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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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Abstract
BACKGROUND Previous literature indicates that flow-mediated dilation (FMD) is associated with impaired cognition among patients with stroke. The relationship between FMD and cognition in individuals without cerebrovascular disease has yet to be systematically reviewed. METHODS The literature was searched using MEDLINE. Exclusion criteria were as follows: focus on neurological disease (e.g., stroke), animal studies, no quantitative measure of endothelial function or cognition, newborn studies, articles with no original data, and articles that are irrelevant to the topic of interest. Neurocognitive tests were categorized in the following domains: executive function, memory (general, working, episodic/semantic, verbal, visual), global cognitive function, information processing speed, language, psychomotor speed, and visual-spatial ability. RESULTS The search yielded 700 articles, of which 10 articles, consisting of 2791 participants, met the criteria for inclusion. Most studies conclude that impaired FMD is associated with poorer neuropsychological functioning, particularly in executive functioning (effect sizes: r = 0.07-0.58) and working memory tasks (effect sizes: r = 0.19-0.39). No association was found between other subdomains of memory and FMD. Visual spatial tasks, information processing speed, language tasks, and global cognition were not associated with FMD overall; however fewer studies examined these domains. CONCLUSIONS Even in the absence of cerebrovascular disease, there are links between cognition, particularly executive tasks, and vascular function. Public health implications include the potential value of examining FMD as a predictor of cognitive decline, as well as the potential value of improving cognition through pharmacological and behavioral interventions that improve vascular function. Future studies incorporating neuroimaging measures of cerebral blood flow are warranted.
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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: 93] [Impact Index Per Article: 11.6] [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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Tsao CW, Himali JJ, Beiser AS, Larson MG, DeCarli C, Vasan RS, Mitchell GF, Seshadri S. Association of arterial stiffness with progression of subclinical brain and cognitive disease. Neurology 2016; 86:619-26. [PMID: 26791155 DOI: 10.1212/wnl.0000000000002368] [Citation(s) in RCA: 91] [Impact Index Per Article: 11.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/28/2015] [Accepted: 10/27/2015] [Indexed: 11/15/2022] Open
Abstract
OBJECTIVE We tested whether abnormal arterial stiffness and blood pressure would be associated with progression of brain aging measured by brain MRI and neurocognitive testing. METHODS Framingham Offspring Cohort participants (n = 1,223, 61 ± 9 years, 56% women) without previous stroke or dementia underwent applanation tonometry, brain MRI, and neurocognitive testing at examination 7 (1998-2001). Follow-up brain MRI and neurocognitive testing was performed at examination 8 (2005-2008, mean interval 6.4 ± 1.3 years). We related examination 7 inverse-transformed carotid-femoral pulse wave velocity (iCFPWV), central pulse pressure (CPP), and mean arterial pressure to changes in the following variables between examinations 7 and 8: total cerebral brain volume, white matter hyperintensity volume, and performance on executive function and abstraction tasks, the Trail Making Test, Parts B and A (ΔTrails B-A), and Similarities tests. RESULTS Higher baseline iCFPWV and CPP were associated with greater progression of neurocognitive decline (iCFPWV and ΔTrails B-A association: SD unit change in outcome variable per SD change in tonometry variable [β] ± SE = 0.10 ± 0.04, p = 0.019; CPP and ΔSimilarities association: -0.08 ± 0.03, p = 0.013). Higher mean arterial pressure, but not iCFPWV or CPP, was associated with increase in white matter hyperintensity volume ([β ± SE] 0.07 ± 0.03, p = 0.017). No tonometry measures were associated with change in cerebral brain volume. CONCLUSIONS In middle-aged and older adults without evidence of clinical stroke or dementia, elevated arterial stiffness and pressure pulsatility are associated with longitudinal progression of subclinical vascular brain injury and greater neurocognitive decline. Treatments to reduce arterial stiffness may potentially reduce the progression of neurovascular disease and cognitive decline.
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Affiliation(s)
- Connie W Tsao
- From the Department of Medicine (C.W.T.), Cardiovascular Division, Beth Israel Deaconess Medical Center, Boston, MA; Departments of Neurology (J.J.H., A.S.B., S.S.) and Medicine (R.S.V.), School of Medicine, Departments of Biostatistics (J.J.H., A.S.B.) and Epidemiology (R.S.V.), School of Public Health, and the Department of Mathematics and Statistics (M.G.L.), Boston University, Boston, MA; Department of Neurology and Center for Neuroscience and Division of Biostatistics (C.D.), Department of Public Health Sciences, School of Medicine, University of California, Davis, CA; The Framingham Heart Study (C.W.T., J.J.H., A.S.B., M.G.L., R.S.V., S.S.), Framingham, MA; and Cardiovascular Engineering Inc. (G.F.M.), Norwood, MA.
| | - Jayandra J Himali
- From the Department of Medicine (C.W.T.), Cardiovascular Division, Beth Israel Deaconess Medical Center, Boston, MA; Departments of Neurology (J.J.H., A.S.B., S.S.) and Medicine (R.S.V.), School of Medicine, Departments of Biostatistics (J.J.H., A.S.B.) and Epidemiology (R.S.V.), School of Public Health, and the Department of Mathematics and Statistics (M.G.L.), Boston University, Boston, MA; Department of Neurology and Center for Neuroscience and Division of Biostatistics (C.D.), Department of Public Health Sciences, School of Medicine, University of California, Davis, CA; The Framingham Heart Study (C.W.T., J.J.H., A.S.B., M.G.L., R.S.V., S.S.), Framingham, MA; and Cardiovascular Engineering Inc. (G.F.M.), Norwood, MA
| | - Alexa S Beiser
- From the Department of Medicine (C.W.T.), Cardiovascular Division, Beth Israel Deaconess Medical Center, Boston, MA; Departments of Neurology (J.J.H., A.S.B., S.S.) and Medicine (R.S.V.), School of Medicine, Departments of Biostatistics (J.J.H., A.S.B.) and Epidemiology (R.S.V.), School of Public Health, and the Department of Mathematics and Statistics (M.G.L.), Boston University, Boston, MA; Department of Neurology and Center for Neuroscience and Division of Biostatistics (C.D.), Department of Public Health Sciences, School of Medicine, University of California, Davis, CA; The Framingham Heart Study (C.W.T., J.J.H., A.S.B., M.G.L., R.S.V., S.S.), Framingham, MA; and Cardiovascular Engineering Inc. (G.F.M.), Norwood, MA
| | - Martin G Larson
- From the Department of Medicine (C.W.T.), Cardiovascular Division, Beth Israel Deaconess Medical Center, Boston, MA; Departments of Neurology (J.J.H., A.S.B., S.S.) and Medicine (R.S.V.), School of Medicine, Departments of Biostatistics (J.J.H., A.S.B.) and Epidemiology (R.S.V.), School of Public Health, and the Department of Mathematics and Statistics (M.G.L.), Boston University, Boston, MA; Department of Neurology and Center for Neuroscience and Division of Biostatistics (C.D.), Department of Public Health Sciences, School of Medicine, University of California, Davis, CA; The Framingham Heart Study (C.W.T., J.J.H., A.S.B., M.G.L., R.S.V., S.S.), Framingham, MA; and Cardiovascular Engineering Inc. (G.F.M.), Norwood, MA
| | - Charles DeCarli
- From the Department of Medicine (C.W.T.), Cardiovascular Division, Beth Israel Deaconess Medical Center, Boston, MA; Departments of Neurology (J.J.H., A.S.B., S.S.) and Medicine (R.S.V.), School of Medicine, Departments of Biostatistics (J.J.H., A.S.B.) and Epidemiology (R.S.V.), School of Public Health, and the Department of Mathematics and Statistics (M.G.L.), Boston University, Boston, MA; Department of Neurology and Center for Neuroscience and Division of Biostatistics (C.D.), Department of Public Health Sciences, School of Medicine, University of California, Davis, CA; The Framingham Heart Study (C.W.T., J.J.H., A.S.B., M.G.L., R.S.V., S.S.), Framingham, MA; and Cardiovascular Engineering Inc. (G.F.M.), Norwood, MA
| | - Ramachandran S Vasan
- From the Department of Medicine (C.W.T.), Cardiovascular Division, Beth Israel Deaconess Medical Center, Boston, MA; Departments of Neurology (J.J.H., A.S.B., S.S.) and Medicine (R.S.V.), School of Medicine, Departments of Biostatistics (J.J.H., A.S.B.) and Epidemiology (R.S.V.), School of Public Health, and the Department of Mathematics and Statistics (M.G.L.), Boston University, Boston, MA; Department of Neurology and Center for Neuroscience and Division of Biostatistics (C.D.), Department of Public Health Sciences, School of Medicine, University of California, Davis, CA; The Framingham Heart Study (C.W.T., J.J.H., A.S.B., M.G.L., R.S.V., S.S.), Framingham, MA; and Cardiovascular Engineering Inc. (G.F.M.), Norwood, MA
| | - Gary F Mitchell
- From the Department of Medicine (C.W.T.), Cardiovascular Division, Beth Israel Deaconess Medical Center, Boston, MA; Departments of Neurology (J.J.H., A.S.B., S.S.) and Medicine (R.S.V.), School of Medicine, Departments of Biostatistics (J.J.H., A.S.B.) and Epidemiology (R.S.V.), School of Public Health, and the Department of Mathematics and Statistics (M.G.L.), Boston University, Boston, MA; Department of Neurology and Center for Neuroscience and Division of Biostatistics (C.D.), Department of Public Health Sciences, School of Medicine, University of California, Davis, CA; The Framingham Heart Study (C.W.T., J.J.H., A.S.B., M.G.L., R.S.V., S.S.), Framingham, MA; and Cardiovascular Engineering Inc. (G.F.M.), Norwood, MA
| | - Sudha Seshadri
- From the Department of Medicine (C.W.T.), Cardiovascular Division, Beth Israel Deaconess Medical Center, Boston, MA; Departments of Neurology (J.J.H., A.S.B., S.S.) and Medicine (R.S.V.), School of Medicine, Departments of Biostatistics (J.J.H., A.S.B.) and Epidemiology (R.S.V.), School of Public Health, and the Department of Mathematics and Statistics (M.G.L.), Boston University, Boston, MA; Department of Neurology and Center for Neuroscience and Division of Biostatistics (C.D.), Department of Public Health Sciences, School of Medicine, University of California, Davis, CA; The Framingham Heart Study (C.W.T., J.J.H., A.S.B., M.G.L., R.S.V., S.S.), Framingham, MA; and Cardiovascular Engineering Inc. (G.F.M.), Norwood, MA
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Gregory MA, Gill DP, Shellington EM, Liu-Ambrose T, Shigematsu R, Zou G, Shoemaker K, Owen AM, Hachinski V, Stuckey M, Petrella RJ. Group-based exercise and cognitive-physical training in older adults with self-reported cognitive complaints: The Multiple-Modality, Mind-Motor (M4) study protocol. BMC Geriatr 2016; 16:17. [PMID: 26772171 PMCID: PMC4715303 DOI: 10.1186/s12877-016-0190-9] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/13/2015] [Accepted: 01/06/2016] [Indexed: 12/15/2022] Open
Abstract
Background Dementia is associated with cognitive and functional deficits, and poses a significant personal, societal, and economic burden. Directing interventions towards older adults with self-reported cognitive complaints may provide the greatest impact on dementia incidence and prevalence. Risk factors for cognitive and functional deficits are multifactorial in nature; many are cardiovascular disease risk factors and are lifestyle-mediated. Evidence suggests that multiple-modality exercise programs can provide cognitive and functional benefits that extend beyond what can be achieved from cognitive, aerobic, or resistance training alone, and preliminary evidence suggests that novel mind-motor interventions (i.e., Square Stepping Exercise; SSE) can benefit cognition and functional fitness. Nevertheless, it remains unclear whether multiple-modality exercise combined with mind-motor interventions can benefit diverse cognitive and functional outcomes in older adults with cognitive complaints. Methods/Design The Multiple-Modality, Mind-Motor (M4) study is a randomized controlled trial investigating the cognitive and functional impact of combined physical and cognitive training among community-dwelling adults with self-reported cognitive complaints who are 55 years of age or older. Participants are randomized to a Multiple-Modality and Mind-Motor (M4) intervention group or a Multiple-Modality (M2) comparison group. Participants exercise for 60 minutes/day, 3-days/week for 24 weeks and are assessed at baseline, 24 weeks and 52 weeks. The primary outcome is global cognitive function at 24 weeks, derived from the Cambridge Brain Sciences computerized cognitive battery. Secondary outcomes are: i) global cognitive function at 52 weeks; ii) domain-specific cognitive function at 24 and 52 weeks; iii) mobility (gait characteristics under single and dual-task conditions and balance); and 3) vascular health (blood pressure and carotid arterial measurements). We will analyze data based on an intent-to-treat approach, using mixed models for repeated measurements. Discussion The design features of the M4 trial and the methods included to address previous limitations within cognitive and exercise research will be discussed. Results from the M4 trial will provide evidence of combined multiple-modality and cognitive training among older adults with self-reported cognitive complaints on cognitive, mobility-related and vascular outcomes. Trial Registration ClinicalTrials.gov NCT02136368.
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Affiliation(s)
- Michael A Gregory
- Health and Rehabilitation Sciences, Western University, London, ON, Canada. .,Lawson Health Research Institute, London, ON, Canada.
| | - Dawn P Gill
- Lawson Health Research Institute, London, ON, Canada. .,Department of Family Medicine, Western University, London, ON, Canada. .,Department of Epidemiology, University of Washington, Seattle, WA, USA.
| | - Erin M Shellington
- Lawson Health Research Institute, London, ON, Canada. .,School of Kinesiology, Western University, London, ON, Canada.
| | - Teresa Liu-Ambrose
- Department of Physical Therapy, University of British Columbia, Vancouver, BC, Canada. .,Djavad Mowafaghian Centre for Brain Health, Vancouver, BC, Canada.
| | | | - Guangyong Zou
- Robarts Clinical Trials of Robarts Research Institute, Western University, London, ON, Canada. .,Department of Epidemiology and Biostatistics, Western University, London, ON, Canada.
| | - Kevin Shoemaker
- School of Kinesiology, Western University, London, ON, Canada.
| | - Adrian M Owen
- The Brain and Mind Institute, Western University, London, ON, Canada.
| | - Vladimir Hachinski
- Department of Clinical Neurological Sciences, Western University, London, ON, Canada.
| | - Melanie Stuckey
- Canadian Centre for Activity and Aging, Faculty of Health Sciences, Western University, London, ON, Canada.
| | - Robert J Petrella
- Lawson Health Research Institute, London, ON, Canada. .,Department of Family Medicine, Western University, London, ON, Canada. .,School of Kinesiology, Western University, London, ON, Canada. .,Canadian Centre for Activity and Aging, Faculty of Health Sciences, Western University, London, ON, Canada. .,Centre for Studies in Family Medicine, Western Centre for Public Health and Family Medicine, Second Floor, Western University, 1465 Richmond St., London, ON, N6G 2M1, Canada.
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Hughes TM, Craft S, Lopez OL. Review of 'the potential role of arterial stiffness in the pathogenesis of Alzheimer's disease'. Neurodegener Dis Manag 2016; 5:121-35. [PMID: 25894876 DOI: 10.2217/nmt.14.53] [Citation(s) in RCA: 59] [Impact Index Per Article: 7.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/06/2023] Open
Abstract
Arterial stiffness is emerging as an important risk marker for poor brain aging and dementia through its associations with cerebral small vessel disease, stroke, β-amyloid deposition, brain atrophy and cognitive impairment. Arterial stiffness directly relates the detrimental effects of hypertension on peripheral organs with dire consequences for the extensive microvasculature structure of the kidneys and brain. In this review, we discuss the evidence linking arterial stiffness, hypertension and brain structural abnormalities in older adults. In particular, we discuss the potential mechanisms linking arterial stiffness to brain β-amyloid deposition and dementia and potential therapeutic strategies to prevent hypertension's adverse effects on the brain.
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Affiliation(s)
- Timothy M Hughes
- Department of Internal Medicine, Division of Gerontology & Geriatric Medicine, Wake Forest School of Medicine, Medical Center Boulevard, Winston-Salem, NC 27157-1207, USA
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Pase MP, Himali JJ, Mitchell GF, Beiser A, Maillard P, Tsao C, Larson MG, DeCarli C, Vasan RS, Seshadri S. Association of Aortic Stiffness With Cognition and Brain Aging in Young and Middle-Aged Adults: The Framingham Third Generation Cohort Study. Hypertension 2016; 67:513-9. [PMID: 26754644 DOI: 10.1161/hypertensionaha.115.06610] [Citation(s) in RCA: 110] [Impact Index Per Article: 13.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/06/2015] [Accepted: 11/17/2015] [Indexed: 12/28/2022]
Abstract
Aortic stiffness is associated with cognitive decline and cerebrovascular disease late in life, although these associations have not been examined in young adults. Understanding the effects of aortic stiffness on the brain at a young age is important both from a pathophysiological and public health perspective. The aim of this study was to examine the cross-sectional associations of aortic stiffness with cognitive function and brain aging in the Framingham Heart Study Third Generation cohort (47% men; mean age, 46 years). Participants completed the assessment of aortic stiffness (carotid-femoral pulse wave velocity), a neuropsychological test battery assessing multiple domains of cognitive performance and magnetic resonance imaging to examine subclinical markers of brain injury. In adjusted regression models, higher aortic stiffness was associated with poorer processing speed and executive function (Trail Making B-A; β±SE, -0.08±0.03; P<0.01), larger lateral ventricular volumes (β±SE, 0.09±0.03; P<0.01) and a greater burden of white-matter hyperintensities (β±SE, 0.09±0.03; P<0.001). When stratifying by age, aortic stiffness was associated with lateral ventricular volume in young adults (30-45 years), whereas aortic stiffness was associated with white-matter injury and cognition in midlife (45-65 years). In conclusion, aortic stiffness was associated with cognitive function and markers of subclinical brain injury in young to middle-aged adults. Prospective studies are needed to examine whether aortic stiffening in young adulthood is associated with vascular cognitive impairment later in life.
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Affiliation(s)
- Matthew P Pase
- From the Department of Neurology, Boston University School of Medicine, MA (M.P.P., J.J.H., A.B., S.S.); Framingham Heart Study, MA (M.P.P., J.J.H., G.F.M., A.B., M.G.L., R.S.V., S.S.); Centre for Human Psychopharmacology, Swinburne University of Technology, Melbourne, Victoria, Australia (M.P.P.); Cardiovascular Engineering Inc, Norwood, MA (G.F.M.); Department of Biostatistics, Boston University School of Public Health, MA (A.B.); Department of Neurology, School of Medicine and Imaging of Dementia and Aging Laboratory, Center for Neuroscience, University of California Davis, Sacramento (P.M., C.D.); and Cardiovascular Division, Department of Medicine, Beth Israel Deaconess Medical Centre, Boston, MA (C.T.).
| | - Jayandra J Himali
- From the Department of Neurology, Boston University School of Medicine, MA (M.P.P., J.J.H., A.B., S.S.); Framingham Heart Study, MA (M.P.P., J.J.H., G.F.M., A.B., M.G.L., R.S.V., S.S.); Centre for Human Psychopharmacology, Swinburne University of Technology, Melbourne, Victoria, Australia (M.P.P.); Cardiovascular Engineering Inc, Norwood, MA (G.F.M.); Department of Biostatistics, Boston University School of Public Health, MA (A.B.); Department of Neurology, School of Medicine and Imaging of Dementia and Aging Laboratory, Center for Neuroscience, University of California Davis, Sacramento (P.M., C.D.); and Cardiovascular Division, Department of Medicine, Beth Israel Deaconess Medical Centre, Boston, MA (C.T.)
| | - Gary F Mitchell
- From the Department of Neurology, Boston University School of Medicine, MA (M.P.P., J.J.H., A.B., S.S.); Framingham Heart Study, MA (M.P.P., J.J.H., G.F.M., A.B., M.G.L., R.S.V., S.S.); Centre for Human Psychopharmacology, Swinburne University of Technology, Melbourne, Victoria, Australia (M.P.P.); Cardiovascular Engineering Inc, Norwood, MA (G.F.M.); Department of Biostatistics, Boston University School of Public Health, MA (A.B.); Department of Neurology, School of Medicine and Imaging of Dementia and Aging Laboratory, Center for Neuroscience, University of California Davis, Sacramento (P.M., C.D.); and Cardiovascular Division, Department of Medicine, Beth Israel Deaconess Medical Centre, Boston, MA (C.T.)
| | - Alexa Beiser
- From the Department of Neurology, Boston University School of Medicine, MA (M.P.P., J.J.H., A.B., S.S.); Framingham Heart Study, MA (M.P.P., J.J.H., G.F.M., A.B., M.G.L., R.S.V., S.S.); Centre for Human Psychopharmacology, Swinburne University of Technology, Melbourne, Victoria, Australia (M.P.P.); Cardiovascular Engineering Inc, Norwood, MA (G.F.M.); Department of Biostatistics, Boston University School of Public Health, MA (A.B.); Department of Neurology, School of Medicine and Imaging of Dementia and Aging Laboratory, Center for Neuroscience, University of California Davis, Sacramento (P.M., C.D.); and Cardiovascular Division, Department of Medicine, Beth Israel Deaconess Medical Centre, Boston, MA (C.T.)
| | - Pauline Maillard
- From the Department of Neurology, Boston University School of Medicine, MA (M.P.P., J.J.H., A.B., S.S.); Framingham Heart Study, MA (M.P.P., J.J.H., G.F.M., A.B., M.G.L., R.S.V., S.S.); Centre for Human Psychopharmacology, Swinburne University of Technology, Melbourne, Victoria, Australia (M.P.P.); Cardiovascular Engineering Inc, Norwood, MA (G.F.M.); Department of Biostatistics, Boston University School of Public Health, MA (A.B.); Department of Neurology, School of Medicine and Imaging of Dementia and Aging Laboratory, Center for Neuroscience, University of California Davis, Sacramento (P.M., C.D.); and Cardiovascular Division, Department of Medicine, Beth Israel Deaconess Medical Centre, Boston, MA (C.T.)
| | - Connie Tsao
- From the Department of Neurology, Boston University School of Medicine, MA (M.P.P., J.J.H., A.B., S.S.); Framingham Heart Study, MA (M.P.P., J.J.H., G.F.M., A.B., M.G.L., R.S.V., S.S.); Centre for Human Psychopharmacology, Swinburne University of Technology, Melbourne, Victoria, Australia (M.P.P.); Cardiovascular Engineering Inc, Norwood, MA (G.F.M.); Department of Biostatistics, Boston University School of Public Health, MA (A.B.); Department of Neurology, School of Medicine and Imaging of Dementia and Aging Laboratory, Center for Neuroscience, University of California Davis, Sacramento (P.M., C.D.); and Cardiovascular Division, Department of Medicine, Beth Israel Deaconess Medical Centre, Boston, MA (C.T.)
| | - Martin G Larson
- From the Department of Neurology, Boston University School of Medicine, MA (M.P.P., J.J.H., A.B., S.S.); Framingham Heart Study, MA (M.P.P., J.J.H., G.F.M., A.B., M.G.L., R.S.V., S.S.); Centre for Human Psychopharmacology, Swinburne University of Technology, Melbourne, Victoria, Australia (M.P.P.); Cardiovascular Engineering Inc, Norwood, MA (G.F.M.); Department of Biostatistics, Boston University School of Public Health, MA (A.B.); Department of Neurology, School of Medicine and Imaging of Dementia and Aging Laboratory, Center for Neuroscience, University of California Davis, Sacramento (P.M., C.D.); and Cardiovascular Division, Department of Medicine, Beth Israel Deaconess Medical Centre, Boston, MA (C.T.)
| | - Charles DeCarli
- From the Department of Neurology, Boston University School of Medicine, MA (M.P.P., J.J.H., A.B., S.S.); Framingham Heart Study, MA (M.P.P., J.J.H., G.F.M., A.B., M.G.L., R.S.V., S.S.); Centre for Human Psychopharmacology, Swinburne University of Technology, Melbourne, Victoria, Australia (M.P.P.); Cardiovascular Engineering Inc, Norwood, MA (G.F.M.); Department of Biostatistics, Boston University School of Public Health, MA (A.B.); Department of Neurology, School of Medicine and Imaging of Dementia and Aging Laboratory, Center for Neuroscience, University of California Davis, Sacramento (P.M., C.D.); and Cardiovascular Division, Department of Medicine, Beth Israel Deaconess Medical Centre, Boston, MA (C.T.)
| | - Ramachandran S Vasan
- From the Department of Neurology, Boston University School of Medicine, MA (M.P.P., J.J.H., A.B., S.S.); Framingham Heart Study, MA (M.P.P., J.J.H., G.F.M., A.B., M.G.L., R.S.V., S.S.); Centre for Human Psychopharmacology, Swinburne University of Technology, Melbourne, Victoria, Australia (M.P.P.); Cardiovascular Engineering Inc, Norwood, MA (G.F.M.); Department of Biostatistics, Boston University School of Public Health, MA (A.B.); Department of Neurology, School of Medicine and Imaging of Dementia and Aging Laboratory, Center for Neuroscience, University of California Davis, Sacramento (P.M., C.D.); and Cardiovascular Division, Department of Medicine, Beth Israel Deaconess Medical Centre, Boston, MA (C.T.)
| | - Sudha Seshadri
- From the Department of Neurology, Boston University School of Medicine, MA (M.P.P., J.J.H., A.B., S.S.); Framingham Heart Study, MA (M.P.P., J.J.H., G.F.M., A.B., M.G.L., R.S.V., S.S.); Centre for Human Psychopharmacology, Swinburne University of Technology, Melbourne, Victoria, Australia (M.P.P.); Cardiovascular Engineering Inc, Norwood, MA (G.F.M.); Department of Biostatistics, Boston University School of Public Health, MA (A.B.); Department of Neurology, School of Medicine and Imaging of Dementia and Aging Laboratory, Center for Neuroscience, University of California Davis, Sacramento (P.M., C.D.); and Cardiovascular Division, Department of Medicine, Beth Israel Deaconess Medical Centre, Boston, MA (C.T.)
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Vascular Dementia and Cognitive Impairment. Stroke 2016. [DOI: 10.1016/b978-0-323-29544-4.00017-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
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Thorin-Trescases N, Thorin E. Lifelong Cyclic Mechanical Strain Promotes Large Elastic Artery Stiffening: Increased Pulse Pressure and Old Age-Related Organ Failure. Can J Cardiol 2015; 32:624-33. [PMID: 26961664 DOI: 10.1016/j.cjca.2015.12.022] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/24/2015] [Revised: 12/02/2015] [Accepted: 12/14/2015] [Indexed: 01/08/2023] Open
Abstract
The arterial wall is under a huge mechanical constraint imposed by the cardiac cycle that is bound to generate damage with time. Each heartbeat indeed imposes a pulsatile pressure that generates a vascular stretch. Lifetime accumulation of pulsatile stretches will eventually induce fatigue of the elastic large arterial walls, such as aortic and carotid artery walls, promoting their stiffening that will gradually perturb the normal blood flow and local pressure within the organs, and lead to organ failure. The augmented pulse pressure induced by arterial stiffening favours left ventricular hypertrophy because of the repeated extra work against stiff high-pressure arteries, and tissue damage as a result of excessive pulsatile pressure transmitted into the microcirculation, especially in low resistance/high-flow organs such as the brain and kidneys. Vascular aging is therefore characterized by the stiffening of large elastic arteries leading to a gradual increase in pulse pressure with age. In this review we focus on the effect of age-related stiffening of large elastic arteries. We report the clinical evidence linking arterial stiffness and organ failure and discuss the molecular pathways that are activated by the increase of mechanical stress in the wall. We also discuss the possible interventions that could limit arterial stiffening with age, such as regular aerobic exercise training, and some pharmacological approaches.
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Affiliation(s)
| | - Eric Thorin
- Montreal Heart Institute, Research Center, Montreal, Quebéc, Canada; Department of Surgery, Faculty of Medicine, Université de Montréal, Montreal, Quebéc, Canada.
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Gregory MA, Gill DP, Zou G, Liu-Ambrose T, Shigematsu R, Fitzgerald C, Hachinski V, Shoemaker K, Petrella RJ. Group-based exercise combined with dual-task training improves gait but not vascular health in active older adults without dementia. Arch Gerontol Geriatr 2015; 63:18-27. [PMID: 26791167 DOI: 10.1016/j.archger.2015.11.008] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/03/2015] [Revised: 11/12/2015] [Accepted: 11/14/2015] [Indexed: 12/01/2022]
Abstract
BACKGROUND Gait abnormalities and vascular disease risk factors are associated with cognitive impairment in aging. OBJECTIVE To determine the impact of group-based exercise and dual-task training on gait and vascular health, in active community-dwelling older adults without dementia. METHODS Participants [n=44, mean (SD) age: 73.5 (7.2) years, 68% female] were randomized to either intervention (exercise+dual-task; EDT) or control (exercise only; EO). Each week, for 26 weeks, both groups accumulated 50 or 75 min of aerobic exercise from group-based classes and 45 min of beginner-level square stepping exercise (SSE). Participants accumulating only 50 min of aerobic exercise were instructed to participate in an additional 25 min each week outside of class. The EDT group also answered cognitively challenging questions while performing SSE (i.e., dual-task training). The effect of the interventions on gait and vascular health was compared between groups using linear mixed effects models. RESULTS At 26 weeks, the EDT group demonstrated increased dual-task (DT) gait velocity [difference between groups in mean change from baseline (95% CI): 0.29 m/s (0.16-0.43), p<0.001], DT step length [5.72 cm (2.19-9.24), p =0.002], and carotid intima-media thickness [0.10mm (0.003-0.20), p=0.04], as well as reduced DT stride time variability [8.31 coefficient of variation percentage points (-12.92 to -3.70), p<0.001], when compared to the EO group. CONCLUSIONS Group-based exercise combined with dual-task training can improve DT gait characteristics in active older adults without dementia.
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Affiliation(s)
- Michael A Gregory
- Health & Rehabilitation Sciences, Faculty of Health Sciences, Western University, London, ON, Canada; Lawson Health Research Institute, London, ON, Canada.
| | - Dawn P Gill
- Health & Rehabilitation Sciences, Faculty of Health Sciences, Western University, London, ON, Canada; Lawson Health Research Institute, London, ON, Canada; Department of Family Medicine, Schulich School of Medicine & Dentistry, Western University, ON, Canada; Department of Epidemiology, School of Public Health, University of Washington, Seattle, WA, USA.
| | - Guangyong Zou
- Department of Epidemiology and Biostatistics, Schulich School of Medicine & Dentistry, Western University, London, ON, Canada; Robarts Clinical Trials, Robarts Research Institute, Western University, London, 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.
| | | | - Clara Fitzgerald
- Canadian Centre for Activity and Aging, Faculty of Health Sciences, Western University, London, ON, Canada.
| | - Vladimir Hachinski
- Department of Clinical Neurological Sciences, Schulich School of Medicine & Dentistry, Western University, London, ON, Canada.
| | - Kevin Shoemaker
- Department of Kinesiology, Faculty of Health Sciences, Western University, London, ON, Canada.
| | - Robert J Petrella
- Health & Rehabilitation Sciences, Faculty of Health Sciences, Western University, London, ON, Canada; Lawson Health Research Institute, London, ON, Canada; Department of Family Medicine, Schulich School of Medicine & Dentistry, Western University, ON, Canada; Canadian Centre for Activity and Aging, Faculty of Health Sciences, Western University, London, ON, Canada; Department of Kinesiology, Faculty of Health Sciences, Western University, London, ON, Canada.
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161
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Hughes TM, Craft S. The role of insulin in the vascular contributions to age-related dementia. Biochim Biophys Acta Mol Basis Dis 2015; 1862:983-91. [PMID: 26657615 DOI: 10.1016/j.bbadis.2015.11.013] [Citation(s) in RCA: 52] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/01/2015] [Revised: 11/17/2015] [Accepted: 11/29/2015] [Indexed: 01/12/2023]
Abstract
In addition to its well-known role in energy metabolism in the body, insulin is a vasoactive hormone that regulates peripheral and cerebral blood flow and neuronal function. Vascular and metabolic dysfunctions are emerging risk factors for Alzheimer's disease (AD) and age-related dementias, and recent evidence suggests that the two pathways are constitutive and interrelated. As a result, an emphasis on correcting metabolic disorders is emerging as an important strategy in the treatment and prevention of age-related cognitive impairment and AD. We review the evidence regarding the unique and interactive effects of vascular and metabolic disorders in pathological brain aging, with special consideration of the role of insulin dysregulation in promoting AD pathologic processes and vascular brain injury. This article is part of a Special Issue entitled: Vascular Contributions to Cognitive Impairment and Dementia edited by M. Paul Murphy, Roderick A. Corriveau and Donna M. Wilcock.
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Affiliation(s)
- Timothy M Hughes
- Department of Internal Medicine, Section on Gerontology and Geriatric Medicine, Wake Forest School of Medicine, Wake Forest University, USA
| | - Suzanne Craft
- Department of Internal Medicine, Section on Gerontology and Geriatric Medicine, Wake Forest School of Medicine, Wake Forest University, USA.
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Lim SL, Gao Q, Nyunt MSZ, Gong L, Lunaria JB, Lim ML, Ling A, Lam CSP, Richards AM, Ling LH, Ng TP. Vascular Health Indices and Cognitive Domain Function: Singapore Longitudinal Ageing Studies. J Alzheimers Dis 2015; 50:27-40. [DOI: 10.3233/jad-150516] [Citation(s) in RCA: 31] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/21/2023]
Affiliation(s)
- Shir Lynn Lim
- Department of Cardiology, National University Heart Center, Singapore
| | - Qi Gao
- Gerontology Research Programme, Department of Psychological Medicine, Yong Loo Lin School of Medicine, National University of Singapore, Singapore
| | - Ma Shwe Zin Nyunt
- Gerontology Research Programme, Department of Psychological Medicine, Yong Loo Lin School of Medicine, National University of Singapore, Singapore
| | - Lingli Gong
- Department of Medicine, Yong Loo Lin School of Medicine, National University of Singapore, Singapore
| | - Josephine B. Lunaria
- Department of Medicine, Yong Loo Lin School of Medicine, National University of Singapore, Singapore
| | - May Li Lim
- Gerontology Research Programme, Department of Psychological Medicine, Yong Loo Lin School of Medicine, National University of Singapore, Singapore
| | - Audrey Ling
- Gerontology Research Programme, Department of Psychological Medicine, Yong Loo Lin School of Medicine, National University of Singapore, Singapore
| | - Carolyn Su-Ping Lam
- Department of Cardiology, National University Heart Center, Singapore
- Department of Medicine, Yong Loo Lin School of Medicine, National University of Singapore, Singapore
- Department of Cardiology, National Heart Center, Singapore
- Cardiovascular and Metabolic Disorders Program, Duke-NUS Graduate Medical School Singapore, Singapore
| | - Arthur Mark Richards
- Department of Medicine, Yong Loo Lin School of Medicine, National University of Singapore, Singapore
- Cardiovascular Research Institute, National University Health System, Singapore
- Christchurch Heart Institute, University of Otago, New Zealand
| | - Lieng Hsi Ling
- Department of Cardiology, National University Heart Center, Singapore
- Department of Medicine, Yong Loo Lin School of Medicine, National University of Singapore, Singapore
| | - Tze Pin Ng
- Gerontology Research Programme, Department of Psychological Medicine, Yong Loo Lin School of Medicine, National University of Singapore, Singapore
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Cooper LL, Woodard T, Sigurdsson S, van Buchem MA, Torjesen AA, Inker LA, Aspelund T, Eiriksdottir G, Harris TB, Gudnason V, Launer LJ, Mitchell GF. Cerebrovascular Damage Mediates Relations Between Aortic Stiffness and Memory. Hypertension 2015; 67:176-82. [PMID: 26573713 DOI: 10.1161/hypertensionaha.115.06398] [Citation(s) in RCA: 94] [Impact Index Per Article: 10.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/28/2015] [Accepted: 09/24/2015] [Indexed: 12/22/2022]
Abstract
Aortic stiffness is associated with cognitive decline. Here, we examined the association between carotid-femoral pulse wave velocity and cognitive function and investigated whether cerebrovascular remodeling and parenchymal small vessel disease damage mediate the relation. Analyses were based on 1820 (60% women) participants in the Age, Gene/Environment Susceptibility-Reykjavik Study. Multivariable linear regression models adjusted for vascular and demographic confounders showed that higher carotid-femoral pulse wave velocity was related to lower memory score (standardized β: -0.071±0.023; P=0.002). Cerebrovascular resistance and white matter hyperintensities were each associated with carotid-femoral pulse wave velocity and memory (P<0.05). Together, cerebrovascular resistance and white matter hyperintensities (total indirect effect: -0.029; 95% CI, -0.043 to -0.017) attenuated the direct relation between carotid-femoral pulse wave velocity and memory (direct effect: -0.042; 95% CI, -0.087 to 0.003; P=0.07) and explained ≈41% of the observed effect. Our results suggest that in older adults, associations between aortic stiffness and memory are mediated by pathways that include cerebral microvascular remodeling and microvascular parenchymal damage.
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Affiliation(s)
- Leroy L Cooper
- From the Cardiovascular Engineering, Inc, Norwood, MA (L.L.C., T.W., A.A.T., G.F.M.); Cardiovascular Research Center, Rhode Island Hospital, W. Alpert Medical School of Brown University, Providence, RI (L.L.C.); Icelandic Heart Association, Kopavogur, Iceland (S.S., T.A., G.E., V.G.); Department of Radiology, Leiden University Medical Center, Leiden, The Netherlands (M.A.B.); Division of Nephrology and Department of Medicine, Tufts Medical Center, Boston, MA (L.A.I.); Faculty of Medicine, University of Iceland, Reykjavik, Iceland (T.A., V.G.); and Laboratory of Epidemiology, Demography, and Biometry, Intramural Research Program, National Institute on Aging, Bethesda, MD (T.B.H., L.J.L.)
| | - Todd Woodard
- From the Cardiovascular Engineering, Inc, Norwood, MA (L.L.C., T.W., A.A.T., G.F.M.); Cardiovascular Research Center, Rhode Island Hospital, W. Alpert Medical School of Brown University, Providence, RI (L.L.C.); Icelandic Heart Association, Kopavogur, Iceland (S.S., T.A., G.E., V.G.); Department of Radiology, Leiden University Medical Center, Leiden, The Netherlands (M.A.B.); Division of Nephrology and Department of Medicine, Tufts Medical Center, Boston, MA (L.A.I.); Faculty of Medicine, University of Iceland, Reykjavik, Iceland (T.A., V.G.); and Laboratory of Epidemiology, Demography, and Biometry, Intramural Research Program, National Institute on Aging, Bethesda, MD (T.B.H., L.J.L.)
| | - Sigurdur Sigurdsson
- From the Cardiovascular Engineering, Inc, Norwood, MA (L.L.C., T.W., A.A.T., G.F.M.); Cardiovascular Research Center, Rhode Island Hospital, W. Alpert Medical School of Brown University, Providence, RI (L.L.C.); Icelandic Heart Association, Kopavogur, Iceland (S.S., T.A., G.E., V.G.); Department of Radiology, Leiden University Medical Center, Leiden, The Netherlands (M.A.B.); Division of Nephrology and Department of Medicine, Tufts Medical Center, Boston, MA (L.A.I.); Faculty of Medicine, University of Iceland, Reykjavik, Iceland (T.A., V.G.); and Laboratory of Epidemiology, Demography, and Biometry, Intramural Research Program, National Institute on Aging, Bethesda, MD (T.B.H., L.J.L.)
| | - Mark A van Buchem
- From the Cardiovascular Engineering, Inc, Norwood, MA (L.L.C., T.W., A.A.T., G.F.M.); Cardiovascular Research Center, Rhode Island Hospital, W. Alpert Medical School of Brown University, Providence, RI (L.L.C.); Icelandic Heart Association, Kopavogur, Iceland (S.S., T.A., G.E., V.G.); Department of Radiology, Leiden University Medical Center, Leiden, The Netherlands (M.A.B.); Division of Nephrology and Department of Medicine, Tufts Medical Center, Boston, MA (L.A.I.); Faculty of Medicine, University of Iceland, Reykjavik, Iceland (T.A., V.G.); and Laboratory of Epidemiology, Demography, and Biometry, Intramural Research Program, National Institute on Aging, Bethesda, MD (T.B.H., L.J.L.)
| | - Alyssa A Torjesen
- From the Cardiovascular Engineering, Inc, Norwood, MA (L.L.C., T.W., A.A.T., G.F.M.); Cardiovascular Research Center, Rhode Island Hospital, W. Alpert Medical School of Brown University, Providence, RI (L.L.C.); Icelandic Heart Association, Kopavogur, Iceland (S.S., T.A., G.E., V.G.); Department of Radiology, Leiden University Medical Center, Leiden, The Netherlands (M.A.B.); Division of Nephrology and Department of Medicine, Tufts Medical Center, Boston, MA (L.A.I.); Faculty of Medicine, University of Iceland, Reykjavik, Iceland (T.A., V.G.); and Laboratory of Epidemiology, Demography, and Biometry, Intramural Research Program, National Institute on Aging, Bethesda, MD (T.B.H., L.J.L.)
| | - Lesley A Inker
- From the Cardiovascular Engineering, Inc, Norwood, MA (L.L.C., T.W., A.A.T., G.F.M.); Cardiovascular Research Center, Rhode Island Hospital, W. Alpert Medical School of Brown University, Providence, RI (L.L.C.); Icelandic Heart Association, Kopavogur, Iceland (S.S., T.A., G.E., V.G.); Department of Radiology, Leiden University Medical Center, Leiden, The Netherlands (M.A.B.); Division of Nephrology and Department of Medicine, Tufts Medical Center, Boston, MA (L.A.I.); Faculty of Medicine, University of Iceland, Reykjavik, Iceland (T.A., V.G.); and Laboratory of Epidemiology, Demography, and Biometry, Intramural Research Program, National Institute on Aging, Bethesda, MD (T.B.H., L.J.L.)
| | - Thor Aspelund
- From the Cardiovascular Engineering, Inc, Norwood, MA (L.L.C., T.W., A.A.T., G.F.M.); Cardiovascular Research Center, Rhode Island Hospital, W. Alpert Medical School of Brown University, Providence, RI (L.L.C.); Icelandic Heart Association, Kopavogur, Iceland (S.S., T.A., G.E., V.G.); Department of Radiology, Leiden University Medical Center, Leiden, The Netherlands (M.A.B.); Division of Nephrology and Department of Medicine, Tufts Medical Center, Boston, MA (L.A.I.); Faculty of Medicine, University of Iceland, Reykjavik, Iceland (T.A., V.G.); and Laboratory of Epidemiology, Demography, and Biometry, Intramural Research Program, National Institute on Aging, Bethesda, MD (T.B.H., L.J.L.)
| | - Gudny Eiriksdottir
- From the Cardiovascular Engineering, Inc, Norwood, MA (L.L.C., T.W., A.A.T., G.F.M.); Cardiovascular Research Center, Rhode Island Hospital, W. Alpert Medical School of Brown University, Providence, RI (L.L.C.); Icelandic Heart Association, Kopavogur, Iceland (S.S., T.A., G.E., V.G.); Department of Radiology, Leiden University Medical Center, Leiden, The Netherlands (M.A.B.); Division of Nephrology and Department of Medicine, Tufts Medical Center, Boston, MA (L.A.I.); Faculty of Medicine, University of Iceland, Reykjavik, Iceland (T.A., V.G.); and Laboratory of Epidemiology, Demography, and Biometry, Intramural Research Program, National Institute on Aging, Bethesda, MD (T.B.H., L.J.L.)
| | - Tamara B Harris
- From the Cardiovascular Engineering, Inc, Norwood, MA (L.L.C., T.W., A.A.T., G.F.M.); Cardiovascular Research Center, Rhode Island Hospital, W. Alpert Medical School of Brown University, Providence, RI (L.L.C.); Icelandic Heart Association, Kopavogur, Iceland (S.S., T.A., G.E., V.G.); Department of Radiology, Leiden University Medical Center, Leiden, The Netherlands (M.A.B.); Division of Nephrology and Department of Medicine, Tufts Medical Center, Boston, MA (L.A.I.); Faculty of Medicine, University of Iceland, Reykjavik, Iceland (T.A., V.G.); and Laboratory of Epidemiology, Demography, and Biometry, Intramural Research Program, National Institute on Aging, Bethesda, MD (T.B.H., L.J.L.)
| | - Vilmundur Gudnason
- From the Cardiovascular Engineering, Inc, Norwood, MA (L.L.C., T.W., A.A.T., G.F.M.); Cardiovascular Research Center, Rhode Island Hospital, W. Alpert Medical School of Brown University, Providence, RI (L.L.C.); Icelandic Heart Association, Kopavogur, Iceland (S.S., T.A., G.E., V.G.); Department of Radiology, Leiden University Medical Center, Leiden, The Netherlands (M.A.B.); Division of Nephrology and Department of Medicine, Tufts Medical Center, Boston, MA (L.A.I.); Faculty of Medicine, University of Iceland, Reykjavik, Iceland (T.A., V.G.); and Laboratory of Epidemiology, Demography, and Biometry, Intramural Research Program, National Institute on Aging, Bethesda, MD (T.B.H., L.J.L.)
| | - Lenore J Launer
- From the Cardiovascular Engineering, Inc, Norwood, MA (L.L.C., T.W., A.A.T., G.F.M.); Cardiovascular Research Center, Rhode Island Hospital, W. Alpert Medical School of Brown University, Providence, RI (L.L.C.); Icelandic Heart Association, Kopavogur, Iceland (S.S., T.A., G.E., V.G.); Department of Radiology, Leiden University Medical Center, Leiden, The Netherlands (M.A.B.); Division of Nephrology and Department of Medicine, Tufts Medical Center, Boston, MA (L.A.I.); Faculty of Medicine, University of Iceland, Reykjavik, Iceland (T.A., V.G.); and Laboratory of Epidemiology, Demography, and Biometry, Intramural Research Program, National Institute on Aging, Bethesda, MD (T.B.H., L.J.L.)
| | - Gary F Mitchell
- From the Cardiovascular Engineering, Inc, Norwood, MA (L.L.C., T.W., A.A.T., G.F.M.); Cardiovascular Research Center, Rhode Island Hospital, W. Alpert Medical School of Brown University, Providence, RI (L.L.C.); Icelandic Heart Association, Kopavogur, Iceland (S.S., T.A., G.E., V.G.); Department of Radiology, Leiden University Medical Center, Leiden, The Netherlands (M.A.B.); Division of Nephrology and Department of Medicine, Tufts Medical Center, Boston, MA (L.A.I.); Faculty of Medicine, University of Iceland, Reykjavik, Iceland (T.A., V.G.); and Laboratory of Epidemiology, Demography, and Biometry, Intramural Research Program, National Institute on Aging, Bethesda, MD (T.B.H., L.J.L.).
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Pase MP, Beiser A, Aparicio H, DeCarli C, Vasan RS, Murabito J, Seshadri S. Interarm differences in systolic blood pressure and the risk of dementia and subclinical brain injury. Alzheimers Dement 2015; 12:438-45. [PMID: 26542262 DOI: 10.1016/j.jalz.2015.09.006] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/02/2015] [Revised: 08/27/2015] [Accepted: 09/19/2015] [Indexed: 02/06/2023]
Abstract
INTRODUCTION This study examined whether interarm differences in systolic blood pressure (IDSBP) ≥10 mm Hg were associated with the risk of incident dementia and subclinical brain injury. METHODS Between 1992 and 1998, 2063 participants of the Framingham Heart Study underwent assessment of IDSBP with results related to the 10-year risk of incident dementia including clinically characterized Alzheimer's disease. Secondary outcomes included markers of subclinical brain injury on magnetic resonance imaging. RESULTS High IDSBP were associated with a greater risk of incident dementia (hazard ratio [HR] 1.92; 95% confidence interval [CI], 1.09-3.40) and Alzheimer's disease (HR, 2.32; 95% CI, 1.29-4.18), but only in those who carried an apolipoprotein E (APOE) ε4 allele. IDSBP also predicted lower total brain volumes and more prevalent silent brain infarcts in those who were APOE ε4 positive. DISCUSSION High IDSBP were associated with an increased risk of dementia, including clinical Alzheimer's disease, and subclinical brain injury in those who were APOE ε4 positive.
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Affiliation(s)
- Matthew P Pase
- Boston University School of Medicine & Framingham Heart Study, Boston, MA, USA; Centre for Human Psychopharmacology, Swinburne University of Technology, Hawthorn, Australia.
| | - Alexa Beiser
- Boston University School of Medicine & Framingham Heart Study, Boston, MA, USA; Boston University School of Public Health, Boston, MA, USA
| | - Hugo Aparicio
- Boston University School of Medicine & Framingham Heart Study, Boston, MA, USA
| | - Charles DeCarli
- Department of Neurology, School of Medicine & Imaging of Dementia and Aging Laboratory, Center for Neuroscience, University of California Davis, Sacramento, CA, USA
| | | | - Joanne Murabito
- Boston University School of Medicine & Framingham Heart Study, Boston, MA, USA
| | - Sudha Seshadri
- Boston University School of Medicine & Framingham Heart Study, Boston, MA, USA
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165
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Abstract
Cognitive impairment in heart failure (HF) is believed to in part stem from structural brain alterations, including shrinkage of subcortical regions. Fortunately, neurocognitive dysfunction in HF can be mitigated by physical activity (PA), though mechanisms for this phenomenon are unclear. PA is protective against age-related cognitive decline that may involve improved structural integrity to brain regions sensitive to aging (e.g., subcortical structures). Yet, no study has examined the benefits of PA on the brain in HF and we sought to do so and clarify related cognitive implications. Fifty older adults with HF completed a neuropsychological battery and wore an accelerometer for 7 days. All participants underwent brain MRI. This study targeted subcortical brain volume given subcortical alterations are often observed in HF and the sensitivity of PA to subcortical structures in other patient populations. Participants averaged 4348.49 (SD=2092.08) steps per day and greater daily steps predicted better attention/executive function, episodic memory, and language abilities, p's<.05. Medical and demographically adjusted regression analyses revealed higher daily steps per day predicted greater subcortical volume, with specific effects for the thalamus and ventral diencephalon, p's<.05. Greater subcortical volume was associated with better attention/executive function, p<.05. Higher daily PA was associated with increased subcortical brain volume and better cognition in older adults with HF. Longitudinal work is needed to clarify whether daily PA can attenuate brain atrophy in HF to reduce accelerated cognitive decline in this population.
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Majeed BA, Eberson LS, Tawinwung S, Larmonier N, Secomb TW, Larson DF. Functional aortic stiffness: role of CD4(+) T lymphocytes. Front Physiol 2015; 6:235. [PMID: 26379554 PMCID: PMC4549563 DOI: 10.3389/fphys.2015.00235] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/16/2015] [Accepted: 08/06/2015] [Indexed: 11/13/2022] Open
Abstract
The immune system is suggested to be essential in vascular remodeling and stiffening. To study the dependence upon lymphocytes in vascular stiffening, we compared an angiotensin II-model of vascular stiffening in normal C57BL/6J mice with lymphocyte-deficient RAG 1−/− mice and additionally characterized the component of vascular stiffness due to vasoconstriction vs. vascular remodeling. Chronic angiotensin II increased aortic pulse wave velocity, effective wall stiffness, and effective Young's modulus in C57BL/6J mice by three-fold but caused no change in the RAG 1−/− mice. These functional measurements were supported by aortic morphometric analysis. Adoptive transfer of CD4+ T helper lymphocytes restored the angiotensin II-mediated aortic stiffening in the RAG 1−/− mice. In order to account for the hydraulic vs. material effects of angiotensin II on pulse wave velocity, subcutaneous osmotic pumps were removed after 21 days of angiotensin II-infusion in the WT mice to achieve normotensive values. The pulse wave velocity (PWV) decreased from three- to two-fold above baseline values up to 7 days following pump removal. This study supports the pivotal role of the CD4+ T-lymphocytes in angiotensin II-mediated vascular stiffening and that angiotensin II-mediated aortic stiffening is due to the additive effect of active vascular smooth muscle vasoconstriction and vascular remodeling.
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Affiliation(s)
- Beenish A Majeed
- Sarver Heart Center, College of Medicine, The University of Arizona Tucson, AZ, USA ; Department of Pharmacology, College of Medicine, The University of Arizona Tucson, AZ, USA
| | - Lance S Eberson
- Sarver Heart Center, College of Medicine, The University of Arizona Tucson, AZ, USA
| | - Supannikar Tawinwung
- Sarver Heart Center, College of Medicine, The University of Arizona Tucson, AZ, USA ; Department of Pharmacology, College of Medicine, The University of Arizona Tucson, AZ, USA
| | - Nicolas Larmonier
- Departments of Pediatrics and Immunology, College of Medicine, The University of Arizona Tucson, AZ, USA
| | - Timothy W Secomb
- Department of Physiology, College of Medicine, The University of Arizona Tucson, AZ, USA
| | - Douglas F Larson
- Sarver Heart Center, College of Medicine, The University of Arizona Tucson, AZ, USA ; Department of Pharmacology, College of Medicine, The University of Arizona Tucson, AZ, USA ; Department of Physiology, College of Medicine, The University of Arizona Tucson, AZ, USA ; Department of Surgery, College of Medicine, The University of Arizona Tucson, AZ, USA
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167
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Abstract
PURPOSE OF REVIEW To examine the putative measures of arterial stiffness and the mechanisms of adverse effects of stiffness on blood pressure and target organ damage using data from comprehensive hemodynamic profiles obtained in the Framingham Heart Study and the Age, Gene/Environment Susceptibility-Reykjavik Study. RECENT FINDINGS Once thought to be a consequence of longstanding hypertension, recent evidence suggests that aortic stiffness antedates and contributes to the pathogenesis of hypertension and target organ damage in the heart, brain, and kidneys. Carotid-femoral pulse-wave velocity (CFPWV) has emerged as the reference standard measure of aortic stiffness and a powerful predictor of cardiovascular disease risk. Augmentation index, a putative measure of arterial stiffness and wave reflection, has complex relations with stiffness and risk. Recent evidence suggests that wave reflection, which is a normal consequence of impedance mismatch between compliant aorta and stiff muscular arteries, is protective and limits the exposure of target organs to potentially harmful pulsatile energy. Aortic stiffening produces impedance matching that reduces wave reflection and exposes the microcirculation to excessive pulsatile stress, resulting in microvascular target organ damage and dysfunction. SUMMARY CFPWV provides a powerful new tool for risk stratification and elucidation of the pathogenesis of target organ damage in hypertension.
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Andersson C, Preis SR, Beiser A, DeCarli C, Wollert KC, Wang TJ, Januzzi JL, Vasan RS, Seshadri S. Associations of Circulating Growth Differentiation Factor-15 and ST2 Concentrations With Subclinical Vascular Brain Injury and Incident Stroke. Stroke 2015. [PMID: 26219649 DOI: 10.1161/strokeaha.115.009026] [Citation(s) in RCA: 53] [Impact Index Per Article: 5.9] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
BACKGROUND AND PURPOSE Growth differentiation factor-15 (GDF-15) and soluble (s)ST2 are markers of cardiac and vascular stress. We investigated the associations between circulating concentrations of these biomarkers and incident stroke and subclinical vascular brain injury in a sample from the Framingham Offspring cohort. METHODS We followed 3374 stroke- and dementia-free individuals (mean age, 59.0±9.7 years; 53% women) attending the Framingham Offspring sixth examination cycle 11.8±3.0 years for incident stroke. A subsample of 2463 individuals underwent brain magnetic resonance imaging and neuropsychological testing ≈4.0±1.7 years after the sixth examination. RESULTS After adjustment for traditional cardiovascular risk factors, B-type natriuretic peptide, high-sensitivity C-reactive protein, and urine albumin levels, higher stress biomarker levels were associated cross-sectionally with lower brain volumes (β coefficients for intracranial volume comparing fourth [Q4] versus first biomarker [Q1] quartiles: -0.71% for GDF-15; P=0.002 and 0.47% for sST2; P=0.02) and worse performance on the visual reproduction test (β coefficients for Q4 versus Q1: -0.62 for GDF-15; P=0.009 and -0.40 for sST2; P=0.04). Higher GDF-15 concentrations were also associated with greater log-transformed white-matter hyperintensity volumes (β for Q4 versus Q1=0.19; P=0.01). Prospectively, a total of 203 (6%) individuals developed incident stroke/transient ischemic attack during follow-up. After multivariable adjustment, sST2 remained significantly associated with stroke/transient ischemic attack, hazard ratio for Q4 versus Q1 of 1.76, 95% confidence interval of 1.06 to 2.92, and P=0.03. CONCLUSIONS Circulating GDF-15 and sST2 are associated with subclinical brain injury and cognitive impairment. Higher sST2 concentrations are also associated with incident stroke, suggesting potential links between cardiac stress biomarkers and brain injury.
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Affiliation(s)
- Charlotte Andersson
- From the Framingham Heart Study, MA (C.A., A.B., T.J.W., R.S.V., S.S.); Department of Cardiology, Gentofte Hospital, University of Copenhagen, Denmark (C.A.); Department of Biostatistics, Boston University School of Public Health, MA (S.R.P., A.B.); Department of Neurology (A.B., S.S.) and Section of Preventive Medicine and Cardiology (R.S.V.), Boston University School of Medicine, MA; Department of Neurology, University of California at Davis, Sacramento (C.D.); Division of Molecular and Translational Cardiology, Department of Cardiology and Angiology, Hannover Medical School, Hannover, Germany (K.C.W.); Division of Cardiovascular Medicine, Vanderbilt University, Nashville, TN (T.J.W.); and Division of Cardiology, Massachusetts General Hospital, Harvard Medical School, Boston (J.L.J.).
| | - Sarah R Preis
- From the Framingham Heart Study, MA (C.A., A.B., T.J.W., R.S.V., S.S.); Department of Cardiology, Gentofte Hospital, University of Copenhagen, Denmark (C.A.); Department of Biostatistics, Boston University School of Public Health, MA (S.R.P., A.B.); Department of Neurology (A.B., S.S.) and Section of Preventive Medicine and Cardiology (R.S.V.), Boston University School of Medicine, MA; Department of Neurology, University of California at Davis, Sacramento (C.D.); Division of Molecular and Translational Cardiology, Department of Cardiology and Angiology, Hannover Medical School, Hannover, Germany (K.C.W.); Division of Cardiovascular Medicine, Vanderbilt University, Nashville, TN (T.J.W.); and Division of Cardiology, Massachusetts General Hospital, Harvard Medical School, Boston (J.L.J.)
| | - Alexa Beiser
- From the Framingham Heart Study, MA (C.A., A.B., T.J.W., R.S.V., S.S.); Department of Cardiology, Gentofte Hospital, University of Copenhagen, Denmark (C.A.); Department of Biostatistics, Boston University School of Public Health, MA (S.R.P., A.B.); Department of Neurology (A.B., S.S.) and Section of Preventive Medicine and Cardiology (R.S.V.), Boston University School of Medicine, MA; Department of Neurology, University of California at Davis, Sacramento (C.D.); Division of Molecular and Translational Cardiology, Department of Cardiology and Angiology, Hannover Medical School, Hannover, Germany (K.C.W.); Division of Cardiovascular Medicine, Vanderbilt University, Nashville, TN (T.J.W.); and Division of Cardiology, Massachusetts General Hospital, Harvard Medical School, Boston (J.L.J.)
| | - Charles DeCarli
- From the Framingham Heart Study, MA (C.A., A.B., T.J.W., R.S.V., S.S.); Department of Cardiology, Gentofte Hospital, University of Copenhagen, Denmark (C.A.); Department of Biostatistics, Boston University School of Public Health, MA (S.R.P., A.B.); Department of Neurology (A.B., S.S.) and Section of Preventive Medicine and Cardiology (R.S.V.), Boston University School of Medicine, MA; Department of Neurology, University of California at Davis, Sacramento (C.D.); Division of Molecular and Translational Cardiology, Department of Cardiology and Angiology, Hannover Medical School, Hannover, Germany (K.C.W.); Division of Cardiovascular Medicine, Vanderbilt University, Nashville, TN (T.J.W.); and Division of Cardiology, Massachusetts General Hospital, Harvard Medical School, Boston (J.L.J.)
| | - Kai C Wollert
- From the Framingham Heart Study, MA (C.A., A.B., T.J.W., R.S.V., S.S.); Department of Cardiology, Gentofte Hospital, University of Copenhagen, Denmark (C.A.); Department of Biostatistics, Boston University School of Public Health, MA (S.R.P., A.B.); Department of Neurology (A.B., S.S.) and Section of Preventive Medicine and Cardiology (R.S.V.), Boston University School of Medicine, MA; Department of Neurology, University of California at Davis, Sacramento (C.D.); Division of Molecular and Translational Cardiology, Department of Cardiology and Angiology, Hannover Medical School, Hannover, Germany (K.C.W.); Division of Cardiovascular Medicine, Vanderbilt University, Nashville, TN (T.J.W.); and Division of Cardiology, Massachusetts General Hospital, Harvard Medical School, Boston (J.L.J.)
| | - Thomas J Wang
- From the Framingham Heart Study, MA (C.A., A.B., T.J.W., R.S.V., S.S.); Department of Cardiology, Gentofte Hospital, University of Copenhagen, Denmark (C.A.); Department of Biostatistics, Boston University School of Public Health, MA (S.R.P., A.B.); Department of Neurology (A.B., S.S.) and Section of Preventive Medicine and Cardiology (R.S.V.), Boston University School of Medicine, MA; Department of Neurology, University of California at Davis, Sacramento (C.D.); Division of Molecular and Translational Cardiology, Department of Cardiology and Angiology, Hannover Medical School, Hannover, Germany (K.C.W.); Division of Cardiovascular Medicine, Vanderbilt University, Nashville, TN (T.J.W.); and Division of Cardiology, Massachusetts General Hospital, Harvard Medical School, Boston (J.L.J.)
| | - James L Januzzi
- From the Framingham Heart Study, MA (C.A., A.B., T.J.W., R.S.V., S.S.); Department of Cardiology, Gentofte Hospital, University of Copenhagen, Denmark (C.A.); Department of Biostatistics, Boston University School of Public Health, MA (S.R.P., A.B.); Department of Neurology (A.B., S.S.) and Section of Preventive Medicine and Cardiology (R.S.V.), Boston University School of Medicine, MA; Department of Neurology, University of California at Davis, Sacramento (C.D.); Division of Molecular and Translational Cardiology, Department of Cardiology and Angiology, Hannover Medical School, Hannover, Germany (K.C.W.); Division of Cardiovascular Medicine, Vanderbilt University, Nashville, TN (T.J.W.); and Division of Cardiology, Massachusetts General Hospital, Harvard Medical School, Boston (J.L.J.)
| | - Ramachandran S Vasan
- From the Framingham Heart Study, MA (C.A., A.B., T.J.W., R.S.V., S.S.); Department of Cardiology, Gentofte Hospital, University of Copenhagen, Denmark (C.A.); Department of Biostatistics, Boston University School of Public Health, MA (S.R.P., A.B.); Department of Neurology (A.B., S.S.) and Section of Preventive Medicine and Cardiology (R.S.V.), Boston University School of Medicine, MA; Department of Neurology, University of California at Davis, Sacramento (C.D.); Division of Molecular and Translational Cardiology, Department of Cardiology and Angiology, Hannover Medical School, Hannover, Germany (K.C.W.); Division of Cardiovascular Medicine, Vanderbilt University, Nashville, TN (T.J.W.); and Division of Cardiology, Massachusetts General Hospital, Harvard Medical School, Boston (J.L.J.)
| | - Sudha Seshadri
- From the Framingham Heart Study, MA (C.A., A.B., T.J.W., R.S.V., S.S.); Department of Cardiology, Gentofte Hospital, University of Copenhagen, Denmark (C.A.); Department of Biostatistics, Boston University School of Public Health, MA (S.R.P., A.B.); Department of Neurology (A.B., S.S.) and Section of Preventive Medicine and Cardiology (R.S.V.), Boston University School of Medicine, MA; Department of Neurology, University of California at Davis, Sacramento (C.D.); Division of Molecular and Translational Cardiology, Department of Cardiology and Angiology, Hannover Medical School, Hannover, Germany (K.C.W.); Division of Cardiovascular Medicine, Vanderbilt University, Nashville, TN (T.J.W.); and Division of Cardiology, Massachusetts General Hospital, Harvard Medical School, Boston (J.L.J.)
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Townsend RR, Wilkinson IB, Schiffrin EL, Avolio AP, Chirinos JA, Cockcroft JR, Heffernan KS, Lakatta EG, McEniery CM, Mitchell GF, Najjar SS, Nichols WW, Urbina EM, Weber T. Recommendations for Improving and Standardizing Vascular Research on Arterial Stiffness: A Scientific Statement From the American Heart Association. Hypertension 2015; 66:698-722. [PMID: 26160955 DOI: 10.1161/hyp.0000000000000033] [Citation(s) in RCA: 972] [Impact Index Per Article: 108.0] [Reference Citation Analysis] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/17/2022]
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Chung CC, Pimentel D, Jor'dan AJ, Hao Y, Milberg W, Novak V. Inflammation-associated declines in cerebral vasoreactivity and cognition in type 2 diabetes. Neurology 2015; 85:450-8. [PMID: 26156513 DOI: 10.1212/wnl.0000000000001820] [Citation(s) in RCA: 75] [Impact Index Per Article: 8.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/19/2014] [Accepted: 04/06/2015] [Indexed: 11/15/2022] Open
Abstract
OBJECTIVE The aim of this prospective study was to investigate the relationships between inflammation, cerebral vasoregulation, and cognitive decline in type 2 diabetes mellitus (T2DM) over a 2-year span. METHODS Sixty-five participants (aged 66 ± 9.2 years, 35 with T2DM, 33 women) were enrolled for this 2-year prospective study. Continuous arterial spin labeling at 3-tesla MRI was used to measure global and regional cerebral perfusion and vasoreactivity. Neuropsychological measures were evaluated at the beginning and completion of the study. The associations between serum inflammatory markers, regional cerebral vasoreactivity, and cognitive functions were examined using least squares models. RESULTS After 2 years of follow-up, participants with T2DM had diminished global and regional cerebral vasoreactivity and a decline in multiple cognitive tasks compared with baseline (p < 0.0001-0.012). In the T2DM group, lower cerebral vasoreactivity was associated with a greater decrease in daily living activities score (r(2) adj = 0.35, p = 0.04), and lower global vasodilation was associated with a greater decline in executive function (r(2) adj = 0.6, p = 0.047). Higher serum soluble intercellular and vascular adhesion molecules, higher cortisol, and higher C-reactive protein levels at baseline were associated with greater decreases in cerebral vasoreactivity and vasodilation only in the T2DM group (r(2) adj = 0.16-0.53, p = 0.007-0.048), independent of diabetes control and 24-hour blood pressure. Higher glycated hemoglobin A1c levels were associated with a greater increase in vasoconstriction in the T2DM group. CONCLUSIONS Inflammation may further impair cerebral vasoregulation, which consequently accelerates decline in executive function and daily activities performance in older people with T2DM.
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Affiliation(s)
- Chen-Chih Chung
- From the Departments of Neurology (C.-C.C., D.P., V.N.) and Gerontology (D.P., A.J.J., Y.H., V.N.), Beth Israel Deaconess Medical Center, Boston, MA; Department of Neurology (C.-C.C.), Shuang Ho Hospital, Taipei Medical University, Taiwan; Institute for Aging Research, Hebrew SeniorLife (A.J.J.), and New England Geriatric, Research, Education and Clinical Center-Boston Division, VA Boston Healthcare, and Department of Psychiatry (W.M.), Harvard Medical School, Boston, MA; and School of Acupuncture-Moxibustion and Tuina (Y.H.), Beijing University of Chinese Medicine, China
| | - Daniela Pimentel
- From the Departments of Neurology (C.-C.C., D.P., V.N.) and Gerontology (D.P., A.J.J., Y.H., V.N.), Beth Israel Deaconess Medical Center, Boston, MA; Department of Neurology (C.-C.C.), Shuang Ho Hospital, Taipei Medical University, Taiwan; Institute for Aging Research, Hebrew SeniorLife (A.J.J.), and New England Geriatric, Research, Education and Clinical Center-Boston Division, VA Boston Healthcare, and Department of Psychiatry (W.M.), Harvard Medical School, Boston, MA; and School of Acupuncture-Moxibustion and Tuina (Y.H.), Beijing University of Chinese Medicine, China
| | - Azizah J Jor'dan
- From the Departments of Neurology (C.-C.C., D.P., V.N.) and Gerontology (D.P., A.J.J., Y.H., V.N.), Beth Israel Deaconess Medical Center, Boston, MA; Department of Neurology (C.-C.C.), Shuang Ho Hospital, Taipei Medical University, Taiwan; Institute for Aging Research, Hebrew SeniorLife (A.J.J.), and New England Geriatric, Research, Education and Clinical Center-Boston Division, VA Boston Healthcare, and Department of Psychiatry (W.M.), Harvard Medical School, Boston, MA; and School of Acupuncture-Moxibustion and Tuina (Y.H.), Beijing University of Chinese Medicine, China
| | - Ying Hao
- From the Departments of Neurology (C.-C.C., D.P., V.N.) and Gerontology (D.P., A.J.J., Y.H., V.N.), Beth Israel Deaconess Medical Center, Boston, MA; Department of Neurology (C.-C.C.), Shuang Ho Hospital, Taipei Medical University, Taiwan; Institute for Aging Research, Hebrew SeniorLife (A.J.J.), and New England Geriatric, Research, Education and Clinical Center-Boston Division, VA Boston Healthcare, and Department of Psychiatry (W.M.), Harvard Medical School, Boston, MA; and School of Acupuncture-Moxibustion and Tuina (Y.H.), Beijing University of Chinese Medicine, China
| | - William Milberg
- From the Departments of Neurology (C.-C.C., D.P., V.N.) and Gerontology (D.P., A.J.J., Y.H., V.N.), Beth Israel Deaconess Medical Center, Boston, MA; Department of Neurology (C.-C.C.), Shuang Ho Hospital, Taipei Medical University, Taiwan; Institute for Aging Research, Hebrew SeniorLife (A.J.J.), and New England Geriatric, Research, Education and Clinical Center-Boston Division, VA Boston Healthcare, and Department of Psychiatry (W.M.), Harvard Medical School, Boston, MA; and School of Acupuncture-Moxibustion and Tuina (Y.H.), Beijing University of Chinese Medicine, China
| | - Vera Novak
- From the Departments of Neurology (C.-C.C., D.P., V.N.) and Gerontology (D.P., A.J.J., Y.H., V.N.), Beth Israel Deaconess Medical Center, Boston, MA; Department of Neurology (C.-C.C.), Shuang Ho Hospital, Taipei Medical University, Taiwan; Institute for Aging Research, Hebrew SeniorLife (A.J.J.), and New England Geriatric, Research, Education and Clinical Center-Boston Division, VA Boston Healthcare, and Department of Psychiatry (W.M.), Harvard Medical School, Boston, MA; and School of Acupuncture-Moxibustion and Tuina (Y.H.), Beijing University of Chinese Medicine, China.
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171
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Zeki Al Hazzouri A, Yaffe K. Arterial stiffness and cognitive function in the elderly. J Alzheimers Dis 2015; 42 Suppl 4:S503-14. [PMID: 25351110 DOI: 10.3233/jad-141563] [Citation(s) in RCA: 25] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/12/2023]
Abstract
Cognitive decline and dementia are a major cause of disability and mortality among older adults. Cross-sectional evidence from observational studies suggests that greater arterial stiffness is associated with worse cognitive performance. These associations have been observed on measures of global cognition and across multiple domains of cognition. Epidemiologic evidence on the association between arterial stiffness and rate of cognitive decline has been less definitive, and very few studies have investigated the risk of developing dementia. This review summarizes the current research on arterial stiffness and cognition, issues around measurement, and the effect that potential intervention might have on the course of cognitive aging. The evidence on pharmacological and non-pharmacological (exercise, nutrition, etc.) interventions in older adults with arterial stiffness is promising. Yet there are no studies or trials that directly evaluate how interventions of arterial stiffness reduce or prevent cognitive impairment and risk of developing dementia. More research is needed to elucidate the causal link between arterial stiffness and cognitive decline and dementia, and to identify whether potential interventions to prevent or reduce arterial stiffness may benefit cognitive health of the elderly.
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Affiliation(s)
- Adina Zeki Al Hazzouri
- Division of Epidemiology and Population Health, Department of Public Health Sciences, University of Miami, Miami, FL, USA
| | - Kristine Yaffe
- Departments of Epidemiology & Biostatistics, Neurology and Psychiatry, University of California San Francisco, San Francisco, CA, USA San Francisco Veterans Affairs Medical Center, San Francisco, CA, USA
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172
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Gustavsson AM, Stomrud E, Abul-Kasim K, Minthon L, Nilsson PM, Hansson O, Nägga K. Cerebral Microbleeds and White Matter Hyperintensities in Cognitively Healthy Elderly: A Cross-Sectional Cohort Study Evaluating the Effect of Arterial Stiffness. Cerebrovasc Dis Extra 2015; 5:41-51. [PMID: 26120319 PMCID: PMC4478329 DOI: 10.1159/000377710] [Citation(s) in RCA: 32] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022] Open
Abstract
BACKGROUND Arterial stiffness reflects the ageing processes in the vascular system, and studies have shown an association between reduced cognitive function and cerebral small vessel disease. Small vessel disease can be visualized as white matter hyperintensities (WMH) and lacunar infarcts but also as cerebral microbleeds on brain magnetic resonance imaging (MRI). We aimed to investigate if arterial stiffness influences the presence of microbleeds, WMH and cognitive function in a population of cognitively healthy elderly. METHODS The study population is part of the Swedish BioFinder study and consisted of 208 individuals without any symptoms of cognitive impairment, who scored >27 points on the Mini-Mental State Examination. The participants (mean age, 72 years; 59% women) underwent MRI of the brain with visual rating of microbleeds and WMH. Arterial stiffness was measured with carotid-femoral pulse wave velocity (cfPWV). Eight cognitive tests covering different cognitive domains were performed. RESULTS Microbleeds were detected in 12% and WMH in 31% of the participants. Mean (±standard deviation, SD) cfPWV was 10.0 (±2.0) m/s. There was no association between the presence of microbleeds and arterial stiffness. There was a positive association between arterial stiffness and WMH independent of age or sex (odds ratio, 1.58; 95% confidence interval, 1.04-2.40, p < 0.05), but the effect was attenuated when further adjustments for several cardiovascular risk factors were performed (p > 0.05). Cognitive performance was not associated with microbleeds, but individuals with WMH performed slightly worse than those without WMH on the Symbol Digit Modalities Test (mean ± SD, 35 ± 7.8 vs. 39 ± 8.1, p < 0.05). Linear regression revealed no direct associations between arterial stiffness and the results of the cognitive tests. CONCLUSIONS Arterial stiffness was not associated with the presence of cerebral microbleeds or cognitive function in cognitively healthy elderly. However, arterial stiffness was related to the presence of WMH, but the association was attenuated when multiple adjustments were made. There was a weak negative association between WMH and performance in one specific test of attention. Longitudinal follow-up studies are needed to further assess the associations.
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Affiliation(s)
- Anna-Märta Gustavsson
- Memory Clinic, Skåne University Hospital, Sweden ; Clinical Memory Research Unit, Department of Clinical Sciences Malmö, Sweden
| | - Erik Stomrud
- Memory Clinic, Skåne University Hospital, Sweden ; Clinical Memory Research Unit, Department of Clinical Sciences Malmö, Sweden
| | - Kasim Abul-Kasim
- Medical Radiology Unit, Department of Clinical Sciences Malmö, Sweden
| | - Lennart Minthon
- Memory Clinic, Skåne University Hospital, Sweden ; Clinical Memory Research Unit, Department of Clinical Sciences Malmö, Sweden
| | - Peter M Nilsson
- Department of Clinical Sciences Malmö, Lund University, Malmö, Sweden
| | - Oskar Hansson
- Memory Clinic, Skåne University Hospital, Sweden ; Clinical Memory Research Unit, Department of Clinical Sciences Malmö, Sweden
| | - Katarina Nägga
- Memory Clinic, Skåne University Hospital, Sweden ; Clinical Memory Research Unit, Department of Clinical Sciences Malmö, Sweden
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Heffernan KS, Spartano NL, Augustine JA, Lefferts WK, Hughes WE, Mitchell GF, Jorgensen RS, Gump BB. Carotid artery stiffness and hemodynamic pulsatility during cognitive engagement in healthy adults: a pilot investigation. Am J Hypertens 2015; 28:615-22. [PMID: 25384407 DOI: 10.1093/ajh/hpu198] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/09/2014] [Accepted: 09/10/2014] [Indexed: 12/21/2022] Open
Abstract
BACKGROUND The matching of vascular supply to neuronal metabolic demand during cognitive engagement is known as neurovascular coupling (NVC). Arterial stiffness is a prominent determinant of pulsatility in the systemic circulation and may thus indirectly impact NVC. In this pilot investigation, we explored changes in carotid artery stiffness and cerebrovascular hemodynamic pulsatiltiy during cognitive engagement in healthy adults. METHODS Twenty-seven adults (age 39 ± 3 years, BMI 24 ± 1 kg/m(2)) underwent Doppler ultrasonography of the common carotid artery (CCA) combined with applanation tonometry to derive (i) CCA elastic modulus (Ep) and β-stiffness index; (ii) CCA flow pulsatility index (PI); (iii) CCA pulse pressure, (iv) CCA augmentation index (AIx). Cerebral PI was assessed using transcranial Doppler at the middle cerebral artery (MCA). All measures were made at rest and during an incongruent Stroop task. RESULTS CCA PI was reduced (1.75 ± 0.06 to 1.57 ± 0.06, P < 0.05) while MCA PI was unchanged (0.75 ± 0.02 to 0.75 ± 0.02, P > 0.05) during Stroop. Brachial pulse pressure increased during Stroop (43 ± 1 to 46 ± 1 mm Hg, P < 0.05) while CCA pulse pressure was unchanged (36 ± 1 to 35 ± 1 mm Hg, P > 0.05). Similarly, CCA Ep (54.5 ± 5.5 to 53.8 ± 4.9 kPa, P > 0.05) and β-stiffness index (4.4 ± 0.4 to 4.2 ± 0.3 aU, P > 0.05) were unchanged. CCA AIx increased (1 ± 4 to 13 ± 4%, P < 0.05). CONCLUSION Carotid pressure pulsatility is unaltered while carotid flow pulsatility is reduced during cognitive engagement. Carotid artery stiffness does not change suggesting that factors other than the dynamic elastic properties of the CCA buffer cerebrovascular hemodynamic pulsatility during cognitive engagement.
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Affiliation(s)
- Kevin S Heffernan
- Department of Exercise Science, Syracuse University, Syracuse, New York, USA;
| | - Nicole L Spartano
- Department of Exercise Science, Syracuse University, Syracuse, New York, USA
| | | | - Wesley K Lefferts
- Department of Exercise Science, Syracuse University, Syracuse, New York, USA
| | - William E Hughes
- Department of Exercise Science, Syracuse University, Syracuse, New York, USA
| | - Gary F Mitchell
- Cardiovascular Engineering, Inc., Norwood, Massachusetts, USA
| | | | - Brooks B Gump
- Department of Public Health, Syracuse University, Syracuse, New York, USA
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Nilsson ED, Elmståhl S, Minthon L, Nilsson PM, Pihlsgård M, Nägga K. Associations of central and brachial blood pressure with cognitive function: a population-based study. J Hum Hypertens 2015; 30:95-9. [DOI: 10.1038/jhh.2015.33] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/05/2014] [Revised: 02/20/2015] [Accepted: 03/10/2015] [Indexed: 12/25/2022]
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Semba RD, Sun K, Schwartz AV, Varadhan R, Harris TB, Satterfield S, Garcia M, Ferrucci L, Newman AB. Serum carboxymethyl-lysine, an advanced glycation end product, is associated with arterial stiffness in older adults. J Hypertens 2015; 33:797-803; discussion 803. [PMID: 25915884 PMCID: PMC4458067 DOI: 10.1097/hjh.0000000000000460] [Citation(s) in RCA: 44] [Impact Index Per Article: 4.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/23/2023]
Abstract
OBJECTIVE The objective of this study is to examine the relationship of serum carboxymethyl-lysine (CML), an advanced glycation end product (AGE), with pulse pressure (PP), aortic pulse wave velocity (aPWV) and hypertension in older adults. BACKGROUND AGEs are bioactive molecules that accumulate in tissues with ageing and can both cross-link collagen and induce inflammation in model systems. The relationship of AGEs with arterial stiffness and hypertension has not been well characterized in community-dwelling older adults. METHODS We measured serum CML and blood pressure in 3044 adults, aged 70-79 years, who participated in the Health, Aging and Body Composition Study, a population-based study of ageing in Pittsburgh, Pennsylvania and Memphis, Tennessee. aPWV was measured in 2468 participants. RESULTS Participants in the highest tertile of serum CML had higher PP (highest tertile: beta = 2.85, SE = 0.82, P = 0.0005; middle tertile: beta = 0.60, SE = 0.80, P = 0.45), and higher aPWV (highest tertile: beta = 51.4, SE = 20.1, P = 0.01; middle tertile: beta = 3.2, SE = 19.8, P = 0.87) than those in the lowest tertile in multivariable linear regression models adjusting for age, sex, race, education, BMI, smoking, alcohol use, total cholesterol, high-density lipoprotein (HDL) cholesterol, diabetes, cardiovascular disease and chronic kidney disease. Participants in the highest and middle tertiles of serum CML had higher odds of hypertension [odds ratio (OR) 1.32, 95% confidence interval (95% CI) 1.06-1.60, P = 0.005; OR 1.27, 95% CI 1.05-1.53, P = 0.01, respectively] than those in the lowest tertile in a multivariable logistic regression model adjusting for the same covariates. CONCLUSION Elevated serum CML was associated with arterial stiffness, as reflected by higher PP and aPWV, in older, community-dwelling adults.
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Affiliation(s)
- Richard D Semba
- aDepartment of Ophthalmology, Johns Hopkins University School of Medicine, Baltimore, Maryland bDepartment of Epidemiology and Biostatistics, University of California, San Francisco, San Francisco, California cDivision of Biostatistics and Bioinformatics, Sidney Kimmel Comprehensive Cancer Center, Johns Hopkins University, Baltimore dLaboratory of Epidemiology and Population Sciences, National Institute on Aging, National Institutes of Health, Rockville, Maryland eDepartment of Preventive Medicine, University of Tennessee, Memphis, Tennessee fNational Institute on Aging, Baltimore, Maryland gDepartment of Epidemiology, University of Pittsburgh Graduate School of Public Health, Pittsburgh, Pennsylvania, USA
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van Sloten TT, Protogerou AD, Henry RMA, Schram MT, Launer LJ, Stehouwer CDA. Association between arterial stiffness, cerebral small vessel disease and cognitive impairment: A systematic review and meta-analysis. Neurosci Biobehav Rev 2015; 53:121-30. [PMID: 25827412 DOI: 10.1016/j.neubiorev.2015.03.011] [Citation(s) in RCA: 167] [Impact Index Per Article: 18.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/24/2014] [Revised: 12/14/2014] [Accepted: 03/22/2015] [Indexed: 12/23/2022]
Abstract
Arterial stiffness may be a cause of cerebral small vessel disease and cognitive impairment. We therefore performed a systematic review and meta-analysis of studies on the association between stiffness, cerebral small vessel disease and cognitive impairment. For the associations between stiffness (i.e. carotid-femoral pulse wave velocity (cfPWV), brachial-ankle PWV (baPWV), carotid stiffness and pulse pressure) on the one hand and cerebral small vessel disease and cognitive impairment on the other, we identified 23 (n=15,666/20 cross-sectional; 1 longitudinal; 2 combined cross-sectional/longitudinal) and 41 studies (n=57,671/26 cross-sectional; 11 longitudinal; 4 combined cross-sectional/longitudinal), respectively. Pooled analyses of cross-sectional studies showed that greater stiffness was associated with markers of cerebral small vessel disease with odds ratios, per +1 SD, of 1.29-1.32 (P<.001). Studies on cognitive impairment could not be pooled due to large heterogeneity. Some (but not all) studies showed an association between greater stiffness and cognitive impairment, and the strength of this association was relatively weak. The present study supports the hypothesis that greater arterial stiffness is a contributor to microvascular brain disease.
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Affiliation(s)
- Thomas T van Sloten
- Department of Medicine, Cardiovascular Research Institute Maastricht and School for Nutrition, Toxicology and Metabolism, Maastricht University Medical Centre, Prof. Debyelaan 25, Maastricht, The Netherlands
| | - Athanase D Protogerou
- Department of Medicine, Cardiovascular Research Institute Maastricht, Maastricht University Medical Centre, Prof. Debyelaan 25, Maastricht, The Netherlands
| | - Ronald M A Henry
- Department of Medicine, Cardiovascular Research Institute Maastricht, Maastricht University Medical Centre, Prof. Debyelaan 25, Maastricht, The Netherlands
| | - Miranda T Schram
- Department of Medicine, Cardiovascular Research Institute Maastricht, Maastricht University Medical Centre, Prof. Debyelaan 25, Maastricht, The Netherlands
| | - Lenore J Launer
- Intramural Research Program, Laboratory of Epidemiology and Population Sciences, National Institute on Aging, National Institutes of Health, 7201 Wisconsin Avenue, Bethesda, MD, USA
| | - Coen D A Stehouwer
- Department of Medicine, Cardiovascular Research Institute Maastricht, Maastricht University Medical Centre, Prof. Debyelaan 25, Maastricht, The Netherlands.
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177
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Seals DR, Justice JN, LaRocca TJ. Physiological geroscience: targeting function to increase healthspan and achieve optimal longevity. J Physiol 2015; 594:2001-24. [PMID: 25639909 DOI: 10.1113/jphysiol.2014.282665] [Citation(s) in RCA: 178] [Impact Index Per Article: 19.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/13/2014] [Accepted: 01/27/2015] [Indexed: 12/17/2022] Open
Abstract
Most nations of the world are undergoing rapid and dramatic population ageing, which presents great socio-economic challenges, as well as opportunities, for individuals, families, governments and societies. The prevailing biomedical strategy for reducing the healthcare impact of population ageing has been 'compression of morbidity' and, more recently, to increase healthspan, both of which seek to extend the healthy period of life and delay the development of chronic diseases and disability until a brief period at the end of life. Indeed, a recently established field within biological ageing research, 'geroscience', is focused on healthspan extension. Superimposed on this background are new attitudes and demand for 'optimal longevity' - living long, but with good health and quality of life. A key obstacle to achieving optimal longevity is the progressive decline in physiological function that occurs with ageing, which causes functional limitations (e.g. reduced mobility) and increases the risk of chronic diseases, disability and mortality. Current efforts to increase healthspan centre on slowing the fundamental biological processes of ageing such as inflammation/oxidative stress, increased senescence, mitochondrial dysfunction, impaired proteostasis and reduced stress resistance. We propose that optimization of physiological function throughout the lifespan should be a major emphasis of any contemporary biomedical policy addressing global ageing. Effective strategies should delay, reduce in magnitude or abolish reductions in function with ageing (primary prevention) and/or improve function or slow further declines in older adults with already impaired function (secondary prevention). Healthy lifestyle practices featuring regular physical activity and ideal energy intake/diet composition represent first-line function-preserving strategies, with pharmacological agents, including existing and new pharmaceuticals and novel 'nutraceutical' compounds, serving as potential complementary approaches. Future research efforts should focus on defining the temporal patterns of functional declines with ageing, identifying the underlying mechanisms and modulatory factors involved, and establishing the most effective lifestyle practices and pharmacological options for maintaining function. Continuing development of effective behavioural approaches for enhancing adherence to healthy ageing practices in diverse populations, and ongoing analysis of the socio-economic costs and benefits of healthspan extension will be important supporting goals. To meet the demands created by rapid population ageing, a new emphasis in physiological geroscience is needed, which will require the collaborative, interdisciplinary efforts of investigators working throughout the translational research continuum from basic science to public health.
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Affiliation(s)
- Douglas R Seals
- Department of Integrative Physiology, University of Colorado Boulder, Boulder, CO, 80309, USA
| | - Jamie N Justice
- Department of Integrative Physiology, University of Colorado Boulder, Boulder, CO, 80309, USA
| | - Thomas J LaRocca
- Department of Integrative Physiology, University of Colorado Boulder, Boulder, CO, 80309, USA
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178
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Tarumi T, de Jong DLK, Zhu DC, Tseng BY, Liu J, Hill C, Riley J, Womack KB, Kerwin DR, Lu H, Munro Cullum C, Zhang R. Central artery stiffness, baroreflex sensitivity, and brain white matter neuronal fiber integrity in older adults. Neuroimage 2015; 110:162-70. [PMID: 25623500 DOI: 10.1016/j.neuroimage.2015.01.041] [Citation(s) in RCA: 38] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/05/2014] [Revised: 12/22/2014] [Accepted: 01/18/2015] [Indexed: 12/21/2022] Open
Abstract
Cerebral hypoperfusion elevates the risk of brain white matter (WM) lesions and cognitive impairment. Central artery stiffness impairs baroreflex, which controls systemic arterial perfusion, and may deteriorate neuronal fiber integrity of brain WM. The purpose of this study was to examine the associations among brain WM neuronal fiber integrity, baroreflex sensitivity (BRS), and central artery stiffness in older adults. Fifty-four adults (65 ± 6 years) with normal cognitive function or mild cognitive impairment (MCI) were tested. The neuronal fiber integrity of brain WM was assessed from diffusion metrics acquired by diffusion tensor imaging. BRS was measured in response to acute changes in blood pressure induced by bolus injections of vasoactive drugs. Central artery stiffness was measured by carotid-femoral pulse wave velocity (cfPWV). The WM diffusion metrics including fractional anisotropy (FA) and radial (RD) and axial (AD) diffusivities, BRS, and cfPWV were not different between the control and MCI groups. Thus, the data from both groups were combined for subsequent analyses. Across WM, fiber tracts with decreased FA and increased RD were associated with lower BRS and higher cfPWV, with many of the areas presenting spatial overlap. In particular, the BRS assessed during hypotension was strongly correlated with FA and RD when compared with hypertension. Executive function performance was associated with FA and RD in the areas that correlated with cfPWV and BRS. These findings suggest that baroreflex-mediated control of systemic arterial perfusion, especially during hypotension, may play a crucial role in maintaining neuronal fiber integrity of brain WM in older adults.
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Affiliation(s)
- Takashi Tarumi
- Institute for Exercise and Environmental Medicine, Texas Health Presbyterian Hospital Dallas, 8200 Walnut Hill Ln, Dallas, TX 75231, USA; Department of Internal Medicine, University of Texas Southwestern Medical Center, 1801 Inwood Rd, Dallas, TX 75235, USA
| | - Daan L K de Jong
- Department of Geriatric Medicine, Radboud University Medical Center, Geert Grooteplein-Zuid 10, 6525 GA Nijmegen, Netherlands
| | - David C Zhu
- Department of Radiology and Psychology, Michigan State University, 220 Trowbridge Rd, East Lansing, MI 48824, USA; Cognitive Imaging Research Center, Michigan State University, 220 Trowbridge Rd, East Lansing, MI 48824, USA
| | - Benjamin Y Tseng
- Institute for Exercise and Environmental Medicine, Texas Health Presbyterian Hospital Dallas, 8200 Walnut Hill Ln, Dallas, TX 75231, USA; Department of Internal Medicine, University of Texas Southwestern Medical Center, 1801 Inwood Rd, Dallas, TX 75235, USA
| | - Jie Liu
- Institute for Exercise and Environmental Medicine, Texas Health Presbyterian Hospital Dallas, 8200 Walnut Hill Ln, Dallas, TX 75231, USA; Department of Internal Medicine, University of Texas Southwestern Medical Center, 1801 Inwood Rd, Dallas, TX 75235, USA
| | - Candace Hill
- Institute for Exercise and Environmental Medicine, Texas Health Presbyterian Hospital Dallas, 8200 Walnut Hill Ln, Dallas, TX 75231, USA
| | - Jonathan Riley
- Institute for Exercise and Environmental Medicine, Texas Health Presbyterian Hospital Dallas, 8200 Walnut Hill Ln, Dallas, TX 75231, USA
| | - Kyle B Womack
- Department of Psychiatry, University of Texas Southwestern Medical Center, 1801 Inwood Rd, Dallas, TX 75235, USA; Department of Neurology and Neurotherapeutics, University of Texas Southwestern Medical Center, 1801 Inwood Rd, Dallas, TX 75235, USA
| | - Diana R Kerwin
- Texas Alzheimer's and Memory Disorders, Texas Health Presbyterian Hospital Dallas, 8200 Walnut Hill Ln, Dallas, TX 75231, USA
| | - Hanzhang Lu
- Advanced Imaging Research Center, University of Texas Southwestern Medical Center, 1801 Inwood Rd, Dallas, TX 75235, USA
| | - C Munro Cullum
- Department of Psychiatry, University of Texas Southwestern Medical Center, 1801 Inwood Rd, Dallas, TX 75235, USA; Department of Neurology and Neurotherapeutics, University of Texas Southwestern Medical Center, 1801 Inwood Rd, Dallas, TX 75235, USA
| | - Rong Zhang
- Institute for Exercise and Environmental Medicine, Texas Health Presbyterian Hospital Dallas, 8200 Walnut Hill Ln, Dallas, TX 75231, USA; Department of Internal Medicine, University of Texas Southwestern Medical Center, 1801 Inwood Rd, Dallas, TX 75235, USA; Department of Neurology and Neurotherapeutics, University of Texas Southwestern Medical Center, 1801 Inwood Rd, Dallas, TX 75235, USA.
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180
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Ravona-Springer R, Haratz S, Tanne D, Schmeidler J, Efrati S, Rosendorff C, Beeri MS, Silverman JM. Arterial wall function is associated with cognitive performance primarily in elderly with type 2 diabetes. J Alzheimers Dis 2015; 44:687-93. [PMID: 25352451 PMCID: PMC5754925 DOI: 10.3233/jad-141197] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
Regression analyses compared 41 type 2 diabetes (T2D) and 131 non-T2D cognitively normal elderly males on the associations of arterial wall function measures [large artery elasticity index (LAEI), small artery elasticity index (SAEI), systemic vascular resistance (SVR), and total vascular impedance (TVI)] with cognitive performance (memory, language, and executive functions), controlling for socio-demographic and cardiovascular factors. Higher LAEI and lower TVI were significantly associated with better executive functions performance in T2D but not in non-T2D subjects. Lower TVI was more associated with better language performance in T2D. Results suggest that arterial wall function is associated with cognition in T2D.
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Affiliation(s)
- Ramit Ravona-Springer
- Memory Clinic, Sheba Medical Center, Tel Hashomer, Ramat Gan, Israel
- Sackler Faculty of Medicine, Tel-Aviv University, Tel-Aviv, Israel
| | - Salo Haratz
- Sackler Faculty of Medicine, Tel-Aviv University, Tel-Aviv, Israel
- Stroke Unit, Neurology Department, Sheba Medical Center, Ramat Gan, Israel
| | - David Tanne
- Sackler Faculty of Medicine, Tel-Aviv University, Tel-Aviv, Israel
- Stroke Unit, Neurology Department, Sheba Medical Center, Ramat Gan, Israel
| | - James Schmeidler
- Department of Psychiatry at the Icahn School of Medicine at Mount Sinai, New York, NY, USA
| | - Shai Efrati
- Sackler Faculty of Medicine, Tel-Aviv University, Tel-Aviv, Israel
- The institute of Hyperbaric Medicine, Assaf Harofeh Medical Center, Zerifin, Israel
- Research and Development Unit, Assaf Harofeh Medical Center, Zerifin, Israel
- Sagol School of Neuroscience, Tel-Aviv University, Tel-Aviv, Israel
| | - Clive Rosendorff
- James J. Peters Veterans Affairs Medical Center, Bronx, NY, USA
- Department of Medicine (Cardiology), Mount Sinai School of Medicine, New York, NY, USA
| | - Michal Schnaider Beeri
- Department of Psychiatry at the Icahn School of Medicine at Mount Sinai, New York, NY, USA
- Josef Sagol Neuroscience Center, Sheba Medical Center, Tel Hashomer, Ramat Gan, Israel
| | - Jeremy M. Silverman
- Department of Psychiatry at the Icahn School of Medicine at Mount Sinai, New York, NY, USA
- James J. Peters Veterans Affairs Medical Center, Bronx, NY, USA
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181
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Stough C, Simpson T, Lomas J, McPhee G, Billings C, Myers S, Oliver C, Downey LA. Reducing occupational stress with a B-vitamin focussed intervention: a randomized clinical trial: study protocol. Nutr J 2014; 13:122. [PMID: 25533338 PMCID: PMC4290459 DOI: 10.1186/1475-2891-13-122] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/30/2014] [Accepted: 12/12/2014] [Indexed: 12/02/2022] Open
Abstract
Background Workplace stress in Australia and other western countries has been steadily increasing over the past decade. It can be observed not only in terms of increased compensation claims but also costs due to absenteeism, loss of productivity at work and reduced psychological and physiological health and well-being. Given the cost and pervasive effects of stress in the modern workforce, time efficient and cost-effective interventions capable of reducing occupational stress (or strain) and burnout are urgently required for the improved well-being of stressed employees. One intervention gaining scientific traction is supplementation with nutritional interventions, particularly the B group vitamins. Methods This study was developed to examine the effects of B group vitamins on workplace stress and mood variables with a sample of full-time employed older adults who subjectively report feeling stressed. The study is a randomized, double-blind, placebo-controlled, parallel-groups clinical trial where 200 (N = 100/group) participants will be randomized to receive Blackmores® Executive B Stress Formula or placebo daily for a period of 6 months. Participants will be tested at baseline and 6 months post-randomization on workplace stress, cognitive, personality and mood measures, cardiovascular (brachial and aortic systolic and diastolic blood pressures as well as arterial stiffness), biochemical (assays to measure inflammation and safety) as well as genetic assessments (to assess stress processing) and neuroimaging measures (to investigate in vivo mechanisms of action of B vitamins). In addition to this pre- and post- supplementation testing, participants will also complete a battery of self-report questionnaires online to assess their stress and mood once a month for the duration of the study. The primary aim of the study is to investigate the effects of B vitamin supplementation on work related stress. The secondary aims are to explore the mechanisms underpinning any changes in mood or workplace stress due to the B vitamin intervention by examining relationships between cognitive, biological, neuroimaging and cardiovascular variables over 6 months. A subset of 40 participants (N = 20/group) will undergo neuroimaging at baseline and at 6 months using functional magnetic resonance imaging (fMRI) and magnetic resonance spectroscopy (MRS) in order to further explore in vivo mechanisms of action of B vitamins. Trial registration Australia and New Zealand Clinical Trials Register (ANZCTR):ACTRN12613000294752
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Affiliation(s)
- Con Stough
- Centre for Human Psychopharmacology, Swinburne University, PO Box 218, HawthornVictoria, Melbourne, Australia.
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182
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Climie RED, Srikanth V, Beare R, Keith LJ, Fell J, Davies JE, Sharman JE. Aortic reservoir characteristics and brain structure in people with type 2 diabetes mellitus; a cross sectional study. Cardiovasc Diabetol 2014; 13:143. [PMID: 25338824 PMCID: PMC4221700 DOI: 10.1186/s12933-014-0143-6] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/24/2014] [Accepted: 10/06/2014] [Indexed: 01/09/2023] Open
Abstract
Background Central hemodynamics help to maintain appropriate cerebral and other end-organ perfusion, and may be altered with ageing and type 2 diabetes mellitus (T2DM). We aimed to determine the associations between central hemodynamics and brain structure at rest and during exercise in people with and without T2DM. Methods In a sample of people with T2DM and healthy controls, resting and exercise measures of aortic reservoir characteristics (including excess pressure integral [Pexcess]) and other central hemodynamics (including augmentation index [AIx] and aortic pulse wave velocity [aPWV]) were recorded. Brain volumes (including gray matter volume [GMV] and white matter lesions [WML]) were derived from magnetic resonance imaging (MRI) scans. Multivariable linear regression was used to study the associations of hemodynamic variables with brain structure in the two groups adjusting for age, sex, daytime systolic BP (SBP) and heart rate. Results There were 37 T2DM (63 ± 9 years; 47% male) and 37 healthy individuals (52 ± 8 years; 51% male). In T2DM, resting aPWV was inversely associated with GMV (standardized β = −0.47, p = 0.036). In healthy participants, resting Pexcess was inversely associated with GMV (β = −0.23, p = 0.043) and AIx was associated with WML volume (β = 0.52, p = 0.021). There were no associations between exercise hemodynamics and brain volumes in either group. Conclusions Brain atrophy is associated with resting aortic stiffness in T2DM, and resting Pexcess in healthy individuals. Central vascular mechanisms underlying structural brain changes may differ between healthy individuals and T2DM.
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183
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López-Olóriz J, López-Cancio E, Arenillas JF, Hernández M, Dorado L, Dacosta-Aguayo R, Barrios M, Soriano-Raya JJ, Miralbell J, Bargalló N, Cáceres C, Torán P, Alzamora M, Dávalos A, Mataró M. Diffusion tensor imaging, intracranial vascular resistance and cognition in middle-aged asymptomatic subjects. Cerebrovasc Dis 2014; 38:24-30. [PMID: 25196863 DOI: 10.1159/000363620] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/04/2014] [Accepted: 05/15/2014] [Indexed: 11/19/2022] Open
Abstract
BACKGROUND The contribution of traditional vascular risk factors to cognitive impairment and dementia is well known. However, in order to obtain possible targets for prevention of vascular cognitive impairment (VCI), it may be important to identify other early and noninvasive markers in asymptomatic middle-aged adults. The calculation of middle cerebral artery-pulsatility index (MCA-PI) is an ultrasonologic, noninvasive, validated and easily reproducible technique to assess increased distal resistance to blood flow. This study aims to assess the relationship between MCA-PI, microstructural white matter (WM) integrity and cognition in a middle-aged asymptomatic population. METHODS Ninety-five participants from the Barcelona-Asymptomatic Intracranial Atherosclerosis (AsIA) neuropsychology study were included. Subjects were 50-65 years old, free from dementia and without history of vascular disease. Transcranial color-coded duplex ultrasound examination was performed to assess MCA-PI as a measure of vascular resistance. WM integrity was evaluated by fractional anisotropy (FA) measurements of diffusion tensor images (DTI) acquired on a 3T-MRI. The neuropsychological battery was specifically selected to be sensitive to VCI, and included tests that were grouped into six cognitive domains: executive functioning, attention, verbal fluency, memory, visuospatial skills and psychomotor speed. A multivariate linear regression model adjusted for age, gender, years of education, diabetes and hypertension was performed. RESULTS MCA-PI was significantly associated with WM disintegration in different tracts (fornix, corticospinal and anterior thalamic), all p < 0.05 uncorrected. Both mean MCA-PI and mean FA of those significant tracts were independently associated with poor performance in attention, psychomotor speed, and visuospatial skills after adjustment for age, gender, years of education, and vascular risk factors (all p < 0.05). MCA-PI was independently associated with lower scores in all cognitive domains, except for visuospatial skills. CONCLUSIONS Our data suggest that MCA-PI may be related to WM disintegration and early vascular cognitive impairment in middle-aged subjects. Although further prospective studies are needed to provide evidence for its validity in longitudinal studies, our results support the proposal of including MCA-PI as part of clinical assessment in order to identify targets for VCI prevention.
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Affiliation(s)
- Jorge López-Olóriz
- Department of Psychiatry and Clinical Psychobiology, Universitat de Barcelona, Barcelona, Spain
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184
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Carmichael O. Preventing vascular effects on brain injury and cognition late in life: knowns and unknowns. Neuropsychol Rev 2014; 24:371-87. [PMID: 25085314 DOI: 10.1007/s11065-014-9264-7] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/16/2014] [Accepted: 07/23/2014] [Indexed: 12/14/2022]
Abstract
For some researchers, the relationship between prevalent cardiovascular risk factors and late-life cognitive decline is not worthy of further study. It is already known that effective treatment of vascular risk factors lowers risk of such major outcomes as stroke and heart attack, the argument goes; thus, any new information about the relationship between vascular risk factors and another major outcome--late-life cognitive decline--is unlikely to have an impact on clinical practice. The purpose of this review is to probe the logic of this argument by focusing on what is known, and what is not known, about the relationship between vascular risk factors and late-life cognitive decline. The unknowns are substantial: in particular, there is relatively little evidence that current vascular risk factor treatment protocols are adequate to prevent late-life cognitive decline or the clinically silent brain injury that precedes it. In addition, there is relatively little understanding of which factors lead to differential vulnerability or resilience to the effects of vascular risk factors on silent brain injury. Differential effects of different classes of treatments are similarly unclear. Finally, there is limited understanding of the impact of clinically-silent neurodegenerative disease processes on cerebrovascular processes. Further study of the relationships among vascular risk factors, brain injury, and late-life cognitive decline could have a major impact on development of new vascular therapies and on clinical management of vascular risk factors, and there are promising avenues for future research in this direction.
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Affiliation(s)
- Owen Carmichael
- Pennington Biomedical Research Center, 6400 Perkins Road, Baton Rouge, LA, 70808, USA,
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185
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Hughes TM, Kuller LH, Barinas-Mitchell EJM, McDade EM, Klunk WE, Cohen AD, Mathis CA, Dekosky ST, Price JC, Lopez OL. Arterial stiffness and β-amyloid progression in nondemented elderly adults. JAMA Neurol 2014; 71:562-8. [PMID: 24687165 DOI: 10.1001/jamaneurol.2014.186] [Citation(s) in RCA: 139] [Impact Index Per Article: 13.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/13/2023]
Abstract
IMPORTANCE Recent studies show that cerebral β-amyloid (Aβ) deposition is associated with blood pressure and measures of arterial stiffness in nondemented individuals. OBJECTIVE To examine the association between measures of arterial stiffness and change in Aβ deposition over time. DESIGN, SETTING, AND PARTICIPANTS Deposition of Aβ was determined in a longitudinal observational study of aging by positron emission tomography using the Pittsburgh compound B twice 2 years apart in 81 nondemented individuals 83 years and older. Arterial stiffness was measured with a noninvasive and automated waveform analyzer at the time closest to the second positron emission tomography scan. All measures were performed under standardized conditions. Pulse wave velocity (PWV) was measured in the central (carotid-femoral and heart-femoral PWV), peripheral (femoral-ankle PWV), and mixed (brachial-ankle PWV) vascular beds. MAIN OUTCOMES AND MEASURES The change in Aβ deposition over 2 years was calculated from the 81 individuals with repeat Aβ-positron emission tomography. RESULTS The proportion of Aβ-positive individuals increased from 48% at baseline to 75% at follow-up. Brachial-ankle PWV was significantly higher among Aβ-positive participants at baseline and follow-up. Femoral-ankle PWV was only higher among Aβ-positive participants at follow-up. Measures of central stiffness and blood pressure were not associated with Aβ status at baseline or follow-up, but central stiffness was associated with a change in Aβ deposition over time. Each standard deviation increase in central stiffness (carotid-femoral PWV, P = .001; heart-femoral PWV, P = .004) was linked with increases in Aβ deposition over 2 years. CONCLUSIONS AND RELEVANCE This study showed that Aβ deposition increases with age in nondemented individuals and that arterial stiffness is strongly associated with the progressive deposition of Aβ in the brain, especially in this age group. The association between Aβ deposition changes over time and generalized arterial stiffness indicated a relationship between the severity of subclinical vascular disease and progressive cerebral Aβ deposition.
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Affiliation(s)
- Timothy M Hughes
- Department of Internal Medicine, Wake Forest School of Medicine, Wake Forest University, Winston-Salem, North Carolina
| | - Lewis H Kuller
- Department of Epidemiology, Graduate School of Public Health, University of Pittsburgh, Pittsburgh, Pennsylvania
| | - Emma J M Barinas-Mitchell
- Department of Epidemiology, Graduate School of Public Health, University of Pittsburgh, Pittsburgh, Pennsylvania
| | - Eric M McDade
- Department of Neurology, School of Medicine, University of Pittsburgh, Pittsburgh, Pennsylvania
| | - William E Klunk
- Department of Psychiatry, School of Medicine, University of Pittsburgh, Pittsburgh, Pennsylvania
| | - Ann D Cohen
- Department of Psychiatry, School of Medicine, University of Pittsburgh, Pittsburgh, Pennsylvania
| | - Chester A Mathis
- Department of Radiology, School of Medicine, University of Pittsburgh, Pittsburgh, Pennsylvania
| | - Steven T Dekosky
- Department of Neurology, School of Medicine, University of Virginia, Charlottesville
| | - Julie C Price
- Department of Radiology, School of Medicine, University of Pittsburgh, Pittsburgh, Pennsylvania
| | - Oscar L Lopez
- Department of Neurology, School of Medicine, University of Pittsburgh, Pittsburgh, Pennsylvania
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186
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Aortic Stiffness Is Related to the Ischemic Brain Injury Biomarker N-Methyl-D-aspartate Receptor Antibody Levels in Aortic Valve Replacement. Neurol Res Int 2014; 2014:970793. [PMID: 25054065 PMCID: PMC4099039 DOI: 10.1155/2014/970793] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/24/2014] [Accepted: 06/15/2014] [Indexed: 01/25/2023] Open
Abstract
Background. Aortic stiffness changes the flow pattern of circulating blood causing microvascular damage to different end-organ tissues, such as brain cells. The relationship between aortic stiffness measured by pulse wave velocity (PWV) and serum ischemic brain injury biomarker N-methyl-D-aspartate receptor antibody (NR2Ab) levels in aortic valve replacement has not been assessed. Methods. Patients undergoing aortic valve replacement (AVR) for aortic stenosis (AS) had their PWV and NR2Ab serum levels measured preoperatively. We analyzed PWV and NR2Ab in two ways: (1) as continuous variables using the actual value and (2) as dichotomous variables (PWV-norm and PWV-high groups) and (NR2Ab-low and NR2Ab-high groups). Results. Fifty-six patients (71 ± 8.4
years) were included in this study. The NR2Ab level (ng/mL) was significantly higher in the PWV-high group (n = 21) than in PWV-norm group (n = 35; median 1.8 ± 1.2 versus 1.2 ± 0.7, resp., P = 0.003). NR2Ab level was positively associated with PWV and negatively associated with male gender. Multiple regression revealed PWV independently related to NR2Ab level, and PWV cut-off was associated with a 7.23 times increase in the likelihood of having high NR2Ab (>1.8 ng/mL). Conclusion. Higher PWV in patients with surgical aortic stenosis is associated with higher levels of the ischemic brain biomarker NR2Ab.
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187
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Ultrasound measurements of brain tissue pulsatility correlate with the volume of MRI white-matter hyperintensity. J Cereb Blood Flow Metab 2014; 34:942-4. [PMID: 24714033 PMCID: PMC4050254 DOI: 10.1038/jcbfm.2014.58] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/28/2013] [Revised: 01/12/2014] [Accepted: 02/22/2014] [Indexed: 11/08/2022]
Abstract
White-matter hyperintensity (WMH) is frequently seen in magnetic resonance imaging (MRI), but the complete physiopathology of WMH remains to be elucidated. In this study, we sought to determine whether there is an association between the maximum brain tissue displacement (maxBTD), as assessed by ultrasound, and the WMH, as observed by MRI. Nine healthy women aged 60 to 85 years underwent ultrasound and MRI assessments. We found a significant negative correlation between maxBTD and WMH (ρ=-0.86, P<0.001), suggesting a link between cerebral hypoperfusion and WMH.
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188
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Tarumi T, Ayaz Khan M, Liu J, Tseng BY, Parker R, Riley J, Tinajero C, Zhang R, Zhang R. Cerebral hemodynamics in normal aging: central artery stiffness, wave reflection, and pressure pulsatility. J Cereb Blood Flow Metab 2014; 34:971-8. [PMID: 24643081 PMCID: PMC4050241 DOI: 10.1038/jcbfm.2014.44] [Citation(s) in RCA: 146] [Impact Index Per Article: 14.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/24/2013] [Revised: 01/17/2014] [Accepted: 02/14/2014] [Indexed: 11/09/2022]
Abstract
Blood ejected from the left ventricle perfuses the brain via central elastic arteries, which stiffen with advancing age and may elevate the risk of end-organ damage. The purpose of this study was to determine the impact of central arterial aging on cerebral hemodynamics. Eighty-three healthy participants aged 22 to 80 years underwent the measurements of cerebral blood flow (CBF) and CBF velocity (CBFV) using magnetic resonance imaging (MRI) and transcranial Doppler, respectively. The CBF pulsatility was determined by the relative amplitude of CBFV to the mean value (CBFV%). Central arterial stiffness (carotid-femoral pulse wave velocity), wave reflection (carotid augmentation index), and pressure were measured using applanation tonometry. Total volume of white-matter hyperintensity (WMH) was quantified from MR images. Total CBF decreased with age while systolic and pulsatile CBFV% increased and diastolic CBFV% decreased. Women showed greater total CBF and lower cerebrovascular resistance than men. Diastolic CBFV% was lower in women than in men. Age- and sex-related differences in CBF pulsatility were independently associated with carotid pulse pressure and arterial wave reflection. In older participants, higher pulsatility of CBF was associated with the greater total volume of WMH. These findings indicate that central arterial aging has an important role in age-related differences in cerebral hemodynamics.
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Affiliation(s)
- Takashi Tarumi
- 1] Institute for Exercise and Environmental Medicine, Texas Health Presbyterian Hospital Dallas, Dallas, Texas, USA [2] Department of Internal Medicine, University of Texas Southwestern Medical Center, Dallas, Texas, USA
| | - Muhammad Ayaz Khan
- 1] Institute for Exercise and Environmental Medicine, Texas Health Presbyterian Hospital Dallas, Dallas, Texas, USA [2] Department of Internal Medicine, University of Texas Southwestern Medical Center, Dallas, Texas, USA
| | - Jie Liu
- 1] Institute for Exercise and Environmental Medicine, Texas Health Presbyterian Hospital Dallas, Dallas, Texas, USA [2] Department of Internal Medicine, University of Texas Southwestern Medical Center, Dallas, Texas, USA
| | - Benjamin Y Tseng
- 1] Institute for Exercise and Environmental Medicine, Texas Health Presbyterian Hospital Dallas, Dallas, Texas, USA [2] Department of Internal Medicine, University of Texas Southwestern Medical Center, Dallas, Texas, USA
| | - Rosemary Parker
- Institute for Exercise and Environmental Medicine, Texas Health Presbyterian Hospital Dallas, Dallas, Texas, USA
| | - Jonathan Riley
- Institute for Exercise and Environmental Medicine, Texas Health Presbyterian Hospital Dallas, Dallas, Texas, USA
| | - Cynthia Tinajero
- Institute for Exercise and Environmental Medicine, Texas Health Presbyterian Hospital Dallas, Dallas, Texas, USA
| | - Rong Zhang
- 1] Institute for Exercise and Environmental Medicine, Texas Health Presbyterian Hospital Dallas, Dallas, Texas, USA [2] Department of Internal Medicine, University of Texas Southwestern Medical Center, Dallas, Texas, USA
| | - Rong Zhang
- 1] Institute for Exercise and Environmental Medicine, Texas Health Presbyterian Hospital Dallas, Dallas, Texas, USA [2] Department of Internal Medicine, University of Texas Southwestern Medical Center, Dallas, Texas, USA
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Arterial stiffness, the brain and cognition: a systematic review. Ageing Res Rev 2014; 15:16-27. [PMID: 24548924 DOI: 10.1016/j.arr.2014.02.002] [Citation(s) in RCA: 145] [Impact Index Per Article: 14.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/03/2014] [Accepted: 02/05/2014] [Indexed: 12/26/2022]
Abstract
BACKGROUND Arterial stiffness is a known predictor of cardiovascular disease, and has also been associated with markers of cerebral small vessel disease as well as poor cognitive function and cognitive decline. The consistency of these associations and their relationship to each other are unclear. METHOD We conducted a systematic review of the evidence associating arterial stiffness with cognitive function and cognitive decline, and with makers of cerebral small vessel disease, specifically lacunar infarcts and white matter hyperintensities. RESULTS Thirteen cross-sectional studies examining arterial stiffness and white matter hyperintensities or lacunar infarctions reported a positive association between increased arterial stiffness and radiological findings of cerebral small vessel disease. Two longitudinal studies examining the relationship between arterial stiffness and white matter hyperintensities found increased pulse wave velocity to be an independent predictor of white matter hyperintensity volume. Fifteen cross-sectional and seven longitudinal studies examining arterial stiffness and cognition were identified. Fourteen of the fifteen cross-sectional studies associated increased arterial stiffness with lower cognitive function, and six of the seven longitudinal studies found arterial stiffness to be predictive of cognitive decline. CONCLUSION Arterial stiffness is associated with cerebral small vessel disease and decreased cognitive function. However methodological limitations such as differing covariates between studies and an over-reliance on the MMSE to measure cognition are a concern across much of the literature.
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Aribisala BS, Morris Z, Eadie E, Thomas A, Gow A, Valdés Hernández MC, Royle NA, Bastin ME, Starr J, Deary IJ, Wardlaw JM. Blood pressure, internal carotid artery flow parameters, and age-related white matter hyperintensities. Hypertension 2014; 63:1011-8. [PMID: 24470459 DOI: 10.1161/hypertensionaha.113.02735] [Citation(s) in RCA: 96] [Impact Index Per Article: 9.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/23/2023]
Abstract
White matter hyperintensities (WMH) are associated with hypertension. We examined interactions among blood pressure (BP), internal carotid artery (ICA) flow velocity parameters, and WMH. We obtained BP measurements from 694 community-dwelling subjects at mean ages 69.6 (±0.8) years and again at 72.6 (±0.7) years, plus brain MRI and ICA ultrasound at age 73±1 years. Diastolic and mean BP decreased and pulse pressure increased, but systolic BP did not change between 70 and 73 years. Multiple linear regression, corrected for vascular disease and risk factors, showed that WMH at the age of 73 years were associated with history of hypertension (β=0.13; P<0.001) and with BP at the age of 70 years (systolic β=0.08, mean β=0.09, diastolic β=0.08; all P<0.05); similar but attenuated associations were seen for BP at the age of 73 years. Lower diastolic BP and higher pulse pressure were associated with higher ICA pulsatility index at the age 73 years (diastolic BP age 70 years: standardized β=-0.24, P<0.001; pulse pressure age 70 years: β=0.19, P<0.001). WMH were associated with higher ICA pulsatility index (β=0.13; P=0.002) after adjusting for BP and correction for multiple testing. Therefore, falling diastolic BP and increased pulse pressure are associated with increased ICA pulsatility index, which in turn is associated with WMH. This suggests that hypertension and WMH may either associate indirectly because hypertension increases arterial stiffness that leads to WMH over time, or coassociate through advancing age and stiffer vessels, or both. Reducing vascular stiffness may reduce WMH progression and should be tested in randomized trials, in addition to testing antihypertensive therapy.
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Affiliation(s)
- Benjamin S Aribisala
- Neuroimaging Sciences, University of Edinburgh, Western General Hospital, Bramwell Dott Bldg, Crewe Rd, Edinburgh EH4 2XU, United Kingdom.
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Mukaetova-Ladinska EB. Arterial stiffness and endothelial function are related to brain aging and episodic memory in community-dwelling middle-aged and older adults. FUTURE NEUROLOGY 2013. [DOI: 10.2217/fnl.13.47] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022]
Abstract
Evaluation of: Tsao CW, Seshadri S, Beiser AS et al. Relations of arterial stiffness and endothelial function to brain aging in the community. Neurology 81, 1–8 (2013). This study reports the association between arterial stiffness and pressure pulsatility in middle-aged and older community-dwelling adults. As part of the Stroke- and Dementia-free Framingham Offspiring Study, 1587 participants were studied for tonometric arterial stiffness and endothelial function (years 1998–2001), and had MRI brain scans and cognitive assessments (1990–2002). The measures of the central aortic hemodynamics (e.g., carotid–femoral pulse wave velocity and mean arterial and central pulse pressure) were associated with greater white matter hyperintensity volumes and lower total cerebral brain volumes; this association was stronger for participants aged 65 years or older. The mean arterial and central pulse pressure were also associated with reduced verbal memory (p < 0.05) but not executive function. The brachial artery endothelial function was not associated with cerebral changes. These findings indicate that peripheral vascular changes are related not only to distal cerebral microvascular pathology, but may also be used as a surrogate marker for subclinical stages of cognitive dysfunction.
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