Medicine and Cardiology Sections (E.J.B., R.S.V.), Boston University School of Medicine, MA; and National Heart, Lung, and Blood Institute, Bethesda, MD (D.L.)
| | - Emelia J Benjamin
- From the Cardiovascular Engineering, Inc, Norwood, MA (A.T., L.L.C., G.F.M.); Cardiovascular Research Center, Rhode Island Hospital, W. Alpert Medical School of Brown University, Providence (L.L.C.); National Heart, Lung, and Blood Institute's and Boston University's Framingham Heart Study, Framingham, MA (J.R., M.G.L., D.L., E.J.B., R.S.V.); Department of Biostatistics, Boston University School of Public Health, MA (M.G.L.); Evans Department of Medicine (N.M.H., E.J.B., R.S.V.), Whitaker Cardiovascular Institute (N.M.H., E.J.B., R.S.V.), and Preventive Medicine and Cardiology Sections (E.J.B., R.S.V.), Boston University School of Medicine, MA; and National Heart, Lung, and Blood Institute, Bethesda, MD (D.L.)
| | - Ramachandran S Vasan
- From the Cardiovascular Engineering, Inc, Norwood, MA (A.T., L.L.C., G.F.M.); Cardiovascular Research Center, Rhode Island Hospital, W. Alpert Medical School of Brown University, Providence (L.L.C.); National Heart, Lung, and Blood Institute's and Boston University's Framingham Heart Study, Framingham, MA (J.R., M.G.L., D.L., E.J.B., R.S.V.); Department of Biostatistics, Boston University School of Public Health, MA (M.G.L.); Evans Department of Medicine (N.M.H., E.J.B., R.S.V.), Whitaker Cardiovascular Institute (N.M.H., E.J.B., R.S.V.), and Preventive Medicine and Cardiology Sections (E.J.B., R.S.V.), Boston University School of Medicine, MA; and National Heart, Lung, and Blood Institute, Bethesda, MD (D.L.)
| | - Gary F Mitchell
- From the Cardiovascular Engineering, Inc, Norwood, MA (A.T., L.L.C., G.F.M.); Cardiovascular Research Center, Rhode Island Hospital, W. Alpert Medical School of Brown University, Providence (L.L.C.); National Heart, Lung, and Blood Institute's and Boston University's Framingham Heart Study, Framingham, MA (J.R., M.G.L., D.L., E.J.B., R.S.V.); Department of Biostatistics, Boston University School of Public Health, MA (M.G.L.); Evans Department of Medicine (N.M.H., E.J.B., R.S.V.), Whitaker Cardiovascular Institute (N.M.H., E.J.B., R.S.V.), and Preventive Medicine and Cardiology Sections (E.J.B., R.S.V.), Boston University School of Medicine, MA; and National Heart, Lung, and Blood Institute, Bethesda, MD (D.L.).
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119
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Johnson NF, Gold BT, Brown CA, Anggelis EF, Bailey AL, Clasey JL, Powell DK. Endothelial Function Is Associated with White Matter Microstructure and Executive Function in Older Adults. Front Aging Neurosci 2017; 9:255. [PMID: 28824417 PMCID: PMC5539079 DOI: 10.3389/fnagi.2017.00255] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/25/2017] [Accepted: 07/17/2017] [Indexed: 11/13/2022] Open
Abstract
Age-related declines in endothelial function can lead to cognitive decline. However, little is known about the relationships between endothelial function and specific neurocognitive functions. This study explored the relationship between measures of endothelial function (reactive hyperemia index; RHI), white matter (WM) health (fractional anisotropy, FA, and WM hyperintensity volume, WMH), and executive function (Trail Making Test (TMT); Trail B - Trail A). Participants were 36 older adults between the ages of 59 and 69 (mean age = 63.89 years, SD = 2.94). WMH volume showed no relationship with RHI or executive function. However, there was a positive relationship between RHI and FA in the genu and body of the corpus callosum. In addition, higher RHI and FA were each associated with better executive task performance. Tractography was used to localize the WM tracts associated with RHI to specific portions of cortex. Results indicated that the RHI-FA relationship observed in the corpus callosum primarily involved tracts interconnecting frontal regions, including the superior frontal gyrus (SFG) and frontopolar cortex, linked with executive function. These findings suggest that superior endothelial function may help to attenuate age-related declines in WM microstructure in portions of the corpus callosum that interconnect prefrontal brain regions involved in executive function.
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Affiliation(s)
- Nathan F. Johnson
- Department of Rehabilitation Sciences, Division of Physical Therapy, University of KentuckyLexington, KY, United States
| | - Brian T. Gold
- Department of Neuroscience, University of KentuckyLexington, KY, United States
- Magnetic Resonance Imaging and Spectroscopy Center, University of KentuckyLexington, KY, United States
- Sanders-Brown Center on Aging, University of KentuckyLexington, KY, United States
| | | | - Emily F. Anggelis
- Department of Neuroscience, University of KentuckyLexington, KY, United States
| | - Alison L. Bailey
- Department of Medicine, University of Tennessee College of Medicine ChattanoogaChattanooga, TN, United States
| | - Jody L. Clasey
- Department of Kinesiology and Health Promotion, University of KentuckyLexington, KY, United States
- Clinical Services Core, University of KentuckyLexington, KY, United States
| | - David K. Powell
- Magnetic Resonance Imaging and Spectroscopy Center, University of KentuckyLexington, KY, United States
- Sanders-Brown Center on Aging, University of KentuckyLexington, KY, United States
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120
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Xu X, Wang B, Ren C, Hu J, Greenberg DA, Chen T, Xie L, Jin K. Recent Progress in Vascular Aging: Mechanisms and Its Role in Age-related Diseases. Aging Dis 2017; 8:486-505. [PMID: 28840062 PMCID: PMC5524810 DOI: 10.14336/ad.2017.0507] [Citation(s) in RCA: 46] [Impact Index Per Article: 6.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/07/2016] [Accepted: 05/07/2017] [Indexed: 01/13/2023] Open
Abstract
As with many age-related diseases including vascular dysfunction, age is considered an independent and crucial risk factor. Complicated alterations of structure and function in the vasculature are linked with aging hence, understanding the underlying mechanisms of age-induced vascular pathophysiological changes holds possibilities for developing clinical diagnostic methods and new therapeutic strategies. Here, we discuss the underlying molecular mediators that could be involved in vascular aging, e.g., the renin-angiotensin system and pro-inflammatory factors, metalloproteinases, calpain-1, monocyte chemoattractant protein-1 (MCP-1) and TGFβ-1 as well as the potential roles of testosterone and estrogen. We then relate all of these to clinical manifestations such as vascular dementia and stroke in addition to reviewing the existing clinical measurements and potential interventions for age-related vascular dysfunction.
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Affiliation(s)
- Xianglai Xu
- 1Zhongshan Hospital, Fudan University, Shanghai 200032, China.,2Department of Pharmacology and Neuroscience, University of North Texas Health Science Center at Fort Worth, TX 76107, USA
| | - Brian Wang
- 2Department of Pharmacology and Neuroscience, University of North Texas Health Science Center at Fort Worth, TX 76107, USA
| | - Changhong Ren
- 2Department of Pharmacology and Neuroscience, University of North Texas Health Science Center at Fort Worth, TX 76107, USA.,4Institute of Hypoxia Medicine, Xuanwu Hospital, Capital Medical University. Beijing, China
| | - Jiangnan Hu
- 2Department of Pharmacology and Neuroscience, University of North Texas Health Science Center at Fort Worth, TX 76107, USA
| | | | - Tianxiang Chen
- 6Department of Thoracic Surgery, Shanghai Chest Hospital, Shanghai Jiaotong University, Shanghai, China
| | - Liping Xie
- 3Department of Urology, the First Affiliated Hospital, Zhejiang University, Zhejiang Province, China
| | - Kunlin Jin
- 2Department of Pharmacology and Neuroscience, University of North Texas Health Science Center at Fort Worth, TX 76107, USA
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121
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Yeung SE, Loken Thornton W. "Do it-yourself": Home blood pressure as a predictor of traditional and everyday cognition in older adults. PLoS One 2017; 12:e0177424. [PMID: 28520751 PMCID: PMC5435167 DOI: 10.1371/journal.pone.0177424] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/24/2017] [Accepted: 04/27/2017] [Indexed: 01/03/2023] Open
Abstract
BACKGROUND Hypertension guidelines recommend home blood pressure (HBP) monitoring in adjunct to office blood pressure (OBP) for its greater reproducibility and prognostic utility in the prevention of cardiovascular outcomes, especially stroke. To date, the relationship between HBP and cognitive function remains unexplored. METHODS We examined HBP as a cognitive predictor in a multi-ethnic group of community-dwelling adults aged 60 and over (N = 133) using neuropsychological measures and analyzed the data using multiple regression analyses. We also employed "everyday cognition" measures that have been found to have higher prognostic utility for real-world functioning than traditional cognitive tasks. RESULTS Good to perfect HBP monitoring compliance over seven days was achieved by 88.7% of the participants with superior reliability (ICC≥.96) to office readings. Higher home systolic BP and pulse pressure predicted worse processing speed, executive function, and everyday cognitive function, whereas lower home diastolic BP predicted worse everyday cognition. Office readings were similarly associated with everyday cognitive function but with no other cognitive measures. CONCLUSION Our findings are the first to validate HBP as a predictor of neuropsychological function in older adults beyond cognitive screening. Differential relationships among blood pressure variables and specific cognitive domains were observed. With proper standardization and training, we demonstrated that HBP can be obtained in a multi-ethnic community-dwelling older adult cohort. Our findings emphasize the importance of employing blood pressure and cognitive measures that are adequately sensitive to detect vascular-related cognitive impairment in a relatively healthy population. Implications regarding proper HBP measurement for hypertension management, cognitive health, and everyday function are discussed.
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Affiliation(s)
- Sophie E Yeung
- Department of Psychology, Simon Fraser University, Burnaby, British Columbia, Canada
| | - Wendy Loken Thornton
- Department of Psychology, Simon Fraser University, Burnaby, British Columbia, Canada
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122
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Ryu DW, Kim JS, Lee JE, Park JW, Oh YS, An JY, Lee KS. Association of arterial stiffness with cognition in patients with Lewy body disorder. Neurol Sci 2017; 38:1307-1313. [PMID: 28474150 DOI: 10.1007/s10072-017-2977-7] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/07/2017] [Accepted: 04/19/2017] [Indexed: 12/26/2022]
Abstract
The brachial-ankle pulse wave velocity (baPWV) is a marker for arterial stiffness, which is associated with cardiovascular diseases. Arterial stiffness is associated with cognitive function in the elderly and patients with Alzheimer's disease (AD). We aimed to investigate the association between arterial stiffness and cognitive function in patients with Lewy body disorder (LBD), including Parkinson's disease (PD) and dementia with Lewy bodies (DLB). We consecutively included 123 patients with PD, 10 patients with DLB, and 27 AD controls. Patients with PD were divided into three groups of normal cognition (PD-NC, n = 63), mild cognitive impairment (PD-MCI, n = 43), and dementia (PD-D, n = 17). Arterial stiffness, measured as baPWV, was compared between the PD-NC, PD-MCI, PD-D, DLB, and AD patients. In LBD, we analyzed the association between arterial stiffness and each cognitive domain with adjustment for covariates. Higher baPWV was significantly associated with cognitive decline in patients with LBD (baPWV in PD-D > PD-MCI > PD-NC; DLB > PD-NC). There was no significant difference in baPWV between PD-D, DLB, and AD patients. In LBD patients, higher baPWV was associated with lower mini mental state examination score (β ± SE = -0.003 ± 0.001, p = 0.007) and more severe dementia. Higher baPWV was also associated with lower performance in attention, language, visuospatial function, memory, and executive function in LBD patients. This suggests that vascular brain injury is associated with cognitive dysfunction in LBD.
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Affiliation(s)
- Dong-Woo Ryu
- Department of Neurology, College of Medicine, Seoul St. Mary's Hospital, The Catholic University of Korea, 222, Banpo-daero, Seocho-gu, Seoul, 06591, Republic of Korea
| | - Joong-Seok Kim
- Department of Neurology, College of Medicine, Seoul St. Mary's Hospital, The Catholic University of Korea, 222, Banpo-daero, Seocho-gu, Seoul, 06591, Republic of Korea.
| | - Jee-Eun Lee
- Department of Neurology, College of Medicine, Seoul St. Mary's Hospital, The Catholic University of Korea, 222, Banpo-daero, Seocho-gu, Seoul, 06591, Republic of Korea
| | - Jeong-Wook Park
- Department of Neurology, College of Medicine, Seoul St. Mary's Hospital, The Catholic University of Korea, 222, Banpo-daero, Seocho-gu, Seoul, 06591, Republic of Korea
| | - Yoon-Sang Oh
- Department of Neurology, College of Medicine, Seoul St. Mary's Hospital, The Catholic University of Korea, 222, Banpo-daero, Seocho-gu, Seoul, 06591, Republic of Korea
| | - Jae-Young An
- Department of Neurology, College of Medicine, Seoul St. Mary's Hospital, The Catholic University of Korea, 222, Banpo-daero, Seocho-gu, Seoul, 06591, Republic of Korea
| | - Kwang-Soo Lee
- Department of Neurology, College of Medicine, Seoul St. Mary's Hospital, The Catholic University of Korea, 222, Banpo-daero, Seocho-gu, Seoul, 06591, Republic of Korea.
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Maillard P, Mitchell GF, Himali JJ, Beiser A, Fletcher E, Tsao CW, Pase MP, Satizabal CL, Vasan RS, Seshadri S, DeCarli C. Aortic Stiffness, Increased White Matter Free Water, and Altered Microstructural Integrity: A Continuum of Injury. Stroke 2017; 48:1567-1573. [PMID: 28473633 DOI: 10.1161/strokeaha.116.016321] [Citation(s) in RCA: 89] [Impact Index Per Article: 12.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/06/2016] [Revised: 03/20/2017] [Accepted: 03/29/2017] [Indexed: 12/17/2022]
Abstract
BACKGROUND AND PURPOSE Previous reports from the Framingham Heart Study have identified cross-sectional associations of arterial stiffness, as reflected by carotid-femoral pulse wave velocity (CFPWV) and systolic blood pressure with vascular brain injury. The purpose of this study is to examine free water (FW), fractional anisotropy (FA), and white matter hyperintensities (WMH) in relation to arterial stiffness among subjects of the Framingham Offspring and Third-Generation cohorts. METHODS In 2422 participants aged 51.3±11.6 years, FA, FW, and WMH were related to CFPWV using voxel-based linear and generalized linear regressions, adjusting for relevant covariables. Mean FW, mean FA, and WMH burden (log transformed) were computed within white matter (WM) region and related to systolic blood pressure and CFPWV using multiple mediation analyses. RESULTS CFPWV was found to be associated with higher FW, lower FA, and higher WMH incidence in WM areas covering, respectively, 356.1, 211.8, and 10.9 mL of the WM mask. Mediation analyses revealed that the effect of systolic blood pressure on FW was mediated by CFPWV (direct and indirect effects: a=0.040; P<0.001, and a'=0.020; P>0.05). Moreover, the effect of CFPWV on FA was mediated by FW (direct and indirect effects: b=-0.092; P<0.001, and b'=0.012; P>0.05), whose effect on WMH was, in turn, mediated by FA (direct and indirect effects: c=0.246; P<0.001, and c'=0.116; P>0.05). CONCLUSIONS From these data, we propose a biomechanical hypothesis designed for future research experiments to explain how hemodynamic alteration may lead to WM injury by impacting cerebral water content and more subtly WM integrity, to finally lead to WMH development.
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Affiliation(s)
- Pauline Maillard
- From the Imaging of Dementia and Aging (IDeA) Laboratory, Davis, CA (P.M., E.F., C.D.); Department of Neurology and Center for Neurosciences, University of California, Davis (P.M., E.F., C.D.); Cardiovascular Engineering, Inc, Norwood, MA (G.F.M.); The Framingham Heart Study, MA (J.J.H., A.B., M.P.P., C.L.S., S.S.); Department of Neurology (J.J.H., A.B., M.P.P., C.L.S., S.S.) and Department of Medicine (R.S.V.), Boston University School of Medicine, MA; Department of Biostatistics, Boston University School of Public Health, MA (J.J.H., A.B.); Cardiovascular Division, Beth Israel Deaconess Medical Center and Harvard Medical School, Boston, MA (C.W.T.); and Centre for Human Psychopharmacology, Swinburne University of Technology, Hawthorn, Australia (M.P.P.).
| | - Gary F Mitchell
- From the Imaging of Dementia and Aging (IDeA) Laboratory, Davis, CA (P.M., E.F., C.D.); Department of Neurology and Center for Neurosciences, University of California, Davis (P.M., E.F., C.D.); Cardiovascular Engineering, Inc, Norwood, MA (G.F.M.); The Framingham Heart Study, MA (J.J.H., A.B., M.P.P., C.L.S., S.S.); Department of Neurology (J.J.H., A.B., M.P.P., C.L.S., S.S.) and Department of Medicine (R.S.V.), Boston University School of Medicine, MA; Department of Biostatistics, Boston University School of Public Health, MA (J.J.H., A.B.); Cardiovascular Division, Beth Israel Deaconess Medical Center and Harvard Medical School, Boston, MA (C.W.T.); and Centre for Human Psychopharmacology, Swinburne University of Technology, Hawthorn, Australia (M.P.P.)
| | - Jayandra J Himali
- From the Imaging of Dementia and Aging (IDeA) Laboratory, Davis, CA (P.M., E.F., C.D.); Department of Neurology and Center for Neurosciences, University of California, Davis (P.M., E.F., C.D.); Cardiovascular Engineering, Inc, Norwood, MA (G.F.M.); The Framingham Heart Study, MA (J.J.H., A.B., M.P.P., C.L.S., S.S.); Department of Neurology (J.J.H., A.B., M.P.P., C.L.S., S.S.) and Department of Medicine (R.S.V.), Boston University School of Medicine, MA; Department of Biostatistics, Boston University School of Public Health, MA (J.J.H., A.B.); Cardiovascular Division, Beth Israel Deaconess Medical Center and Harvard Medical School, Boston, MA (C.W.T.); and Centre for Human Psychopharmacology, Swinburne University of Technology, Hawthorn, Australia (M.P.P.)
| | - Alexa Beiser
- From the Imaging of Dementia and Aging (IDeA) Laboratory, Davis, CA (P.M., E.F., C.D.); Department of Neurology and Center for Neurosciences, University of California, Davis (P.M., E.F., C.D.); Cardiovascular Engineering, Inc, Norwood, MA (G.F.M.); The Framingham Heart Study, MA (J.J.H., A.B., M.P.P., C.L.S., S.S.); Department of Neurology (J.J.H., A.B., M.P.P., C.L.S., S.S.) and Department of Medicine (R.S.V.), Boston University School of Medicine, MA; Department of Biostatistics, Boston University School of Public Health, MA (J.J.H., A.B.); Cardiovascular Division, Beth Israel Deaconess Medical Center and Harvard Medical School, Boston, MA (C.W.T.); and Centre for Human Psychopharmacology, Swinburne University of Technology, Hawthorn, Australia (M.P.P.)
| | - Evan Fletcher
- From the Imaging of Dementia and Aging (IDeA) Laboratory, Davis, CA (P.M., E.F., C.D.); Department of Neurology and Center for Neurosciences, University of California, Davis (P.M., E.F., C.D.); Cardiovascular Engineering, Inc, Norwood, MA (G.F.M.); The Framingham Heart Study, MA (J.J.H., A.B., M.P.P., C.L.S., S.S.); Department of Neurology (J.J.H., A.B., M.P.P., C.L.S., S.S.) and Department of Medicine (R.S.V.), Boston University School of Medicine, MA; Department of Biostatistics, Boston University School of Public Health, MA (J.J.H., A.B.); Cardiovascular Division, Beth Israel Deaconess Medical Center and Harvard Medical School, Boston, MA (C.W.T.); and Centre for Human Psychopharmacology, Swinburne University of Technology, Hawthorn, Australia (M.P.P.)
| | - Connie W Tsao
- From the Imaging of Dementia and Aging (IDeA) Laboratory, Davis, CA (P.M., E.F., C.D.); Department of Neurology and Center for Neurosciences, University of California, Davis (P.M., E.F., C.D.); Cardiovascular Engineering, Inc, Norwood, MA (G.F.M.); The Framingham Heart Study, MA (J.J.H., A.B., M.P.P., C.L.S., S.S.); Department of Neurology (J.J.H., A.B., M.P.P., C.L.S., S.S.) and Department of Medicine (R.S.V.), Boston University School of Medicine, MA; Department of Biostatistics, Boston University School of Public Health, MA (J.J.H., A.B.); Cardiovascular Division, Beth Israel Deaconess Medical Center and Harvard Medical School, Boston, MA (C.W.T.); and Centre for Human Psychopharmacology, Swinburne University of Technology, Hawthorn, Australia (M.P.P.)
| | - Matthew P Pase
- From the Imaging of Dementia and Aging (IDeA) Laboratory, Davis, CA (P.M., E.F., C.D.); Department of Neurology and Center for Neurosciences, University of California, Davis (P.M., E.F., C.D.); Cardiovascular Engineering, Inc, Norwood, MA (G.F.M.); The Framingham Heart Study, MA (J.J.H., A.B., M.P.P., C.L.S., S.S.); Department of Neurology (J.J.H., A.B., M.P.P., C.L.S., S.S.) and Department of Medicine (R.S.V.), Boston University School of Medicine, MA; Department of Biostatistics, Boston University School of Public Health, MA (J.J.H., A.B.); Cardiovascular Division, Beth Israel Deaconess Medical Center and Harvard Medical School, Boston, MA (C.W.T.); and Centre for Human Psychopharmacology, Swinburne University of Technology, Hawthorn, Australia (M.P.P.)
| | - Claudia L Satizabal
- From the Imaging of Dementia and Aging (IDeA) Laboratory, Davis, CA (P.M., E.F., C.D.); Department of Neurology and Center for Neurosciences, University of California, Davis (P.M., E.F., C.D.); Cardiovascular Engineering, Inc, Norwood, MA (G.F.M.); The Framingham Heart Study, MA (J.J.H., A.B., M.P.P., C.L.S., S.S.); Department of Neurology (J.J.H., A.B., M.P.P., C.L.S., S.S.) and Department of Medicine (R.S.V.), Boston University School of Medicine, MA; Department of Biostatistics, Boston University School of Public Health, MA (J.J.H., A.B.); Cardiovascular Division, Beth Israel Deaconess Medical Center and Harvard Medical School, Boston, MA (C.W.T.); and Centre for Human Psychopharmacology, Swinburne University of Technology, Hawthorn, Australia (M.P.P.)
| | - Ramachandran S Vasan
- From the Imaging of Dementia and Aging (IDeA) Laboratory, Davis, CA (P.M., E.F., C.D.); Department of Neurology and Center for Neurosciences, University of California, Davis (P.M., E.F., C.D.); Cardiovascular Engineering, Inc, Norwood, MA (G.F.M.); The Framingham Heart Study, MA (J.J.H., A.B., M.P.P., C.L.S., S.S.); Department of Neurology (J.J.H., A.B., M.P.P., C.L.S., S.S.) and Department of Medicine (R.S.V.), Boston University School of Medicine, MA; Department of Biostatistics, Boston University School of Public Health, MA (J.J.H., A.B.); Cardiovascular Division, Beth Israel Deaconess Medical Center and Harvard Medical School, Boston, MA (C.W.T.); and Centre for Human Psychopharmacology, Swinburne University of Technology, Hawthorn, Australia (M.P.P.)
| | - Sudha Seshadri
- From the Imaging of Dementia and Aging (IDeA) Laboratory, Davis, CA (P.M., E.F., C.D.); Department of Neurology and Center for Neurosciences, University of California, Davis (P.M., E.F., C.D.); Cardiovascular Engineering, Inc, Norwood, MA (G.F.M.); The Framingham Heart Study, MA (J.J.H., A.B., M.P.P., C.L.S., S.S.); Department of Neurology (J.J.H., A.B., M.P.P., C.L.S., S.S.) and Department of Medicine (R.S.V.), Boston University School of Medicine, MA; Department of Biostatistics, Boston University School of Public Health, MA (J.J.H., A.B.); Cardiovascular Division, Beth Israel Deaconess Medical Center and Harvard Medical School, Boston, MA (C.W.T.); and Centre for Human Psychopharmacology, Swinburne University of Technology, Hawthorn, Australia (M.P.P.)
| | - Charles DeCarli
- From the Imaging of Dementia and Aging (IDeA) Laboratory, Davis, CA (P.M., E.F., C.D.); Department of Neurology and Center for Neurosciences, University of California, Davis (P.M., E.F., C.D.); Cardiovascular Engineering, Inc, Norwood, MA (G.F.M.); The Framingham Heart Study, MA (J.J.H., A.B., M.P.P., C.L.S., S.S.); Department of Neurology (J.J.H., A.B., M.P.P., C.L.S., S.S.) and Department of Medicine (R.S.V.), Boston University School of Medicine, MA; Department of Biostatistics, Boston University School of Public Health, MA (J.J.H., A.B.); Cardiovascular Division, Beth Israel Deaconess Medical Center and Harvard Medical School, Boston, MA (C.W.T.); and Centre for Human Psychopharmacology, Swinburne University of Technology, Hawthorn, Australia (M.P.P.)
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Tonacci A, Bruno RM, Ghiadoni L, Pratali L, Berardi N, Tognoni G, Cintoli S, Volpi L, Bonuccelli U, Sicari R, Taddei S, Maffei L, Picano E. Olfactory evaluation in Mild Cognitive Impairment: correlation with neurocognitive performance and endothelial function. Eur J Neurosci 2017; 45:1279-1288. [PMID: 28370677 DOI: 10.1111/ejn.13565] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/23/2016] [Revised: 03/15/2017] [Accepted: 03/15/2017] [Indexed: 01/05/2023]
Abstract
Mild Cognitive Impairment (MCI) is an intermediate condition between normal aging and dementia, associated with an increased risk of progression into the latter within months or years. Olfactory impairment, a well-known biomarker for neurodegeneration, might be present in the condition early, possibly representing a signal for future pathological onset. Our study aimed at evaluating olfactory function in MCI and healthy controls in relation to neurocognitive performance and endothelial function. A total of 85 individuals with MCI and 41 healthy controls, matched for age and gender, were recruited. Olfactory function was assessed by Sniffin' Sticks Extended Test (Burghart, Medizintechnik, GmbH, Wedel, Germany). A comprehensive neurocognitive assessment was performed. Endothelial function was assessed by flow-mediated dilation (FMD) of the brachial artery by ultrasound. MCI individuals showed an impaired olfactory function compared to controls. The overall olfactory score is able to predict MCI with a good sensitivity and specificity (70.3 and 77.4% respectively). In MCI, olfactory identification score is correlated with a number of neurocognitive abilities, including overall cognitive status, dementia rating, immediate and delayed memory, visuospatial ability and verbal fluency. FMD was reduced in MCI (2.90 ± 2.15 vs. 3.66 ± 1.96%, P = 0.016) and was positively associated with olfactory identification score (ρs =0.219, P = 0.025). The association remained significant after controlling for age, gender, and smoking. In conclusion, olfactory evaluation is able to discriminate between MCI and healthy individuals. Systemic vascular dysfunction might be involved, at least indirectly, in olfactory dysfunction in MCI.
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Affiliation(s)
- Alessandro Tonacci
- Clinical Physiology Institute - National Research Council (IFC-CNR), Via Moruzzi 1, 56124, Pisa, Italy
| | - Rosa M Bruno
- Clinical Physiology Institute - National Research Council (IFC-CNR), Via Moruzzi 1, 56124, Pisa, Italy.,Department of Clinical and Experimental Medicine, University of Pisa, Pisa, Italy
| | - Lorenzo Ghiadoni
- Department of Clinical and Experimental Medicine, University of Pisa, Pisa, Italy
| | - Lorenza Pratali
- Clinical Physiology Institute - National Research Council (IFC-CNR), Via Moruzzi 1, 56124, Pisa, Italy
| | - Nicoletta Berardi
- Neuroscience Institute, National Research Council (IN-CNR), Pisa, Italy.,Department of Neuroscience, Psychology, Drug Research and Child Health NEUROFARBA, University of Florence, Florence, Italy
| | - Gloria Tognoni
- Neurological Unit, Department of Clinical and Experimental Medicine, University of Pisa, Pisa, Italy
| | - Simona Cintoli
- Neurological Unit, Department of Clinical and Experimental Medicine, University of Pisa, Pisa, Italy
| | - Leda Volpi
- Neurological Unit, Department of Clinical and Experimental Medicine, University of Pisa, Pisa, Italy
| | - Ubaldo Bonuccelli
- Neurological Unit, Department of Clinical and Experimental Medicine, University of Pisa, Pisa, Italy
| | - Rosa Sicari
- Clinical Physiology Institute - National Research Council (IFC-CNR), Via Moruzzi 1, 56124, Pisa, Italy
| | - Stefano Taddei
- Department of Clinical and Experimental Medicine, University of Pisa, Pisa, Italy
| | - Lamberto Maffei
- Neuroscience Institute, National Research Council (IN-CNR), Pisa, Italy.,Laboratory of Neurobiology, Scuola Normale Superiore, Pisa, Italy
| | - Eugenio Picano
- Clinical Physiology Institute - National Research Council (IFC-CNR), Via Moruzzi 1, 56124, Pisa, Italy
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125
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Aortic hemodynamics and white matter hyperintensities in normotensive postmenopausal women. J Neurol 2017; 264:938-945. [PMID: 28389742 PMCID: PMC5413519 DOI: 10.1007/s00415-017-8476-1] [Citation(s) in RCA: 21] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/31/2017] [Revised: 03/13/2017] [Accepted: 03/27/2017] [Indexed: 12/02/2022]
Abstract
Hypertension is associated with development of white matter hyperintensities (WMH) in the brain, which are risk factors for mild cognitive impairment. Hormonal shifts at menopause alter vascular function putting women at risk for both hypertension and WMH. Elevations in aortic hemodynamics precede the appearance of clinically defined hypertension but the relationship of aortic hemodynamics to development of WMH in women is not known. Therefore, this study aimed to characterize aortic hemodynamics in relationship to WMH in postmenopausal women. Aortic systolic and diastolic blood pressure (BP), aortic augmentation index (Alx) and aortic round trip travel time (Aortic TR) by tonometry were examined in 53 postmenopausal women (age 60 ± 2 years). WMH was calculated from fluid-attenuated inversion recovery MRI using a semi-automated segmentation algorithm. WMH as a fraction of total white matter volume positively associated with aortic systolic BP (regression coefficient = 0.018; p = 0.04) after adjusting for age. In addition, WMH fraction was positively associated with AIx (0.025; p = 0.04), and inversely associated with Aortic TR (−0.015; p = 0.04) after adjusting for age. Our results suggest that assessing aortic hemodynamics may identify individuals at risk for accelerated development of WMH and guide early treatment to reduce WMH burden and cognitive impairment in the future.
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126
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Midlife level and 15-year changes in general cognitive ability in a sample of men: The role of education, early adult ability, BMI, and pulse pressure. INTELLIGENCE 2017. [DOI: 10.1016/j.intell.2017.01.007] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
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127
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Raignault A, Bolduc V, Lesage F, Thorin E. Pulse pressure-dependent cerebrovascular eNOS regulation in mice. J Cereb Blood Flow Metab 2017; 37:413-424. [PMID: 26823473 PMCID: PMC5381440 DOI: 10.1177/0271678x16629155] [Citation(s) in RCA: 31] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
Arterial blood pressure is oscillatory; whether pulse pressure (PP) regulates cerebral artery myogenic tone (MT) and endothelial function is currently unknown. To test the impact of PP on MT and dilation to flow (FMD) or to acetylcholine (Ach), isolated pressurized mouse posterior cerebral arteries were subjected to either static pressure (SP) or a physiological PP (amplitude: 30 mm Hg; frequency: 550 bpm). Under PP, MT was significantly higher than in SP conditions ( p < 0.05) and was not affected by eNOS inhibition. In contrast, under SP, eNOS inhibition increased ( p < 0.05) MT to levels observed under PP, suggesting that PP may inhibit eNOS. At a shear stress of 20 dyn/cm2, FMD was lower ( p < 0.05) under SP than PP. Under SP, eNOS-dependent [Formula: see text] production contributed to FMD, while under PP, eNOS-dependent NO was responsible for FMD, indicating that PP favours eNOS coupling. Differences in FMD between pressure conditions were abolished after NOX2 inhibition. In contrast to FMD, Ach-induced dilations were higher ( p < 0.05) under SP than PP. Reactive oxygen species scavenging reduced ( p < 0.05) Ach-dependent dilations under SP, but increased ( p < 0.05) them under PP; hence, under PP, Ach promotes ROS production and limits eNOS-derived NO activity. In conclusion, PP finely regulates eNOS, controlling cerebral artery reactivity.
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Affiliation(s)
- Adeline Raignault
- 1 Faculty of Medicine, Department of Pharmacology, Université de Montréal, Montreal, Quebec, Canada.,2 Montreal Heart Institute Research Center, Montreal, Quebec, Canada
| | - Virginie Bolduc
- 1 Faculty of Medicine, Department of Pharmacology, Université de Montréal, Montreal, Quebec, Canada.,2 Montreal Heart Institute Research Center, Montreal, Quebec, Canada
| | - Frédéric Lesage
- 2 Montreal Heart Institute Research Center, Montreal, Quebec, Canada.,3 Ecole Polytechnique de Montréal, Montreal, Quebec, Canada
| | - Eric Thorin
- 1 Faculty of Medicine, Department of Pharmacology, Université de Montréal, Montreal, Quebec, Canada.,2 Montreal Heart Institute Research Center, Montreal, Quebec, Canada.,4 Faculty of Medicine, Department of Surgery, Université de Montréal, Montreal, Quebec, Canada
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128
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DuBose LE, Voss MW, Weng TB, Kent JD, Dubishar KM, Lane-Cordova A, Sigurdsson G, Schmid P, Barlow PB, Pierce GL. Carotid β-stiffness index is associated with slower processing speed but not working memory or white matter integrity in healthy middle-aged/older adults. J Appl Physiol (1985) 2017; 122:868-876. [PMID: 28126907 DOI: 10.1152/japplphysiol.00769.2016] [Citation(s) in RCA: 21] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/01/2016] [Revised: 01/05/2017] [Accepted: 01/17/2017] [Indexed: 01/09/2023] Open
Abstract
Aging is associated with increased carotid artery stiffness, a predictor of incident stroke, and reduced cognitive performance and brain white matter integrity (WMI) in humans. Therefore, we hypothesized that higher carotid stiffness/lower compliance would be independently associated with slower processing speed, higher working memory cost, and lower WMI in healthy middle-aged/older (MA/O) adults. Carotid β-stiffness (P < 0.001) was greater and compliance (P < 0.001) was lower in MA/O (n = 32; 64.4 ± 4.3 yr) vs. young (n = 19; 23.8 ± 2.9 yr) adults. MA/O adults demonstrated slower processing speed (27.4 ± 4.6 vs. 35.4 ± 5.0 U/60 s, P < 0.001) and higher working memory cost (-15.4 ± 0.14 vs. -2.2 ± 0.05%, P < 0.001) vs. young adults. Global WMI was lower in MA/O adults (P < 0.001) and regionally in the frontal lobe (P = 0.020) and genu (P = 0.009). In the entire cohort, multiple regression analysis that included education, sex, and body mass index, carotid β-stiffness index (B = -0.53 ± 0.15 U, P = 0.001) and age group (B = -4.61 ± 1.7, P = 0.012, adjusted R2 = 0.4) predicted processing speed but not working memory cost or WMI. Among MA/O adults, higher β-stiffness (B = -0.60 ± 0.18, P = 0.002) and lower compliance (B = 0.93 ± 0.26, P = 0.002) were associated with slower processing speed but not working memory cost or WMI. These data suggest that greater carotid artery stiffness is independently and selectively associated with slower processing speed but not working memory among MA/O adults. Carotid artery stiffening may modulate reductions in processing speed earlier than working memory with healthy aging in humans.NEW & NOTEWORTHY Previously, studies investigating the relation between large elastic artery stiffness, cognition, and brain structure have focused mainly on aortic stiffness in aged individuals with cardiovascular disease risk factors and other comorbidities. This study adds to the field by demonstrating that the age-related increases in carotid artery stiffness, but not aortic stiffness, is independently and selectively associated with slower processing speed but not working memory among middle-aged/older adults with low cardiovascular disease risk factor burden.
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Affiliation(s)
- Lyndsey E DuBose
- Department of Health and Human Physiology, University of Iowa, Iowa
| | - Michelle W Voss
- Department of Psychological and Brain Sciences, University of Iowa, Iowa.,Aging, Mind and Brain Initiative, University of Iowa, Iowa.,Interdisciplinary Neuroscience Program, University of Iowa, Iowa
| | - Timothy B Weng
- Department of Psychological and Brain Sciences, University of Iowa, Iowa
| | - James D Kent
- Interdisciplinary Neuroscience Program, University of Iowa, Iowa
| | | | | | | | - Phillip Schmid
- Department of Internal Medicine, University of Iowa, Iowa.,Abboud Cardiovascular Research Center, University of Iowa, Iowa City, Iowa
| | | | - Gary L Pierce
- Department of Health and Human Physiology, University of Iowa, Iowa; .,Center for Hypertension Research, University of Iowa, Iowa; and.,Abboud Cardiovascular Research Center, University of Iowa, Iowa City, Iowa
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129
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Suleman R, Padwal R, Hamilton P, Senthilselvan A, Alagiakrishnan K. Association between central blood pressure, arterial stiffness, and mild cognitive impairment. Clin Hypertens 2017; 23:2. [PMID: 28105372 PMCID: PMC5237557 DOI: 10.1186/s40885-016-0058-5] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/08/2016] [Accepted: 12/26/2016] [Indexed: 01/23/2023] Open
Abstract
Background To determine the relationship between central blood pressure (CBP) indices and mild cognitive impairment (MCI) in adults over the age of 50. Methods A cross-sectional study conducted using a non-invasive SphygmoCor XCEL device. CBP indices and brachial blood pressure were measured in 50 inpatients and outpatients. MCI was assessed using the Montreal Cognitive Assessment (MoCA) instrument and by the European Consortium Criteria (ECC). Results Seventy-six percent of subjects had hypertension, and 52% were diagnosed as having MCI using the ECC. No significant association was found between any of the measured blood pressure variables and global cognition. A significant relationship was observed between augmentation index (AI) and abnormal clock-drawing (p = 0.04) and language (p = 0.02), and between pulse pressure amplification (PPA) and language (p = 0.03). Conclusion CBP indices like AI and PPA, which are markers of vascular stiffness, are associated with poor executive function and language cognitive domain deficits.
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Affiliation(s)
- R Suleman
- Department of Medicine, Division of General Internal Medicine, University of Alberta, Edmonton, AB Canada
| | - R Padwal
- Department of Medicine, Division of General Internal Medicine, University of Alberta, Edmonton, AB Canada
| | - P Hamilton
- Department of Medicine, Division of General Internal Medicine, University of Alberta, Edmonton, AB Canada
| | - A Senthilselvan
- School of Public Health, University of Alberta, Edmonton, AB Canada
| | - K Alagiakrishnan
- Department of Medicine, Division of Geriatric Medicine, University of Alberta, Edmonton, Canada ; University of Alberta Hospital, B146, Clinical Sciences Building, 8440-112 Street, Edmonton, T6G 2G3 Canada
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Verjugina NI, Chimagomedova AS, Starovoitova IM, Levin OS. Endothelial dysfunction in chronic vascular encephalopathy. Zh Nevrol Psikhiatr Im S S Korsakova 2017; 117:73-80. [DOI: 10.17116/jnevro20171176273-80] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/27/2022]
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131
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Toth P, Tarantini S, Csiszar A, Ungvari Z. Functional vascular contributions to cognitive impairment and dementia: mechanisms and consequences of cerebral autoregulatory dysfunction, endothelial impairment, and neurovascular uncoupling in aging. Am J Physiol Heart Circ Physiol 2017; 312:H1-H20. [PMID: 27793855 PMCID: PMC5283909 DOI: 10.1152/ajpheart.00581.2016] [Citation(s) in RCA: 324] [Impact Index Per Article: 46.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/07/2016] [Revised: 10/10/2016] [Accepted: 10/26/2016] [Indexed: 12/16/2022]
Abstract
Increasing evidence from epidemiological, clinical and experimental studies indicate that age-related cerebromicrovascular dysfunction and microcirculatory damage play critical roles in the pathogenesis of many types of dementia in the elderly, including Alzheimer's disease. Understanding and targeting the age-related pathophysiological mechanisms that underlie vascular contributions to cognitive impairment and dementia (VCID) are expected to have a major role in preserving brain health in older individuals. Maintenance of cerebral perfusion, protecting the microcirculation from high pressure-induced damage and moment-to-moment adjustment of regional oxygen and nutrient supply to changes in demand are prerequisites for the prevention of cerebral ischemia and neuronal dysfunction. This overview discusses age-related alterations in three main regulatory paradigms involved in the regulation of cerebral blood flow (CBF): cerebral autoregulation/myogenic constriction, endothelium-dependent vasomotor function, and neurovascular coupling responses responsible for functional hyperemia. The pathophysiological consequences of cerebral microvascular dysregulation in aging are explored, including blood-brain barrier disruption, neuroinflammation, exacerbation of neurodegeneration, development of cerebral microhemorrhages, microvascular rarefaction, and ischemic neuronal dysfunction and damage. Due to the widespread attention that VCID has captured in recent years, the evidence for the causal role of cerebral microvascular dysregulation in cognitive decline is critically examined.
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Affiliation(s)
- Peter Toth
- Department of Geriatric Medicine, Reynolds Oklahoma Center on Aging, University of Oklahoma Health Sciences Center, Oklahoma City, Oklahoma
- Department of Neurosurgery and Szentagothai Research Center, University of Pecs, Pecs, Hungary; and
| | - Stefano Tarantini
- Department of Geriatric Medicine, Reynolds Oklahoma Center on Aging, University of Oklahoma Health Sciences Center, Oklahoma City, Oklahoma
| | - Anna Csiszar
- Department of Geriatric Medicine, Reynolds Oklahoma Center on Aging, University of Oklahoma Health Sciences Center, Oklahoma City, Oklahoma
- Department of Medical Physics and Informatics, University of Szeged, Szeged, Hungary
| | - Zoltan Ungvari
- Department of Geriatric Medicine, Reynolds Oklahoma Center on Aging, University of Oklahoma Health Sciences Center, Oklahoma City, Oklahoma;
- Department of Medical Physics and Informatics, University of Szeged, Szeged, Hungary
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Meyer ML, Palta P, Tanaka H, Deal JA, Wright J, Knopman DS, Griswold ME, Mosley TH, Heiss G. Association of Central Arterial Stiffness and Pressure Pulsatility with Mild Cognitive Impairment and Dementia: The Atherosclerosis Risk in Communities Study-Neurocognitive Study (ARIC-NCS). J Alzheimers Dis 2017; 57:195-204. [PMID: 28222517 PMCID: PMC5450915 DOI: 10.3233/jad-161041] [Citation(s) in RCA: 45] [Impact Index Per Article: 6.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/25/2022]
Abstract
BACKGROUND The association of central arterial stiffness and pressure pulsatility with mild cognitive impairment (MCI) and dementia is not well characterized in the population-based setting. OBJECTIVE The aim of this study was to quantify the cross-sectional association of arterial stiffness and pressure pulsatility with MCI and dementia among 4,461 older white and black adults from the population-based Atherosclerosis Risk in Communities Study-Neurocognitive Study. METHODS We used race-stratified multinomial logistic regression to evaluate associations of percentile cut points of carotid-femoral pulse wave velocity, central systolic blood pressure, central pulse pressure, and pulse pressure amplification with MCI and dementia versus no cognitive impairment. RESULTS Among whites, those with carotid-femoral pulse wave velocity or central systolic blood pressure ≥75th percentile had a higher prevalence of MCI compared to participants <75th percentile (conditional odds ratio (OR); 95% confidence interval (CI): 1.27 (1.02, 1.56) and 1.28 (1.04, 1.57), respectively) and those with central pulse pressure ≥75th percentile had a higher prevalence of MCI (OR 1.27 (95% CI: 1.03, 1.58)) and dementia (OR 1.76 (95% CI: 1.06, 2.92) compared to participants <75th percentile. Also among whites, those with pulse pressure amplification ≤25th percentile had a higher prevalence of dementia compared to participants >25th percentile (OR 1.65; (95% CI: 1.01, 2.70). Weaker associations were seen among black participants. CONCLUSION Higher arterial stiffness and pulsatility were associated with MCI and dementia in white participants. Longitudinal characterization of the observed associations is warranted to assess whether arterial stiffness and pressure pulsatility predict MCI and dementia among older adults.
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Affiliation(s)
- Michelle L Meyer
- Department of Epidemiology, University of North Carolina at Chapel Hill, Chapel Hill, NC
| | - Priya Palta
- Department of Epidemiology, University of North Carolina at Chapel Hill, Chapel Hill, NC
| | - Hirofumi Tanaka
- Department of Kinesiology and Health Education, University of Texas at Austin, Austin, TX
| | - Jennifer A Deal
- Department of Epidemiology, Johns Hopkins University, Baltimore, MD
| | | | | | - Michael E Griswold
- Center of Biostatistics and Bioinformatics, University of Mississippi Medical Center, Jackson, MS
| | - Thomas H Mosley
- Department of Medicine, University of Mississippi Medical Center, Jackson, MS
| | - Gerardo Heiss
- Department of Epidemiology, University of North Carolina at Chapel Hill, Chapel Hill, NC
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Zonneveld HI, Ikram MA, Hofman A, Niessen WJ, van der Lugt A, Krestin GP, Franco OH, Vernooij MW. N-Terminal Pro-B-Type Natriuretic Peptide and Subclinical Brain Damage in the General Population. Radiology 2016; 283:205-214. [PMID: 27924720 DOI: 10.1148/radiol.2016160548] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/06/2023]
Abstract
Purpose To investigate the association between N-terminal pro-B-type natriuretic peptide (NT-proBNP), which is a marker of heart disease, and markers of subclinical brain damage on magnetic resonance (MR) images in community-dwelling middle-aged and elderly subjects without dementia and without a clinical diagnosis of heart disease. Materials and Methods This prospective population-based cohort study was approved by a medical ethics committee overseen by the national government, and all participants gave written informed consent. Serum levels of NT-proBNP were measured in 2397 participants without dementia or stroke (mean age, 56.6 years; age range, 45.7-87.3 years) and without clinical diagnosis of heart disease who were drawn from the population-based Rotterdam Study. All participants were examined with a 1.5-T MR imager. Multivariable linear and logistic regression analyses were used to investigate the association between NT-proBNP level and MR imaging markers of subclinical brain damage, including volumetric, focal, and microstructural markers. Results A higher NT-proBNP level was associated with smaller total brain volume (mean difference in z score per standard deviation increase in NT-proBNP level, -0.021; 95% confidence interval [CI]: -0.034, -0.007; P = .003) and was predominantly driven by gray matter volume (mean difference in z score per standard deviation increase in NT-proBNP level, -0.037; 95% CI: -0.057, -0.017; P < .001). Higher NT-proBNP level was associated with larger white matter lesion volume (mean difference in z score per standard deviation increase in NT-proBNP level, 0.090; 95% CI: 0.051, 0.129; P < .001), with lower fractional anisotropy (mean difference in z score per standard deviation increase in NT-proBNP level, -0.048; 95% CI: -0.088, -0.008; P = .019) and higher mean diffusivity (mean difference in z score per standard deviation increase in NT-proBNP level, 0.054; 95% CI: 0.018, 0.091; P = .004) of normal-appearing white matter. Conclusion In community-dwelling persons, higher serum NT-proBNP levels are associated with volumetric and microstructural MR imaging markers of subclinical brain damage. © RSNA, 2016 Online supplemental material is available for this article.
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Affiliation(s)
- Hazel I Zonneveld
- From the Departments of Epidemiology (H.I.Z., M.A.I., A.H., O.H.F., M.W.V.), Radiology and Nuclear Medicine (H.I.Z., M.A.I., W.J.N., A.v.d.L., G.P.K., M.W.V.), Neurology (M.A.I.), and Medical Informatics (W.J.N.), Erasmus MC, University Medical Center Rotterdam, Room Na28-18, PO Box 2040, 3000 CA Rotterdam, the Netherlands; Department of Epidemiology, Harvard T.H. Chan School of Public Health, Boston, Mass (A.H.); and Department of Imaging Physics, Faculty of Applied Sciences, Delft University of Technology, Delft, the Netherlands (W.J.N.)
| | - M Arfan Ikram
- From the Departments of Epidemiology (H.I.Z., M.A.I., A.H., O.H.F., M.W.V.), Radiology and Nuclear Medicine (H.I.Z., M.A.I., W.J.N., A.v.d.L., G.P.K., M.W.V.), Neurology (M.A.I.), and Medical Informatics (W.J.N.), Erasmus MC, University Medical Center Rotterdam, Room Na28-18, PO Box 2040, 3000 CA Rotterdam, the Netherlands; Department of Epidemiology, Harvard T.H. Chan School of Public Health, Boston, Mass (A.H.); and Department of Imaging Physics, Faculty of Applied Sciences, Delft University of Technology, Delft, the Netherlands (W.J.N.)
| | - Albert Hofman
- From the Departments of Epidemiology (H.I.Z., M.A.I., A.H., O.H.F., M.W.V.), Radiology and Nuclear Medicine (H.I.Z., M.A.I., W.J.N., A.v.d.L., G.P.K., M.W.V.), Neurology (M.A.I.), and Medical Informatics (W.J.N.), Erasmus MC, University Medical Center Rotterdam, Room Na28-18, PO Box 2040, 3000 CA Rotterdam, the Netherlands; Department of Epidemiology, Harvard T.H. Chan School of Public Health, Boston, Mass (A.H.); and Department of Imaging Physics, Faculty of Applied Sciences, Delft University of Technology, Delft, the Netherlands (W.J.N.)
| | - Wiro J Niessen
- From the Departments of Epidemiology (H.I.Z., M.A.I., A.H., O.H.F., M.W.V.), Radiology and Nuclear Medicine (H.I.Z., M.A.I., W.J.N., A.v.d.L., G.P.K., M.W.V.), Neurology (M.A.I.), and Medical Informatics (W.J.N.), Erasmus MC, University Medical Center Rotterdam, Room Na28-18, PO Box 2040, 3000 CA Rotterdam, the Netherlands; Department of Epidemiology, Harvard T.H. Chan School of Public Health, Boston, Mass (A.H.); and Department of Imaging Physics, Faculty of Applied Sciences, Delft University of Technology, Delft, the Netherlands (W.J.N.)
| | - Aad van der Lugt
- From the Departments of Epidemiology (H.I.Z., M.A.I., A.H., O.H.F., M.W.V.), Radiology and Nuclear Medicine (H.I.Z., M.A.I., W.J.N., A.v.d.L., G.P.K., M.W.V.), Neurology (M.A.I.), and Medical Informatics (W.J.N.), Erasmus MC, University Medical Center Rotterdam, Room Na28-18, PO Box 2040, 3000 CA Rotterdam, the Netherlands; Department of Epidemiology, Harvard T.H. Chan School of Public Health, Boston, Mass (A.H.); and Department of Imaging Physics, Faculty of Applied Sciences, Delft University of Technology, Delft, the Netherlands (W.J.N.)
| | - Gabriel P Krestin
- From the Departments of Epidemiology (H.I.Z., M.A.I., A.H., O.H.F., M.W.V.), Radiology and Nuclear Medicine (H.I.Z., M.A.I., W.J.N., A.v.d.L., G.P.K., M.W.V.), Neurology (M.A.I.), and Medical Informatics (W.J.N.), Erasmus MC, University Medical Center Rotterdam, Room Na28-18, PO Box 2040, 3000 CA Rotterdam, the Netherlands; Department of Epidemiology, Harvard T.H. Chan School of Public Health, Boston, Mass (A.H.); and Department of Imaging Physics, Faculty of Applied Sciences, Delft University of Technology, Delft, the Netherlands (W.J.N.)
| | - Oscar H Franco
- From the Departments of Epidemiology (H.I.Z., M.A.I., A.H., O.H.F., M.W.V.), Radiology and Nuclear Medicine (H.I.Z., M.A.I., W.J.N., A.v.d.L., G.P.K., M.W.V.), Neurology (M.A.I.), and Medical Informatics (W.J.N.), Erasmus MC, University Medical Center Rotterdam, Room Na28-18, PO Box 2040, 3000 CA Rotterdam, the Netherlands; Department of Epidemiology, Harvard T.H. Chan School of Public Health, Boston, Mass (A.H.); and Department of Imaging Physics, Faculty of Applied Sciences, Delft University of Technology, Delft, the Netherlands (W.J.N.)
| | - Meike W Vernooij
- From the Departments of Epidemiology (H.I.Z., M.A.I., A.H., O.H.F., M.W.V.), Radiology and Nuclear Medicine (H.I.Z., M.A.I., W.J.N., A.v.d.L., G.P.K., M.W.V.), Neurology (M.A.I.), and Medical Informatics (W.J.N.), Erasmus MC, University Medical Center Rotterdam, Room Na28-18, PO Box 2040, 3000 CA Rotterdam, the Netherlands; Department of Epidemiology, Harvard T.H. Chan School of Public Health, Boston, Mass (A.H.); and Department of Imaging Physics, Faculty of Applied Sciences, Delft University of Technology, Delft, the Netherlands (W.J.N.)
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Iadecola C, Yaffe K, Biller J, Bratzke LC, Faraci FM, Gorelick PB, Gulati M, Kamel H, Knopman DS, Launer LJ, Saczynski JS, Seshadri S, Zeki Al Hazzouri A. Impact of Hypertension on Cognitive Function: A Scientific Statement From the American Heart Association. Hypertension 2016; 68:e67-e94. [PMID: 27977393 DOI: 10.1161/hyp.0000000000000053] [Citation(s) in RCA: 431] [Impact Index Per Article: 53.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/06/2023]
Abstract
BACKGROUND Age-related dementia, most commonly caused by Alzheimer disease or cerebrovascular factors (vascular dementia), is a major public health threat. Chronic arterial hypertension is a well-established risk factor for both types of dementia, but the link between hypertension and its treatment and cognition remains poorly understood. In this scientific statement, a multidisciplinary team of experts examines the impact of hypertension on cognition to assess the state of the knowledge, to identify gaps, and to provide future directions. METHODS Authors with relevant expertise were selected to contribute to this statement in accordance with the American Heart Association conflict-of-interest management policy. Panel members were assigned topics relevant to their areas of expertise, reviewed the literature, and summarized the available data. RESULTS Hypertension disrupts the structure and function of cerebral blood vessels, leads to ischemic damage of white matter regions critical for cognitive function, and may promote Alzheimer pathology. There is strong evidence of a deleterious influence of midlife hypertension on late-life cognitive function, but the cognitive impact of late-life hypertension is less clear. Observational studies demonstrated a cumulative effect of hypertension on cerebrovascular damage, but evidence from clinical trials that antihypertensive treatment improves cognition is not conclusive. CONCLUSIONS After carefully reviewing the literature, the group concluded that there were insufficient data to make evidence-based recommendations. However, judicious treatment of hypertension, taking into account goals of care and individual characteristics (eg, age and comorbidities), seems justified to safeguard vascular health and, as a consequence, brain health.
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Bateman GA, Lechner-Scott J, Lea RA. A comparison between the pathophysiology of multiple sclerosis and normal pressure hydrocephalus: is pulse wave encephalopathy a component of MS? Fluids Barriers CNS 2016; 13:18. [PMID: 27658732 PMCID: PMC5034419 DOI: 10.1186/s12987-016-0041-2] [Citation(s) in RCA: 29] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/20/2016] [Accepted: 09/08/2016] [Indexed: 12/24/2022] Open
Abstract
BACKGROUND It has been suggested there is a chronic neurodegenerative disorder, underlying the pathophysiology of multiple sclerosis (MS), which is distinct from the more obvious immune-mediated attack on the white matter. Limited data exists indicating there is an alteration in pulse wave propagation within the craniospinal cavity in MS, similar to the findings in normal pressure hydrocephalus (NPH). It is hypothesized MS may harbor pulse wave encephalopathy. The purpose of this study is to compare blood flow and pulse wave measurements in MS patients with a cohort of NPH patients and control subjects, to test this hypothesis. METHODS Twenty patients with MS underwent magnetic resonance (MR) flow quantification techniques. Mean blood flow and stroke volume were measured in the arterial inflow and venous out flow from the sagittal (SSS) and straight sinus (ST). The arteriovenous delay (AVD) was defined. The results were compared with both age-matched controls and NPH patients. RESULTS In MS there was a 35 % reduction in arteriovenous delay and a 5 % reduction in the percentage of the arterial inflow returning via the sagittal sinus compared to age matched controls. There was an alteration in pulse wave propagation, with a 26 % increase in arterial stroke volume but 30 % reduction in SSS and ST stroke volume. The AVD and blood flow changes were in the same direction to those of NPH patients. CONCLUSIONS There are blood flow and pulsation propagation changes in MS patients which are similar to those of NPH patients. The findings would be consistent with an underlying pulse wave encephalopathy component in MS.
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Affiliation(s)
- Grant A. Bateman
- Department of Medical Imaging, John Hunter Hospital, Locked Bag 1, Newcastle Region Mail Center, Newcastle, 2310 Australia
- Newcastle University Faculty of Health, Callaghan Campus Newcastle, Newcastle, Australia
| | - Jeannette Lechner-Scott
- Newcastle University Faculty of Health, Callaghan Campus Newcastle, Newcastle, Australia
- Department of Neurology, John Hunter Hospital, Newcastle, Australia
- Hunter Medical Research Institute, Newcastle, Australia
| | - Rodney A. Lea
- Institute of Health and Biomedical Innovation, Queensland University of Technology, Brisbane, Australia
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Yang D, Cabral D, Gaspard EN, Lipton RB, Rundek T, Derby CA. Cerebral Hemodynamics in the Elderly: A Transcranial Doppler Study in the Einstein Aging Study Cohort. JOURNAL OF ULTRASOUND IN MEDICINE : OFFICIAL JOURNAL OF THE AMERICAN INSTITUTE OF ULTRASOUND IN MEDICINE 2016; 35:1907-14. [PMID: 27417737 PMCID: PMC5500193 DOI: 10.7863/ultra.15.10040] [Citation(s) in RCA: 28] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/15/2015] [Accepted: 12/07/2015] [Indexed: 05/19/2023]
Abstract
OBJECTIVES We sought to describe the relationship between age, sex, and race/ethnicity with transcranial Doppler hemodynamic characteristics from major intracerebral arterial segments in a large elderly population with varying demographics. METHODS We analyzed 369 stroke-free participants aged 70 years and older from the Einstein Aging Study. Single-gate, nonimaging transcranial Doppler sonography, a noninvasive sonographic technique that assesses real-time cerebrovascular hemodynamics, was used to interrogate 9 cerebral arterial segments. Individual Doppler spectra and cerebral blood flow velocities were acquired, and the pulsatility index and resistive index were calculated by the device's automated waveform-tracking function. Multiple linear regression models were used to examine the independent associations of age, sex, and race/ethnicity with transcranial Doppler measures, adjusting for hypertension, history of myocardial infarction or revascularization, and history of diabetes. RESULTS Among enrolled participants, 303 individuals had at least 1 vessel insonated (mean age [SD], 80 [6] years; 63% women; 58% white; and 32% black). With age, transcranial Doppler measures of mean blood flow velocity were significantly decreased in the basilar artery (P = .001) and posterior cerebral artery (right, P = .003; left, P = .02). Pulsatility indices increased in the left middle cerebral artery (P = .01) and left anterior cerebral artery (P = .03), and the resistive index was increased in the left middle cerebral artery (P = .007) with age. Women had higher pulsatility and resistive indices compared to men in several vessels. CONCLUSIONS We report a decreased mean blood flow velocity and weakly increased arterial pulsatility and resistance with aging in a large elderly stroke-free population. These referential trends in cerebrovascular hemodynamics may carry important implications in vascular diseases associated with advanced age, increased risk of cerebrovascular disease, cognitive decline, and dementia.
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Affiliation(s)
- Dixon Yang
- Department of Neurology, Miller School of Medicine, University of Miami, Miami, Florida USA
| | - Digna Cabral
- Department of Neurology, Miller School of Medicine, University of Miami, Miami, Florida USA
| | - Emmanuel N Gaspard
- Saul R. Korey Department of Neurology, Albert Einstein College of Medicine, Bronx, New York USA
| | - Richard B Lipton
- Saul R. Korey Department of Neurology, Albert Einstein College of Medicine, Bronx, New York USA, Department of Epidemiology and Population Health, Albert Einstein College of Medicine, Bronx, New York USA
| | - Tatjana Rundek
- Department of Neurology, Miller School of Medicine, University of Miami, Miami, Florida USA
| | - Carol A Derby
- Saul R. Korey Department of Neurology, Albert Einstein College of Medicine, Bronx, New York USA, Department of Epidemiology and Population Health, Albert Einstein College of Medicine, Bronx, New York USA
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Pase MP, Beiser A, Himali JJ, Tsao C, Satizabal CL, Vasan RS, Seshadri S, Mitchell GF. Aortic Stiffness and the Risk of Incident Mild Cognitive Impairment and Dementia. Stroke 2016; 47:2256-61. [PMID: 27491735 DOI: 10.1161/strokeaha.116.013508] [Citation(s) in RCA: 104] [Impact Index Per Article: 13.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/17/2016] [Accepted: 05/27/2016] [Indexed: 01/03/2023]
Abstract
BACKGROUND AND PURPOSE Aortic stiffening increases the transfers of high pressure and flow pulsatility to small cerebral vessels potentially causing the accumulation of vascular brain injury. Our aim was to investigate the prospective association of aortic stiffness with the risks of incident mild cognitive impairment and dementia. METHODS We studied 1101 dementia-free Framingham Offspring study participants (mean age, 69±6 years; 54% women). Aortic stiffness was measured as carotid-femoral pulse wave velocity using applanation tonometry and modeled as a linear variable and the top 2 quintiles (>11.4 m/s). Outcomes were the 10-year risk of incident mild cognitive impairment and dementia, including clinically characterized Alzheimer disease. We observed 106, 77, and 59 events of mild cognitive impairment, all-cause dementia, and clinical Alzheimer disease, respectively. RESULTS After adjustment for age and sex, higher continuous aortic stiffness predicted an increased risk of mild cognitive impairment (hazard ratio, 1.40 [95% confidence interval, 1.13-1.73]), all-cause dementia (hazard ratio, 1.45 [95% confidence interval, 1.13-1.87]), and Alzheimer disease (hazard ratio, 1.41 [95% confidence interval, 1.06-1.87]). In risk factor-adjusted statistical models, aortic stiffness remained a significant predictor of mild cognitive impairment but not incident dementia. In nondiabetic patients, the top 2 quintiles of aortic stiffness were associated with a higher risk of incident all-cause dementia across all statistical models. CONCLUSIONS Aortic stiffness was an independent predictor of incident mild cognitive impairment in the whole sample and with incident dementia in nondiabetic patients. Our findings suggest aortic stiffness as a potentially modifiable risk factor for clinical cognitive impairment and dementia.
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Affiliation(s)
- Matthew P Pase
- From the Department of Neurology, Boston University School of Medicine, MA (M.P.P., A.B., J.J.H., C.L.S., S.S.); Framingham Heart Study, MA (M.P.P., A.B., J.J.H., C.L.S., R.S.V., S.S., G.F.M.); Centre for Human Psychopharmacology, Swinburne University of Technology, Hawthorn, Australia (M.P.P.); Department of Biostatistics, Boston University School of Public Health, MA (A.B.); Department of Medicine, Cardiovascular Division, Beth Israel Deaconess Medical Centre, Boston, MA (C.T.); and Cardiovascular Engineering Inc, Norwood, MA (G.F.M.).
| | - Alexa Beiser
- From the Department of Neurology, Boston University School of Medicine, MA (M.P.P., A.B., J.J.H., C.L.S., S.S.); Framingham Heart Study, MA (M.P.P., A.B., J.J.H., C.L.S., R.S.V., S.S., G.F.M.); Centre for Human Psychopharmacology, Swinburne University of Technology, Hawthorn, Australia (M.P.P.); Department of Biostatistics, Boston University School of Public Health, MA (A.B.); Department of Medicine, Cardiovascular Division, Beth Israel Deaconess Medical Centre, Boston, MA (C.T.); and Cardiovascular Engineering Inc, Norwood, MA (G.F.M.)
| | - Jayandra J Himali
- From the Department of Neurology, Boston University School of Medicine, MA (M.P.P., A.B., J.J.H., C.L.S., S.S.); Framingham Heart Study, MA (M.P.P., A.B., J.J.H., C.L.S., R.S.V., S.S., G.F.M.); Centre for Human Psychopharmacology, Swinburne University of Technology, Hawthorn, Australia (M.P.P.); Department of Biostatistics, Boston University School of Public Health, MA (A.B.); Department of Medicine, Cardiovascular Division, Beth Israel Deaconess Medical Centre, Boston, MA (C.T.); and Cardiovascular Engineering Inc, Norwood, MA (G.F.M.)
| | - Connie Tsao
- From the Department of Neurology, Boston University School of Medicine, MA (M.P.P., A.B., J.J.H., C.L.S., S.S.); Framingham Heart Study, MA (M.P.P., A.B., J.J.H., C.L.S., R.S.V., S.S., G.F.M.); Centre for Human Psychopharmacology, Swinburne University of Technology, Hawthorn, Australia (M.P.P.); Department of Biostatistics, Boston University School of Public Health, MA (A.B.); Department of Medicine, Cardiovascular Division, Beth Israel Deaconess Medical Centre, Boston, MA (C.T.); and Cardiovascular Engineering Inc, Norwood, MA (G.F.M.)
| | - Claudia L Satizabal
- From the Department of Neurology, Boston University School of Medicine, MA (M.P.P., A.B., J.J.H., C.L.S., S.S.); Framingham Heart Study, MA (M.P.P., A.B., J.J.H., C.L.S., R.S.V., S.S., G.F.M.); Centre for Human Psychopharmacology, Swinburne University of Technology, Hawthorn, Australia (M.P.P.); Department of Biostatistics, Boston University School of Public Health, MA (A.B.); Department of Medicine, Cardiovascular Division, Beth Israel Deaconess Medical Centre, Boston, MA (C.T.); and Cardiovascular Engineering Inc, Norwood, MA (G.F.M.)
| | - Ramachandran S Vasan
- From the Department of Neurology, Boston University School of Medicine, MA (M.P.P., A.B., J.J.H., C.L.S., S.S.); Framingham Heart Study, MA (M.P.P., A.B., J.J.H., C.L.S., R.S.V., S.S., G.F.M.); Centre for Human Psychopharmacology, Swinburne University of Technology, Hawthorn, Australia (M.P.P.); Department of Biostatistics, Boston University School of Public Health, MA (A.B.); Department of Medicine, Cardiovascular Division, Beth Israel Deaconess Medical Centre, Boston, MA (C.T.); and Cardiovascular Engineering Inc, Norwood, MA (G.F.M.)
| | - Sudha Seshadri
- From the Department of Neurology, Boston University School of Medicine, MA (M.P.P., A.B., J.J.H., C.L.S., S.S.); Framingham Heart Study, MA (M.P.P., A.B., J.J.H., C.L.S., R.S.V., S.S., G.F.M.); Centre for Human Psychopharmacology, Swinburne University of Technology, Hawthorn, Australia (M.P.P.); Department of Biostatistics, Boston University School of Public Health, MA (A.B.); Department of Medicine, Cardiovascular Division, Beth Israel Deaconess Medical Centre, Boston, MA (C.T.); and Cardiovascular Engineering Inc, Norwood, MA (G.F.M.)
| | - Gary F Mitchell
- From the Department of Neurology, Boston University School of Medicine, MA (M.P.P., A.B., J.J.H., C.L.S., S.S.); Framingham Heart Study, MA (M.P.P., A.B., J.J.H., C.L.S., R.S.V., S.S., G.F.M.); Centre for Human Psychopharmacology, Swinburne University of Technology, Hawthorn, Australia (M.P.P.); Department of Biostatistics, Boston University School of Public Health, MA (A.B.); Department of Medicine, Cardiovascular Division, Beth Israel Deaconess Medical Centre, Boston, MA (C.T.); and Cardiovascular Engineering Inc, Norwood, MA (G.F.M.)
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Carotid stiffness is associated with impairment of cognitive performance in individuals with and without type 2 diabetes. The Maastricht Study. Atherosclerosis 2016; 253:186-193. [PMID: 27503567 DOI: 10.1016/j.atherosclerosis.2016.07.912] [Citation(s) in RCA: 35] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/29/2016] [Revised: 07/17/2016] [Accepted: 07/20/2016] [Indexed: 01/03/2023]
Abstract
BACKGROUND AND AIMS There is increasing evidence linking arterial (mainly aortic) stiffness and type 2 diabetes, a risk factor for arterial stiffness, to cognitive impairment and dementia. However, data on carotid stiffness, which may be especially relevant for cognitive performance, are scarce, and few studies have addressed the interplay between arterial stiffness, type 2 diabetes, and cognitive performance. METHODS We studied individuals with (n = 197) and without (n = 528) type 2 diabetes, who completed a neuropsychological test battery and underwent applanation tonometry and vascular ultrasound to evaluate aortic (i.e. carotid-to-femoral pulse wave velocity) and carotid stiffness (i.e. distensibility, compliance and Young's elastic modulus). Linear regression analyses were performed and adjusted for demographics, vascular risk factors, and depression. RESULTS Overall, our results showed that carotid, but not aortic, stiffness was associated with worse cognitive performance, primarily in the domains of processing speed (standardized regression coefficient for distensibility -0.083, p = 0.040; compliance -0.077, p = 0.032) and executive function and attention (distensibility -0.133, p = 0.001; compliance -0.090, p = 0.015; Young's elastic modulus -0.081, p = 0.027). These associations did not differ by diabetes status. The differences in cognitive performance between individuals with and without type 2 diabetes (mean difference in domain scores relative to those without diabetes for free recall memory -0.23, processing speed -0.19, executive function and attention -0.23; all p ≤ 0.009 and adjusted for demographics, traditional vascular risk factors, and depression) were not substantially altered after additional adjustment for carotid stiffness. CONCLUSIONS Our findings suggest that carotid stiffness is associated with cognitive performance in both individuals with and without diabetes, but does not mediate the relationship between type 2 diabetes and cognitive dysfunction.
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Li ZJ, Liu Y, Du LF, Luo XH. Evaluating arterial stiffness in type 2 diabetes patients using ultrasonic radiofrequency. ACTA ACUST UNITED AC 2016; 36:442-448. [PMID: 27376818 DOI: 10.1007/s11596-016-1606-7] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/10/2015] [Revised: 04/29/2016] [Indexed: 12/21/2022]
Abstract
Differences in arterial stiffness between the two sides of the carotid arteries were investigated using ultrasonic radiofrequency in 88 patients with type 2 diabetes and 70 controls. The compliance coefficient (CC), pulse wave velocity (PWV), intima-media thickness (CIMT) and diameter (CCAD) of the common carotid arteries (CCAs) were measured. The ratio of the left to right CCAs was calculated to provide four indexes: CC ratio, PWV ratio, CIMT ratio and CCAD ratio. In the diabetes group, the PWV on the left side was significantly higher than that on the right side, while the CC on the left side was significantly lower than that on the right side. The bilateral CIMT was thicker and CCAD was wider, the left PWV traveled faster, and the right CC was higher in the diabetes group than in the control group. The PWV ratio between the two groups was significantly different and correlated positively with duration of diabetes and systolic blood pressure (SBP). The differences between the two sides of CCAs in patients with diabetes suggested that disease duration and SBP were important risk factors for arterial stiffness. Identifying the difference could potentially lead to the much earlier diagnosis of arteriosclerosis.
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Affiliation(s)
- Zhao-Jun Li
- Department of Ultrasound, Shanghai Jiaotong University, Shanghai, 200080, China
| | - Yang Liu
- Department of Ultrasound, Shanghai Jiaotong University, Shanghai, 200080, China
| | - Lian-Fang Du
- Department of Ultrasound, Shanghai Jiaotong University, Shanghai, 200080, China
| | - Xiang-Hong Luo
- Department of Echocardiography, Shanghai General Hospital, Shanghai Jiaotong University, Shanghai, 200080, China.
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140
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Scott BM, Maye J, Jones J, Thomas K, Mangal PC, Trifilio E, Hass C, Marsiske M, Bowers D. Post-exercise pulse pressure is a better predictor of executive function than pre-exercise pulse pressure in cognitively normal older adults. NEUROPSYCHOLOGY, DEVELOPMENT, AND COGNITION. SECTION B, AGING, NEUROPSYCHOLOGY AND COGNITION 2016; 23:464-76. [PMID: 26629911 PMCID: PMC4856549 DOI: 10.1080/13825585.2015.1118007] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
Abstract
Exercise "stress tests" are widely used to assess cardiovascular function and to detect abnormalities. In line with the view of exercise as a stressor, the present study examined the relationship between cognitive function and cardiovascular activity before and after light physical exercise in a sample of 84 non-demented community-dwelling older adults. Based on known relationships between hypertension, executive function and cerebral white matter changes, we hypothesized that greater post-exercise reactivity, as indexed by higher pulse pressure, would be more related to worse performance on frontal-executive tasks than pre-exercise physiologic measures. All participants were administered a comprehensive neuropsychological battery and underwent a Six Minute Walk Test (6MWT), with blood pressure (BP) measures obtained immediately before and after the walk. Pulse pressure (PP) was derived from BP as an indicator of vascular auto-regulation and composite scores were computed for each cognitive domain assessed. As predicted, worse executive function scores exhibited a stronger relationship with post-exercise PP than pre-exercise PP. Results suggest that PP following system stress in the form of walking may be more reflective of the state of vascular integrity and associated executive dysfunction in older adults than baseline physiologic measures.
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Affiliation(s)
- Bonnie M. Scott
- University of Florida, Department of Clinical and Health Psychology, P.O. Box 100165, Gainesville, Florida, 32610
| | - Jacqueline Maye
- University of Florida, Department of Clinical and Health Psychology, P.O. Box 100165, Gainesville, Florida, 32610
| | - Jacob Jones
- University of Florida, Department of Clinical and Health Psychology, P.O. Box 100165, Gainesville, Florida, 32610
| | - Kelsey Thomas
- University of Florida, Department of Clinical and Health Psychology, P.O. Box 100165, Gainesville, Florida, 32610
| | - Paul C. Mangal
- University of Florida, Department of Clinical and Health Psychology, P.O. Box 100165, Gainesville, Florida, 32610
| | - Erin Trifilio
- University of Florida, Department of Clinical and Health Psychology, P.O. Box 100165, Gainesville, Florida, 32610
| | - Chris Hass
- University of Florida, Department of Applied Physiology and Kinesiology, P.O. Box 118205, Gainesville, Florida, 32611
| | - Michael Marsiske
- University of Florida, Department of Clinical and Health Psychology, P.O. Box 100165, Gainesville, Florida, 32610
| | - Dawn Bowers
- University of Florida, Department of Clinical and Health Psychology, P.O. Box 100165, Gainesville, Florida, 32610
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141
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McDade E, Sun Z, Lee CW, Snitz B, Hughes T, Chang CCH, Ganguli M. The association between pulse pressure change and cognition in late life: Age and where you start matters. ALZHEIMER'S & DEMENTIA (AMSTERDAM, NETHERLANDS) 2016; 4:56-66. [PMID: 27489881 PMCID: PMC4961825 DOI: 10.1016/j.dadm.2016.03.008] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 01/10/2023]
Abstract
INTRODUCTION Variations across studies in the association between blood pressure (BP) and cognition might be explained partly by duration of exposure to hypertension and partly by nonrandom attrition over time. Pulse pressure (PP) reflects arterial stiffness which may better reflect chronicity of hypertension. METHODS Over six annual cycles, 1954 individuals aged 65+ years from a prospective population-based cohort underwent BP measurements and cognitive evaluations. We examined the relationship of change in five cognitive domains to longitudinal PP patterns across the late-life age spectrum, before and after stratifying by baseline systolic blood pressure (SBP) and adjusting for attrition. RESULTS There were four longitudinal PP patterns: stable normal, stable high, increasing, and decreasing. Those with lower baseline SBP and an increasing or stable high PP had less decline in cognition, an effect that was attenuated with aging. Among those with higher baseline SBP, there were no differences across PP groups, but increasing age was consistently associated with greater cognitive decline. DISCUSSION The effect of PP on cognitive decline depends on age, baseline SBP, and the trajectory of PP change. Cardiovascular mechanisms underlying cognitive aging should be recognized as nuanced and dynamic processes when exploring prevention and treatment targets in the elderly, so that the optimal timing and type of intervention can be identified.
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Affiliation(s)
- Eric McDade
- Department of Neurology, School of Medicine, Washington University at St. Louis, St. Louis, MO, USA
| | - Zhaowen Sun
- Department of Psychiatry, School of Medicine, University of Pittsburgh, Pittsburgh, PA, USA
| | - Ching-Wen Lee
- Department of Psychiatry, School of Medicine, University of Pittsburgh, Pittsburgh, PA, USA
| | - Beth Snitz
- Department of Psychiatry, School of Medicine, University of Pittsburgh, Pittsburgh, PA, USA
| | - Tiffany Hughes
- Department of Sociology, Anthropology, and Gerontology, Youngstown State University, Youngstown, OH, USA
| | - Chung-Chou H. Chang
- Department of Medicine, School of Medicine, University of Pittsburgh, Pittsburgh, PA, USA
- Department of Biostatistics, Graduate School of Public Health, University of Pittsburgh, Pittsburgh, PA, USA
| | - Mary Ganguli
- Department of Psychiatry, School of Medicine, University of Pittsburgh, Pittsburgh, PA, USA
- Department of Epidemiology, Graduate School of Public Health, University of Pittsburgh, Pittsburgh, PA, USA
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142
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Smagula SF, Aizenstein HJ. Brain structural connectivity in late-life major depressive disorder. BIOLOGICAL PSYCHIATRY: COGNITIVE NEUROSCIENCE AND NEUROIMAGING 2016; 1:271-277. [PMID: 27430029 DOI: 10.1016/j.bpsc.2015.11.005] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/27/2022]
Abstract
Disrupted brain connectivity might explain both the pathogenesis and consequences of late-life major depressive disorder (LLD). However, it remains difficult to ascertain whether and how specific circuits are affected. We reviewed literature regarding brain connectivity in LLD, and we specifically focused on the role of structural pathology. LLD is associated with greater levels of cerebrovascular disease, and greater levels of cerebrovascular disease are associated with both depression development and treatment responsiveness. Cerebrovascular disease is most often measured as white matter hyperintensity (WMH) burden, and histopathology studies suggest WMH reflect myelin damage and fluid accumulation (among other underlying pathology). WMHs appear as confluent caps around the ventricles (periventricular), as well as isolated lesions in the deep white matter. The underlying tissue damage and implications for brain connectivity may differ by WMH location or severity. WMHs are associated with lower white matter microstructural integrity (measured with diffusion tensor imaging) and altered brain function (measured with functional MRI). LLD is also associated with lower white matter microstructural integrity and grey matter loss which may also alter the network properties and function of the brain. Damage to brain structure reflected by WMH, reduced white matter microstructural integrity, and atrophy may affect brain function, and are therefore likely pathophysiological mechanisms of LLD. Additional research is needed to fully characterize the developmental course and pathology underlying these imaging markers, and to understand how structural damage explains LLD's various clinical manifestations.
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Affiliation(s)
- Stephen F Smagula
- Department of Psychiatry, Western Psychiatric Institute and Clinic of University of Pittsburgh Medical Center, Pittsburgh, PA, USA
| | - Howard J Aizenstein
- Department of Psychiatry, Western Psychiatric Institute and Clinic of University of Pittsburgh Medical Center, Pittsburgh, PA, USA
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143
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van Sloten TT, Mitchell GF, Sigurdsson S, van Buchem MA, Jonsson PV, Garcia ME, Harris TB, Henry RM, Levey AS, Stehouwer CD, Gudnason V, Launer LJ. Associations between arterial stiffness, depressive symptoms and cerebral small vessel disease: cross-sectional findings from the AGES-Reykjavik Study. J Psychiatry Neurosci 2016; 41:162-8. [PMID: 26505140 PMCID: PMC4853207 DOI: 10.1503/jpn.140334] [Citation(s) in RCA: 44] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/22/2022] Open
Abstract
BACKGROUND Arterial stiffness may contribute to depression via cerebral microvascular damage, but evidence for this is scarce. We therefore investigated whether arterial stiffness is associated with depressive symptoms and whether cerebral small vessel disease contributes to this association. METHODS This cross-sectional study included a subset of participants from the AGES-Reykjavik study second examination round, which was conducted from 2007 to 2011. Arterial stiffness (carotid-femoral pulse wave velocity [CFPWV]), depressive symptoms (15-item geriatric depression scale [GDS-15]) and cerebral small vessel disease (MRI) were determined. Manifestations of cerebral small vessel disease included higher white matter hyperintensity volume, subcortical infarcts, cerebral microbleeds, Virchow-Robin spaces and lower total brain parenchyma volume. RESULTS We included 2058 participants (mean age 79.6 yr; 59.0% women) in our analyses. Higher CFPWV was associated with a higher GDS-15 score, after adjustment for potential confounders (β 0.096, 95% confidence interval [CI] 0.005-0.187). Additional adjustment for white matter hyperintensity volume or subcortical infarcts attenuated the association between CFPWV and the GDS-15 score, which became nonsignificant (p > 0.05). Formal mediation tests showed that the attenuating effects of white matter hyperintensity volume and subcortical infarcts were statistically significant. Virchow-Robin spaces, cerebral microbleeds and cerebral atrophy did not explain the association between CFPWV and depressive symptoms. LIMITATIONS Our study was limited by its cross-sectional design, which precludes any conclusions about causal mediation. Depressive symptoms were assessed by a self-report questionnaire. CONCLUSION Greater arterial stiffness is associated with more depressive symptoms; this association is partly accounted for by white matter hyperintensity volume and subcortical infarcts. This study supports the hypothesis that arterial stiffness leads to depression in part via cerebral small vessel disease.
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Affiliation(s)
| | | | | | | | | | | | | | | | | | | | | | - Lenore J. Launer
- Correspondence to: L.J. Launer, Intramural Research Program, National Institute on Aging, Bethesda, MD;
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McFall GP, Sapkota S, McDermott KL, Dixon RA. Risk-reducing Apolipoprotein E and Clusterin genotypes protect against the consequences of poor vascular health on executive function performance and change in nondemented older adults. Neurobiol Aging 2016; 42:91-100. [PMID: 27143425 DOI: 10.1016/j.neurobiolaging.2016.02.032] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/04/2015] [Revised: 02/24/2016] [Accepted: 02/29/2016] [Indexed: 02/06/2023]
Abstract
We examined independent and cumulative effects of 2 Alzheimer's-related genetic polymorphisms, Apolipoprotein E (APOE) and Clusterin (CLU), in relation to the deleterious effects of poor vascular health (pulse pressure [PP]) on executive function (EF) performance and change in nondemented older adults. Using a sample (n = 593; age range = 53-95 years) from the Victoria Longitudinal Study, we applied latent growth modeling to test the effect of PP, as moderated by APOE and CLU, on an EF latent variable. EF was affected by higher levels of PP but differentially less so for carriers of low-risk alleles (APOE ɛ2+; CLU TT) than for moderate- or high-risk alleles (APOE ɛ2-; CLU C+). The cumulative genetic risk of APOE plus CLU provided similar moderation of PP level effects on EF. Future research may focus on how APOE and CLU might provide different but complementary contributions to predicting EF level and change. Vascular health risk in synergistic association with risk-related polymorphisms can elucidate the neurobiological underpinnings of cognitive trajectories in nondemented aging.
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Affiliation(s)
- G Peggy McFall
- Department of Psychology, University of Alberta, Edmonton, Canada; Neuroscience and Mental Health Institute, University of Alberta, Edmonton, Canada
| | - Shraddha Sapkota
- Neuroscience and Mental Health Institute, University of Alberta, Edmonton, Canada
| | - Kirstie L McDermott
- Neuroscience and Mental Health Institute, University of Alberta, Edmonton, Canada
| | - Roger A Dixon
- Department of Psychology, University of Alberta, Edmonton, Canada; Neuroscience and Mental Health Institute, University of Alberta, Edmonton, Canada.
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145
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Maillard P, Mitchell GF, Himali JJ, Beiser A, Tsao CW, Pase MP, Satizabal CL, Vasan RS, Seshadri S, DeCarli C. Effects of Arterial Stiffness on Brain Integrity in Young Adults From the Framingham Heart Study. Stroke 2016; 47:1030-6. [PMID: 26965846 DOI: 10.1161/strokeaha.116.012949] [Citation(s) in RCA: 88] [Impact Index Per Article: 11.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/26/2016] [Accepted: 02/22/2016] [Indexed: 12/24/2022]
Abstract
BACKGROUND AND PURPOSE Previous work from the Framingham Heart Study suggests that brain changes because of arterial aging may begin in young adulthood and that such changes precede cognitive deficits. The objective of this study was to determine the association of arterial stiffness with measures of white matter and gray matter (GM) integrity in young adults. METHODS One thousand nine hundred three participants from the Framingham Heart Study Third Generation (mean age, 46±8.7 years) had complete tonometry measurements and brain magnetic resonance imaging (T1-weighted and diffusion tensor imaging). Tonometry measures included carotid-femoral pulse wave velocity, augmentation index, carotid-brachial pressure amplification, and central pulse pressure. Fractional anisotropy and GM density images were computed from diffusion tensor imaging and T1 images. Registration to a common anatomic template enabled voxel-based linear regressions relating measures of fractional anisotropy and GM to tonometry measures, adjusting for relevant covariables. RESULTS Higher carotid-femoral pulse wave velocity was associated with lower regional fractional anisotropy, including the corpus callosum and the corona radiata (8.7 and 8.6 cc, respectively, P<0.001), as well as lower GM density in the thalamus region (0.9 cc, P<0.001). Analyses did not reveal significant associations between other tonometry measures and fractional anisotropy or GM. CONCLUSIONS Among young healthy adults, higher aortic stiffness was associated with measures of reduced white matter and GM integrity in areas implicated in cognitive decline and Alzheimer's disease. Greater aortic stiffness may result in subclinical vascular brain injury at ages much younger than previously described.
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Affiliation(s)
- Pauline Maillard
- From the Imaging of Dementia and Aging (IDeA) Laboratory, Davis, CA (P.M.); Department of Neurology and Center for Neurosciences, University of California, Davis, CA (P.M., C.D.); Cardiovascular Engineering, Inc, Norwood, MA (G.F.M.); The Framingham Heart Study, MA (J.J.H., A.B., M.P.P., C.L.S., S.S.); Boston University School of Medicine, MA (J.J.H., A.B., M.P.P., C.L.S., R.S.V., S.S.); Department of Biostatistics, Boston University School of Public Health, MA (A.B.); Cardiovascular Division, Beth Israel Deaconess Medical Center and Harvard Medical School, Boston, MA (C.W.T.); and Centre for Human Psychopharmacology, Swinburne University of Technology, Hawthorn, Australia (M.P.P.).
| | - Gary F Mitchell
- From the Imaging of Dementia and Aging (IDeA) Laboratory, Davis, CA (P.M.); Department of Neurology and Center for Neurosciences, University of California, Davis, CA (P.M., C.D.); Cardiovascular Engineering, Inc, Norwood, MA (G.F.M.); The Framingham Heart Study, MA (J.J.H., A.B., M.P.P., C.L.S., S.S.); Boston University School of Medicine, MA (J.J.H., A.B., M.P.P., C.L.S., R.S.V., S.S.); Department of Biostatistics, Boston University School of Public Health, MA (A.B.); Cardiovascular Division, Beth Israel Deaconess Medical Center and Harvard Medical School, Boston, MA (C.W.T.); and Centre for Human Psychopharmacology, Swinburne University of Technology, Hawthorn, Australia (M.P.P.)
| | - Jayandra J Himali
- From the Imaging of Dementia and Aging (IDeA) Laboratory, Davis, CA (P.M.); Department of Neurology and Center for Neurosciences, University of California, Davis, CA (P.M., C.D.); Cardiovascular Engineering, Inc, Norwood, MA (G.F.M.); The Framingham Heart Study, MA (J.J.H., A.B., M.P.P., C.L.S., S.S.); Boston University School of Medicine, MA (J.J.H., A.B., M.P.P., C.L.S., R.S.V., S.S.); Department of Biostatistics, Boston University School of Public Health, MA (A.B.); Cardiovascular Division, Beth Israel Deaconess Medical Center and Harvard Medical School, Boston, MA (C.W.T.); and Centre for Human Psychopharmacology, Swinburne University of Technology, Hawthorn, Australia (M.P.P.)
| | - Alexa Beiser
- From the Imaging of Dementia and Aging (IDeA) Laboratory, Davis, CA (P.M.); Department of Neurology and Center for Neurosciences, University of California, Davis, CA (P.M., C.D.); Cardiovascular Engineering, Inc, Norwood, MA (G.F.M.); The Framingham Heart Study, MA (J.J.H., A.B., M.P.P., C.L.S., S.S.); Boston University School of Medicine, MA (J.J.H., A.B., M.P.P., C.L.S., R.S.V., S.S.); Department of Biostatistics, Boston University School of Public Health, MA (A.B.); Cardiovascular Division, Beth Israel Deaconess Medical Center and Harvard Medical School, Boston, MA (C.W.T.); and Centre for Human Psychopharmacology, Swinburne University of Technology, Hawthorn, Australia (M.P.P.)
| | - Connie W Tsao
- From the Imaging of Dementia and Aging (IDeA) Laboratory, Davis, CA (P.M.); Department of Neurology and Center for Neurosciences, University of California, Davis, CA (P.M., C.D.); Cardiovascular Engineering, Inc, Norwood, MA (G.F.M.); The Framingham Heart Study, MA (J.J.H., A.B., M.P.P., C.L.S., S.S.); Boston University School of Medicine, MA (J.J.H., A.B., M.P.P., C.L.S., R.S.V., S.S.); Department of Biostatistics, Boston University School of Public Health, MA (A.B.); Cardiovascular Division, Beth Israel Deaconess Medical Center and Harvard Medical School, Boston, MA (C.W.T.); and Centre for Human Psychopharmacology, Swinburne University of Technology, Hawthorn, Australia (M.P.P.)
| | - Matthew P Pase
- From the Imaging of Dementia and Aging (IDeA) Laboratory, Davis, CA (P.M.); Department of Neurology and Center for Neurosciences, University of California, Davis, CA (P.M., C.D.); Cardiovascular Engineering, Inc, Norwood, MA (G.F.M.); The Framingham Heart Study, MA (J.J.H., A.B., M.P.P., C.L.S., S.S.); Boston University School of Medicine, MA (J.J.H., A.B., M.P.P., C.L.S., R.S.V., S.S.); Department of Biostatistics, Boston University School of Public Health, MA (A.B.); Cardiovascular Division, Beth Israel Deaconess Medical Center and Harvard Medical School, Boston, MA (C.W.T.); and Centre for Human Psychopharmacology, Swinburne University of Technology, Hawthorn, Australia (M.P.P.)
| | - Claudia L Satizabal
- From the Imaging of Dementia and Aging (IDeA) Laboratory, Davis, CA (P.M.); Department of Neurology and Center for Neurosciences, University of California, Davis, CA (P.M., C.D.); Cardiovascular Engineering, Inc, Norwood, MA (G.F.M.); The Framingham Heart Study, MA (J.J.H., A.B., M.P.P., C.L.S., S.S.); Boston University School of Medicine, MA (J.J.H., A.B., M.P.P., C.L.S., R.S.V., S.S.); Department of Biostatistics, Boston University School of Public Health, MA (A.B.); Cardiovascular Division, Beth Israel Deaconess Medical Center and Harvard Medical School, Boston, MA (C.W.T.); and Centre for Human Psychopharmacology, Swinburne University of Technology, Hawthorn, Australia (M.P.P.)
| | - Ramachandran S Vasan
- From the Imaging of Dementia and Aging (IDeA) Laboratory, Davis, CA (P.M.); Department of Neurology and Center for Neurosciences, University of California, Davis, CA (P.M., C.D.); Cardiovascular Engineering, Inc, Norwood, MA (G.F.M.); The Framingham Heart Study, MA (J.J.H., A.B., M.P.P., C.L.S., S.S.); Boston University School of Medicine, MA (J.J.H., A.B., M.P.P., C.L.S., R.S.V., S.S.); Department of Biostatistics, Boston University School of Public Health, MA (A.B.); Cardiovascular Division, Beth Israel Deaconess Medical Center and Harvard Medical School, Boston, MA (C.W.T.); and Centre for Human Psychopharmacology, Swinburne University of Technology, Hawthorn, Australia (M.P.P.)
| | - Sudha Seshadri
- From the Imaging of Dementia and Aging (IDeA) Laboratory, Davis, CA (P.M.); Department of Neurology and Center for Neurosciences, University of California, Davis, CA (P.M., C.D.); Cardiovascular Engineering, Inc, Norwood, MA (G.F.M.); The Framingham Heart Study, MA (J.J.H., A.B., M.P.P., C.L.S., S.S.); Boston University School of Medicine, MA (J.J.H., A.B., M.P.P., C.L.S., R.S.V., S.S.); Department of Biostatistics, Boston University School of Public Health, MA (A.B.); Cardiovascular Division, Beth Israel Deaconess Medical Center and Harvard Medical School, Boston, MA (C.W.T.); and Centre for Human Psychopharmacology, Swinburne University of Technology, Hawthorn, Australia (M.P.P.)
| | - Charles DeCarli
- From the Imaging of Dementia and Aging (IDeA) Laboratory, Davis, CA (P.M.); Department of Neurology and Center for Neurosciences, University of California, Davis, CA (P.M., C.D.); Cardiovascular Engineering, Inc, Norwood, MA (G.F.M.); The Framingham Heart Study, MA (J.J.H., A.B., M.P.P., C.L.S., S.S.); Boston University School of Medicine, MA (J.J.H., A.B., M.P.P., C.L.S., R.S.V., S.S.); Department of Biostatistics, Boston University School of Public Health, MA (A.B.); Cardiovascular Division, Beth Israel Deaconess Medical Center and Harvard Medical School, Boston, MA (C.W.T.); and Centre for Human Psychopharmacology, Swinburne University of Technology, Hawthorn, Australia (M.P.P.)
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146
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De Buyzere M. Young Adults With Stiff Arteries. Hypertension 2016; 67:490-2. [DOI: 10.1161/hypertensionaha.115.06716] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Affiliation(s)
- Marc De Buyzere
- From the Department of Cardiology, University Hospital, Ghent, Belgium
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147
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Nilsson ED, Elmståhl S, Minthon L, Nilsson PM, Pihlsgård M, Tufvesson E, Nägga K. Nonlinear association between pulse wave velocity and cognitive function: a population-based study. J Hypertens 2016; 32:2152-7; discussion 2157. [PMID: 25275244 DOI: 10.1097/hjh.0000000000000329] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/31/2023]
Abstract
BACKGROUND Arterial stiffness has been hypothesized to contribute to cognitive decline. However, previous studies have reported inconsistent results. The aim of this cross-sectional study was to investigate the association between carotid-femoral pulse wave velocity (cfPWV), a marker of arterial stiffness, and cognitive function. METHODS The study population comprised 2637 individuals from the population-based Malmö Diet and Cancer Study (mean age 72.1 years, 60.8% women). During the follow-up examinations between 2007 and 2012, cfPWV and results on the a quick test of cognitive speed (AQT) and Mini Mental State Examination (MMSE) cognitive tests were measured. RESULTS After adjustments for demographics and traditional cardiovascular risk factors, a linear association was found between cfPWV and AQT (B = 0.37; P = 0.039). On the basis of hypothesis that individuals with high cfPWV values have worse cognitive function than can be inferred from a linear association, cfPWV was dichotomized at the 90th percentile (the binary variable denoted cfPWV >13.8). When cfPWV >13.8 was added to the model, the linear association between continuous cfPWV and AQT disappeared (B = -0.08; P = 0.72), but cfPWV >13.8 was highly significant (B = 4.81; P = 0.004). In the adjusted model with MMSE as outcome variable, cfPWV >13.8 also reached a statistically significant effect. CONCLUSION Arterial stiffness was inversely associated with cognitive function in a nonlinear fashion, with individuals in the top decentile of cfPWV explaining the association. Results from linear regressions should thus be interpreted with caution because, even when statistical significance is reached, they can be explained by pronounced nonlinearity.
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Affiliation(s)
- Erik D Nilsson
- aClinical Memory Research Unit, Department of Clinical Sciences, Lund University bDivision of Geriatric Medicine, Department of Health Sciences cDepartment of Clinical Sciences, Lund University, Skåne University Hospital, Malmö, Sweden
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148
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Spartano NL, Himali JJ, Beiser AS, Lewis GD, DeCarli C, Vasan RS, Seshadri S. Midlife exercise blood pressure, heart rate, and fitness relate to brain volume 2 decades later. Neurology 2016; 86:1313-1319. [PMID: 26865519 DOI: 10.1212/wnl.0000000000002415] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/11/2015] [Accepted: 12/14/2015] [Indexed: 11/15/2022] Open
Abstract
OBJECTIVE To determine whether poor cardiovascular (CV) fitness and exaggerated exercise blood pressure (BP) and heart rate (HR) were associated with worse brain morphology in later life. METHODS Framingham Offspring participants (n = 1,094, 53.9% female) free from dementia and CV disease (CVD) underwent an exercise treadmill test at a mean age of 40 ± 9 years. A second treadmill test and MRI scans of the brain were administered 2 decades later at mean age of 58 ± 8 years. RESULTS Poor CV fitness and greater diastolic BP and HR response to exercise at baseline were associated with a smaller total cerebral brain volume (TCBV) almost 2 decades later (all p < 0.05) in multivariable adjusted models; the effect of 1 SD lower fitness was equivalent to approximately 1 additional year of brain aging in individuals free of CVD. In participants with prehypertension or hypertension at baseline, exercise systolic BP was also associated with smaller TCBV (p < 0.05). CONCLUSION Our results suggest that lower CV fitness and exaggerated exercise BP and HR responses in middle-aged adults are associated with smaller brain volume nearly 2 decades later. Promotion of midlife CV fitness may be an important step towards ensuring healthy brain aging.
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Affiliation(s)
- Nicole L Spartano
- From the Section of Preventive Medicine and Epidemiology (N.L.S., R.S.V.), The Whitaker Cardiovascular Institute (N.L.S.), and Department of Neurology (J.J.H., A.S.B., S.S.), Boston University School of Medicine; the Framingham Heart Study (N.L.S., J.J.H., A.S.B., R.S.V., S.S.); Departments of Biostatistics (A.S.B.) and Epidemiology (R.S.V.), Boston University School of Public Health; Cardiology Division (G.D.L.) and the Pulmonary and Critical Care Unit (G.D.L.), Massachusetts General Hospital, Harvard Medical School; Broad Institute of MIT & Harvard (G.D.L.), Cambridge, MA; and Department of Neurology and Center for Neuroscience (C.D.), University of California at Davis.
| | - Jayandra J Himali
- From the Section of Preventive Medicine and Epidemiology (N.L.S., R.S.V.), The Whitaker Cardiovascular Institute (N.L.S.), and Department of Neurology (J.J.H., A.S.B., S.S.), Boston University School of Medicine; the Framingham Heart Study (N.L.S., J.J.H., A.S.B., R.S.V., S.S.); Departments of Biostatistics (A.S.B.) and Epidemiology (R.S.V.), Boston University School of Public Health; Cardiology Division (G.D.L.) and the Pulmonary and Critical Care Unit (G.D.L.), Massachusetts General Hospital, Harvard Medical School; Broad Institute of MIT & Harvard (G.D.L.), Cambridge, MA; and Department of Neurology and Center for Neuroscience (C.D.), University of California at Davis
| | - Alexa S Beiser
- From the Section of Preventive Medicine and Epidemiology (N.L.S., R.S.V.), The Whitaker Cardiovascular Institute (N.L.S.), and Department of Neurology (J.J.H., A.S.B., S.S.), Boston University School of Medicine; the Framingham Heart Study (N.L.S., J.J.H., A.S.B., R.S.V., S.S.); Departments of Biostatistics (A.S.B.) and Epidemiology (R.S.V.), Boston University School of Public Health; Cardiology Division (G.D.L.) and the Pulmonary and Critical Care Unit (G.D.L.), Massachusetts General Hospital, Harvard Medical School; Broad Institute of MIT & Harvard (G.D.L.), Cambridge, MA; and Department of Neurology and Center for Neuroscience (C.D.), University of California at Davis
| | - Gregory D Lewis
- From the Section of Preventive Medicine and Epidemiology (N.L.S., R.S.V.), The Whitaker Cardiovascular Institute (N.L.S.), and Department of Neurology (J.J.H., A.S.B., S.S.), Boston University School of Medicine; the Framingham Heart Study (N.L.S., J.J.H., A.S.B., R.S.V., S.S.); Departments of Biostatistics (A.S.B.) and Epidemiology (R.S.V.), Boston University School of Public Health; Cardiology Division (G.D.L.) and the Pulmonary and Critical Care Unit (G.D.L.), Massachusetts General Hospital, Harvard Medical School; Broad Institute of MIT & Harvard (G.D.L.), Cambridge, MA; and Department of Neurology and Center for Neuroscience (C.D.), University of California at Davis
| | - Charles DeCarli
- From the Section of Preventive Medicine and Epidemiology (N.L.S., R.S.V.), The Whitaker Cardiovascular Institute (N.L.S.), and Department of Neurology (J.J.H., A.S.B., S.S.), Boston University School of Medicine; the Framingham Heart Study (N.L.S., J.J.H., A.S.B., R.S.V., S.S.); Departments of Biostatistics (A.S.B.) and Epidemiology (R.S.V.), Boston University School of Public Health; Cardiology Division (G.D.L.) and the Pulmonary and Critical Care Unit (G.D.L.), Massachusetts General Hospital, Harvard Medical School; Broad Institute of MIT & Harvard (G.D.L.), Cambridge, MA; and Department of Neurology and Center for Neuroscience (C.D.), University of California at Davis
| | - Ramachandran S Vasan
- From the Section of Preventive Medicine and Epidemiology (N.L.S., R.S.V.), The Whitaker Cardiovascular Institute (N.L.S.), and Department of Neurology (J.J.H., A.S.B., S.S.), Boston University School of Medicine; the Framingham Heart Study (N.L.S., J.J.H., A.S.B., R.S.V., S.S.); Departments of Biostatistics (A.S.B.) and Epidemiology (R.S.V.), Boston University School of Public Health; Cardiology Division (G.D.L.) and the Pulmonary and Critical Care Unit (G.D.L.), Massachusetts General Hospital, Harvard Medical School; Broad Institute of MIT & Harvard (G.D.L.), Cambridge, MA; and Department of Neurology and Center for Neuroscience (C.D.), University of California at Davis
| | - Sudha Seshadri
- From the Section of Preventive Medicine and Epidemiology (N.L.S., R.S.V.), The Whitaker Cardiovascular Institute (N.L.S.), and Department of Neurology (J.J.H., A.S.B., S.S.), Boston University School of Medicine; the Framingham Heart Study (N.L.S., J.J.H., A.S.B., R.S.V., S.S.); Departments of Biostatistics (A.S.B.) and Epidemiology (R.S.V.), Boston University School of Public Health; Cardiology Division (G.D.L.) and the Pulmonary and Critical Care Unit (G.D.L.), Massachusetts General Hospital, Harvard Medical School; Broad Institute of MIT & Harvard (G.D.L.), Cambridge, MA; and Department of Neurology and Center for Neuroscience (C.D.), University of California at Davis
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Kim YB, Park KY, Chung PW, Kim JM, Moon HS, Youn YC. Brachial-ankle pulse wave velocity is associated with both acute and chronic cerebral small vessel disease. Atherosclerosis 2016; 245:54-9. [DOI: 10.1016/j.atherosclerosis.2015.12.006] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/09/2015] [Revised: 12/01/2015] [Accepted: 12/02/2015] [Indexed: 10/22/2022]
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150
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Hughes TM, Sink KM. Hypertension and Its Role in Cognitive Function: Current Evidence and Challenges for the Future. Am J Hypertens 2016; 29:149-57. [PMID: 26563965 DOI: 10.1093/ajh/hpv180] [Citation(s) in RCA: 86] [Impact Index Per Article: 10.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/28/2015] [Accepted: 10/06/2015] [Indexed: 12/17/2022] Open
Abstract
This review summarizes evidence from studies of blood pressure and dementia-related biomarkers into our understanding of cognitive health and highlights the challenges facing studies, particularly randomized trials, of hypertension and cognition. Several lines of research suggest that elevated blood pressure, especially at midlife, is associated with cognitive decline and dementia and that treatment of hypertension could prevent these conditions. Further, studies of hypertension and brain structure show that blood pressure is associated with several forms of small vessel disease that can result in vascular dementia or interact with Alzheimer's pathology to lower the pathologic threshold at which Alzheimer's signs and symptoms manifest. In addition, recent studies of hypertension and Alzheimer's biomarkers show that elevated blood pressure and pulse pressure are associated with the extent of brain beta amyloid (Aβ) deposition and altered cerebral spinal fluid profiles of Aβ and tau indicative of Alzheimer's pathology. However, in spite of strong evidence of biological mechanisms, results from randomized trials of antihypertensive therapy for the prevention of cardiovascular or cerebrovascular disease that include cognitive endpoints do not strongly support the observational evidence that treatment of hypertension should be better for cognition. We propose that future clinical trials should consider including dementia biomarkers and assess genetic and cardiometabolic risk factors that have been associated with progression of the underlying disease pathology to help bridge these gaps.
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Affiliation(s)
- Timothy M Hughes
- Department of Internal Medicine, Division of Gerontology and Geriatric Medicine, Wake Forest School of Medicine, Winston-Salem, North Carolina, USA
| | - Kaycee M Sink
- Department of Internal Medicine, Division of Gerontology and Geriatric Medicine, Wake Forest School of Medicine, Winston-Salem, North Carolina, USA.
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