Systolic blood pressure tracking over 25 to 30 years and cognitive performance in older adults

Hypertension Impacts the Oscillatory Dynamics Serving the Encoding Phase of Verbal Working Memory

BACKGROUND

Chronic hypertension is known to be a major contributor to cognitive decline, with executive function and working memory being among the domains most commonly affected. Despite the growing literature on such dysfunction in patients with hypertension, the underlying neural processes are poorly understood.

METHODS

In this cross-sectional study, we examine these neural processes by having participants with controlled hypertension, uncontrolled hypertension, and healthy controls perform a verbal working memory task during magnetoencephalography. Neural oscillations associated with the encoding and maintenance components of the working memory task were imaged and statistically evaluated among the 3 groups.

RESULTS

Differences related to hypertension emerged during the encoding phase, where the hypertension groups exhibited weaker α-β oscillatory responses compared with controls in the left parietal cortices, whereas such oscillatory activity differed between the 2 hypertension groups in the right prefrontal regions. Importantly, these neural responses in the prefrontal and parietal cortices during encoding were also significantly associated with behavioral performance across all participants.

CONCLUSIONS

Overall, our data suggest that hypertension is associated with neurophysiological abnormalities during working memory encoding, whereas the neural processes serving maintenance seem to be preserved. The right hemispheric neural responses likely reflected compensatory processing, which patients with controlled hypertension may use to achieve verbal working memory function at the level of controls, as opposed to the uncontrolled hypertension group where diminished resources may have limited such additional recruitment.

Investigating the effect of hypertension on vascular cognitive impairment by using the resting-state functional connectome

Hypertension (HTN) affects over 1.2 billion individuals worldwide and is defined as systolic blood pressure (BP) ≥ 140 mmHg and diastolic BP ≥ 90 mmHg. Hypertension is also considered a high risk factor for cerebrovascular diseases, which may lead to vascular cognitive impairment (VCI). VCI is associated with executive dysfunction and is also a transitional stage between hypertension and vascular dementia. Hence, it is essential to establish a reliable approach to diagnosing the severity of VCI. In 28 HTN (51-83 yrs; 18 males, 10 females) and 28 healthy controls (HC) (51-75 yrs; 7 males, 21 females), we investigated which regions demonstrate alterations in the resting-state functional connectome due to vascular cognitive impairment in HTN by using the amplitude of the low-frequency fluctuations (ALFF), regional homogeneity (ReHo), graph theoretical analysis (GTA), and network-based statistic (NBS) methods. In the group comparison between ALFF/ReHo, HTN showed reduced spontaneous activity in the regions corresponding to vascular or metabolic dysfunction and enhanced brain activity, mainly in the primary somatosensory cortex and prefrontal areas. We also observed cognitive dysfunction in HTN, such as executive function, processing speed, and memory. Both the GTA and NBS analyses indicated that the HTN demonstrated complex local segregation, worse global integration, and weak functional connectivity. Our findings show that resting-state functional connectivity was altered, particularly in the frontal and parietal regions, by hypertensive individuals with potential vascular cognitive impairment.

Midlife hypertension is a risk factor for some, but not all, domains of cognitive decline in later life: a systematic review and meta-analysis

INTRODUCTION

Management of midlife blood pressure and hypertension status may provide a window of intervention to mitigate cognitive decline with advancing age. The aim of this review was to investigate the relationship between midlife hypertension and cognition in midlife and later life.

METHODS

Online electronic databases were searched from their inception to May 2022. Studies assessing midlife (40-65 years) hypertension and cognition at mid and/or later-life were included. A random effects meta-analysis was deemed appropriate.

RESULTS

One hundred forty-nine studies across 26 countries were included. Qualitative synthesis found negative relationships between midlife hypertension and later life cognition in the domains of memory, executive function, and global cognition. Metanalytical evidence revealed midlife hypertension negatively impacts memory, executive function, and global cognition but had no observed effect on attention at midlife.

DISCUSSION

Hypertension at midlife has a significant negative impact on cognition in mid-life and later life, namely memory, executive function, and global cognition.

Association between low values of mean arterial pressure and impaired cognitive performance in older patients with mild cognitive impairment: cross-sectional preliminary findings from the STRENGTH Project

BACKGROUND

Uncontrolled blood pressure (BP) is a risk factor for Mild Cognitive Impairment (MCI) and dementia.

AIMS

This study examined the relationship between BP and clinical/cognitive/neuropsychological aspects in MCI individuals.

METHODS

MCI patients underwent clinical, functional, cognitive and metacognitive, as well as psychological assessments. Social network, lifestyle characteristics, and medication prescriptions were also evaluated. Each patient underwent BP measurements.

RESULTS

Lower values of systolic BP (SBP), diastolic BP (DBP), and mean arterial pressure (MAP) were associated with poorer cognitive performance. Notably, MAP showed greater capability in detecting impairments in attention and visuospatial abilities compared to SBP and DBP.

DISCUSSION

These findings support the notion that in older individuals with MCI excessively low BP values, particularly MAP, might represent a risk and suggest that cerebral hypoperfusion may play a key role.

CONCLUSIONS

Routine assessment of MAP could aid clinicians in adjusting antihypertensive treatment and closely monitoring cognitive function in MCI patients.

Central obesity and elevated blood pressure in middle life are associated with physical and cognitive impairment in later life: A retrospective design with repeated measures

BACKGROUND AND AIMS

Physical and cognitive function decline indicates the prestage of disability and is associated with mortality among older adults. We investigated the association of metabolic disorders in midlife with physical and cognitive function decline in later life in a retrospective cohort.

MATERIAL AND METHODS

A total of 618 older adults aged ≥60 years in wave-6 (2014-2017) were enrolled in the Cardiovascular Disease Risk Factor Two-Township Study to evaluate physical (hand grip strength and 4-m walking speed) and cognitive function (Mine-Mental State Examination [MMSE] score). Repeated metabolic disorder measures in wave-2, wave-3, and wave-5 were obtained to identify three trajectory pattern groups according to each metabolic disorder through group-based trajectory modeling. Linear and logistic regressions were conducted to investigate the association of metabolic disorders in middle life with physical and cognitive function decline in later life.

RESULTS

The prevalence rates of a weak hand grip (<28 kg for men and <18 kg for women), slow walking speed (<0.8 m/s), and poor cognitive function (MMSE <25) were 24.43 %, 16.83 % and 10.5 %, respectively, among the older adults. In the retrospective cohort with 15-year follow-up, those with a waist circumference of ≥95 cm for men and ≥85 cm for women in middle life exhibited a significantly weak hand grip (odds ratio: 2.78 [95 % confidence interval: 1.26, 6.11]) and slow walking speed (2.26 [1.15, 4.43]) in later life compared with those with a smaller waist circumference (<85 cm for men and <75 cm for women). Elevated blood pressure (systolic blood pressure [BP] ≥130 mmHg or diastolic BP ≥80 mmHg) was significantly associated with a higher risk of cognitive function decline in later life. Furthermore, the high-trajectory and middle-trajectory groups' body mass index (3.17 [1.25, 8.04] and 2.27 [1.28, 4.00], respectively) and waist circumference (4.39 [2.07, 9.31] and 2.54 [1.39, 4.67], respectively) were significantly associated with a weak hand grip and slow walking speed, respectively, compared with those of the low-trajectory group. The high-trajectory diastolic BP group was significantly associated with a higher risk of cognitive function decline compared with the low-trajectory diastolic BP group.

CONCLUSION

Waist circumference and BP in middle life were associated with physical function decline and poor cognitive function in later life. The management of central obesity and BP in midlife may slow the decline of physical and cognitive function in later life.

Hypertension and cognition are minimally associated in late life

Hypertension impacts approximately 65% of persons over 60 years of age. Although previous studies have proposed an association between mid-life hypertension and late-life cognition, reports of associations between late-life hypertension and cognition have been mixed in the direction and magnitude of the observed associations and in the cognitive domains that may be affected. This study contrasted older adults with and without self-reported hypertension at two time points in late life (M_{Baseline age} = 64.3 years, SD₁ = 0.7; M_{Follow-up age} = 71.2 years, SD₂ = 0.9), separated by approximately seven years. Participants included 4314 1957 high school graduates from the Wisconsin Longitudinal Study who were followed longitudinally until 2011. Cognitive, demographic, and health variables from the 2003-2005 and 2011 data collection waves were used. Cognitive measures included letter and category fluency, digit ordering, similarities, and immediate and delayed recall. Bayesian independent t tests and regressions examined the association between self-reported hypertension status and cognition at baseline and follow-up. Persons with self-reported hypertension over seven years showed slightly worse letter fluency and digit ordering performance at follow-up than persons without self-reported hypertension. No baseline cognitive differences were observed between groups. Participants with self-reported hypertension showed no improvement in letter fluency or digit ordering compared to persons without self-reported hypertension. After controlling for cardiovascular risk factors, hypertension was associated only with a slight decline in letter fluency. Finally, hypertension duration was not associated with cognitive performance. Self-reported hypertension was associated with minimal to no effects on cognition in older adults. Controlling for cardiovascular risk factors eliminated virtually all associations between self-reported hypertension and cognition.

Cerebrospinal Fluid Biomarkers, Brain Structural and Cognitive Performances Between Normotensive and Hypertensive Controlled, Uncontrolled and Untreated 70-Year-Old Adults

Background: Hypertension is an important risk factor for Alzheimer's disease (AD). The pathophysiological mechanisms underlying the relationship between AD and hypertension are not fully understood, but they most likely involve microvascular dysfunction and cerebrovascular pathology. Although previous studies have assessed the impact of hypertension on different markers of brain integrity, no study has yet provided a comprehensive comparison of cerebrospinal fluid (CSF) biomarkers and structural brain differences between normotensive and hypertensive groups in a single and large cohort of older adults in relationship to cognitive performances. Objective: The aim of the present work was to investigate the differences in cognitive performances, CSF biomarkers and magnetic resonance imaging (MRI) of brain structure between normotensive, controlled hypertensive, uncontrolled hypertensive, and untreated hypertensive older adults from the Gothenburg H70 Birth Cohort Studies. Methods: As an indicator of vascular brain pathology, we measured white matter hyperintensities (WMHs), lacunes, cerebral microbleeds, enlarged perivascular space (epvs), and fractional anisotropy (FA). To assess markers of AD pathology/neurodegeneration, we measured hippocampal volume, temporal cortical thickness on MRI, and amyloid-β42, phosphorylated tau, and neurofilament light protein (NfL) in cerebrospinal fluid. Various neuropsychological tests were used to assess performances in memory, attention/processing speed, executive function, verbal fluency, and visuospatial abilities. Results: We found more white matter pathology in hypertensive compared to normotensive participants, with the highest vascular burden in uncontrolled participants (e.g., lower FA, more WMHs, and epvs). No significant difference was found in any MRI or CSF markers of AD pathology/neurodegeneration when comparing normotensive and hypertensive participants, nor among hypertensive groups. No significant difference was found in most cognitive functions between groups. Conclusion: Our results suggest that good blood pressure control may help prevent cerebrovascular pathology. In addition, hypertension may contribute to cognitive decline through its effect on cerebrovascular pathology rather than AD-related pathology. These findings suggest that hypertension is associated with MRI markers of vascular pathology in the absence of a significant decline in cognitive functions.

Cognitive impairment and the threat of dementia pandemic or the journey of hypertensive patients to self-care deficit

In the Czech Republic, due to the population aging, the prevalence of cognitive dysfunction is increasing. Researchers estimate that by 2050 the number of patients with dementia in the Czech Republic will more than double. Since dementia cannot be cured, it is important to prevent the cognitive dysfunction development by influencing modifiable risk factors. Arterial hypertension (AH) is one of the main risk factors for the development of cognitive dysfunction and dementia. Elevated blood pressure values in youth are associated with a higher risk of cognitive decline in middle age and with the development of dementia in old age. Blood pressure control in low-risk patients with stage I hypertension reduces the risk of dementia development, including Alzheimers disease. Therefore, improving the AH control in the population since younghood will be needed to influence the emerging cognitive dysfunction pandemic.

Blood Pressure and T-Tau in Spinal Fluid Are Associated With Delayed Recall in Participants With Memory Complaints and Dementia of the Alzheimer's Type

Objective: The aim of the study was to determine if systolic blood pressure (SBP), total-tau (t-tau), and beta-amyloid (Aβ) in the cerebral spinal fluid (CSF) were associated with the results on the Consortium to Establish a Registry for Alzheimer's Disease Word List (CERAD-WL) immediate and delayed recall, and the Mini Mental State Examination (MMSE) in "younger" older adults, controlling for age and sex. Method: We included 72 participants, mean age: 62.9 (SD 8.6, range 41-76) from a Norwegian memory clinic; eight were diagnosed with subjective cognitive decline, 32 with mild cognitive impairment (MCI), 30 with dementia of the Alzheimer's type (DAT), and two with combined DAT and vascular dementia (VaD). Data were examined in three fitted multiple linear regression models using the CERAD-WL immediate and delayed recall, and MMSE as dependent variables; and SBP, t-tau, and Aβ as independent variables, controlling for age and sex. Results: The strongest associations were found in the model using CERAD-WL delayed recall as the dependent variable, where 45% of the variance was explained (standardized Beta = -0.313, p = 0.004 for t-tau and standardized Beta -0.238, p = 0.01 for SBP). The unique contribution of age was close to 8%, t-tau close to 7%, and SBP above 5%. When cardiovascular medication was entered into the analysis, the explained variance increased to 51% and Aβ became significant (standardized Beta = 0.216, p = 0.03). Participants on this medication exhibited worse performance on CERAD-WL delayed recall than those who were not on medication. Age (7%), t-tau (6%), and SBP (5%) showed the same unique contribution, whereas medication contributed 6% and Aβ contributed 4%. CERAD-WL immediate recall, and MMSE yielded similar findings, but explained variance was poorer for these two variables. Conclusions: Both elevated SBP and t-tau were associated with poorer cognitive performance, especially delayed recall. Those on cardiovascular medication were more impaired than were participants who were not on this medication-a finding that probably reflected cerebral incidents in the medicated group.

Burden and correlates of cognitive impairment among hypertensive patients in Tanzania: a cross-sectional study

BACKGROUND

The evolution of cognitive impairment of vascular origin is increasingly becoming a prominent health threat particularly in this era where hypertension is the leading contributor of global disease burden and overall health loss. Hypertension is associated with the alteration of the cerebral microcirculation coupled by unfavorable vascular remodeling with consequential slowing of mental processing speed, reduced abstract reasoning, loss of linguistic abilities, and attention and memory deficits. Owing to the rapidly rising burden of hypertension in Tanzania, we sought to assess the prevalence and correlates of cognitive impairment among hypertensive patients attending a tertiary cardiovascular hospital in Tanzania.

METHODOLOGY

A hospital-based cross-sectional study was conducted at Jakaya Kikwete Cardiac Institute, a tertiary care public teaching hospital in Dar es Salaam, Tanzania between March 2020 and February 2021. A consecutive sampling method was utilized to recruit consented hypertensive outpatients during their scheduled clinic visit. General Practitioner Assessment of Cognition (GPCOG) Score was utilized in the assessment of cognitive functions. All statistical analyses utilized STATA v11.0 software. Pearson Chi square and Student's T-test were used to compare categorical and continuous variables respectively. Logistic regression analyses were used to assess for factors associated with cognitive impairment. Odd ratios with 95% confidence intervals and p-values are reported. All tests were 2-sided and p < 0.05 was used to denote a statistical significance.

RESULTS

A total of 1201 hypertensive patients were enrolled in this study. The mean age was 58.1 years and females constituted nearly two-thirds of the study population. About three quarters had excess body weight, 16.6% had diabetes, 7.7% had history of stroke, 5.7% had heart failure, 16.7% had renal dysfunction, 53.7% had anemia, 27.7% had hypertriglyceridemia, 38.5% had elevated LDL, and 2.4% were HIV-infected. Nearly two-thirds of participants had uncontrolled blood pressure and 8.7% had orthostatic hypotension. Overall, 524 (43.6%) of participants had cognitive impairment. During bivariate analysis in a logistic regression model of 16 characteristics, 14 parameters showed association with cognitive functions. However, after controlling for confounders, multivariate analysis revealed ≤primary education (OR 3.5, 95%CI 2.4-5.2, p < 0.001), unemployed state (OR 1.7, 95%CI 1.2-2.6, p < 0.01), rural habitation (OR 1.8, 95%CI 1.1-2.9, p = 0.01) and renal dysfunction (OR 1.7, 95%CI 1.0-2.7, p = 0.04) to have independent association with cognitive impairment.

CONCLUSION

This present study underscore that cognitive decline is considerably prevalent among individuals with systemic hypertension. In view of this, it is pivotal to incorporate cognitive assessment in routine evaluation of hypertensive patients.

Blood pressure, frailty and dementia

High blood pressure (BP) affects 75% of people aged over 70. Ageing alters BP homeostasis, resulting in postural hypotension and increased BP variability. Co-morbidity and frailty add complexity to understanding BP changes in later life. Longitudinal BP declines are likely driven by accumulating co-morbidity and are accelerated in both frailty and dementia. This narrative review summarises what is known about the association between BP and frailty, the clinical management of BP in frailty and the association between BP, cognitive decline and dementia.

Blood pressure, executive function, and network connectivity in middle-aged adults at risk of dementia in late life

Midlife blood pressure is associated with structural brain changes, cognitive decline, and dementia in late life. However, the relationship between early adulthood blood pressure exposure, brain structure and function, and cognitive performance in midlife is not known. A better understanding of these relationships in the preclinical stage may advance our mechanistic understanding of vascular contributions to late-life cognitive decline and dementia and may provide early therapeutic targets. To identify resting-state functional connectivity of executive control networks (ECNs), a group independent components analysis was performed of functional MRI scans of 600 individuals from the Coronary Artery Risk Development in Young Adults longitudinal cohort study, with cumulative systolic blood pressure (cSBP) measured at nine visits over the preceding 30 y. Dual regression analysis investigated performance-related connectivity of ECNs in 578 individuals (mean age 55.5 ± 3.6 y, 323 female, 243 Black) with data from the Stroop color-word task of executive function. Greater connectivity of a left ECN to the bilateral anterior gyrus rectus, right posterior orbitofrontal cortex, and nucleus accumbens was associated with better executive control performance on the Stroop. Mediation analyses showed that while the relationship between cSBP and Stroop performance was mediated by white matter hyperintensities (WMH), resting-state connectivity of the ECN mediated the relationship between WMH and executive function. Increased connectivity of the left ECN to regions involved in reward processing appears to compensate for the deleterious effects of WMH on executive function in individuals across the burden of cumulative systolic blood pressure exposure in midlife.

Trajectory patterns of blood pressure change up to six years and the risk of dementia: a nationwide cohort study

The present study aimed to investigate the associations between the trajectory of blood pressure (BP) change and the risk of subsequent dementia and to explore the differences in age, gender, and hypertension subgroups. We included 10,660 participants aged ≥ 60 years from 1998 to 2018 waves of the Chinese Longitudinal Healthy Longevity Survey. Latent growth mixture models were used to estimate BP trajectories. Cox-proportional hazard models were used to analyze the effects of BP trajectories on the risk of dementia. According to the results, stabilized systolic BP (SBP) was found to be associated with a higher risk of dementia compared with normal SBP [adjusted hazard ratio (aHR): 1.62; 95% confidence interval (CI): 1.27-2.07] and elevated SBP (aHR: 2.22; 95% CI: 1.51-3.28) in and only in the subgroups of the oldest-old, women, and subjects without hypertension at baseline. Similarly, stabilized pulse pressure (PP) was associated with a higher risk of dementia compared with normal PP (aHR: 1.52; 95% CI: 1.24-1.88) and elevated PP (aHR: 2.12; 95% CI: 1.48-3.04) in and only in the subgroups of the oldest-old, women, and subjects with hypertension at baseline. These findings suggest that stabilized SBP and PP have predictive significance for the occurrence of dementia in late life, and the factors of age, gender, and late-life hypertension should be considered when estimating the risk of BP decline on dementia.

Blood pressure in dementia, mild cognitive impairment, and subjective cognitive decline related to time of death

OBJECTIVE

It is unknown whether systolic blood pressure (SBP) drop is part of the normal aging process or due to the onset of dementia for some people. SBP drop is referring to the decrease in blood pressure often seen before death. Thus, the aim of this study was to examine whether SBP at time of diagnosis of dementia, mild cognitive impairment, or subjective cognitive decline was associated with years prior to death, and whether these associations were modified by diagnoses, age, and sex.

METHODS

Participants were 2,236 patients from the Norwegian Registry of Persons Assessed for Cognitive Symptoms (NorCog), who died during follow-up (2009-2017) for whom we had valid blood pressure measurements. Mean age at diagnosis was 77.5 years (SD 8.3), and patients were followed for an average of 3.9 years (SD 2.2, maximum 10.5 years). The patients had subjective cognitive decline (95), mild cognitive impairment (573), dementia (1,401), or no diagnoses related to cognitive deficits (167). SBP as dependent variable was regressed against years prior to death.

RESULTS

In men, SBP was 1.8 mmHg lower per year closer to death (p < .01), and this trend was linear without any acceleration. This association between years prior to death and SBP in men was not modified by age, year of diagnosis, or diagnosis. There was no such association in women.

CONCLUSION

SBP was significantly lower for those diagnosed close to death in men, but not in women. This association was not modified by either age or onset of diagnosis. Thus, the lowering of SBP is more related to closeness to death and sex than to dementia or age. The downward trend was linear all 10 years prior to death, with no acceleration closer to death.

Association between nocturnal activity of the sympathetic nervous system and cognitive dysfunction in obstructive sleep apnoea

Obstructive sleep apnoea (OSA) is associated with repetitive breathing obstructions during sleep. These episodes of hypoxia and associated arousals from sleep induce physiological stress and nocturnal over-activation of the sympathetic nervous system (SNS). One consequence of OSA is impairment in a range of cognitive domains. Previous research into cognitive impairment in OSA have focussed on intermittent hypoxia and disrupted sleep, but not nocturnal over-activation of the SNS. Therefore, we investigated whether nocturnal over-activity of the SNS was associated with cognitive impairments in OSA. The extent of nocturnal SNS activation was estimated from heart rate variability (HRV), pulse wave amplitude (PWA) and stress response biomarkers (cortisol and glucose levels). OSA severity was significantly associated with PWA indices and the HRV low frequency/ high frequency ratio (p < 0.05). Morning blood glucose levels were significantly associated with the duration of a blood oxygen saturation (SaO₂) < 90% (p < 0.01). PWA and HRV were significantly associated with the time taken to perform a task involving visuospatial functioning (p < 0.05), but not with impairments in sustained attention, reaction time or autobiographical memory. These results suggest that the visuospatial dysfunction observed in people with OSA is associated with increased nocturnal activity of the SNS.

Role of angiotensin II in chronic intermittent hypoxia-induced hypertension and cognitive decline

Sleep apnea is characterized by momentary interruptions in normal respiration and leads to periods of decreased oxygen, or intermittent hypoxia. Chronic intermittent hypoxia is a model of the hypoxemia associated with sleep apnea and results in a sustained hypertension that is maintained during normoxia. Adaptations of the carotid body and activation of the renin-angiotensin system may contribute to the development of hypertension associated with chronic intermittent hypoxia. The subsequent activation of the brain renin-angiotensin system may produce changes in sympathetic regulatory neural networks that support the maintenance of the hypertension associated with intermittent hypoxia. Hypertension and sleep apnea not only increase risk for cardiovascular disease but are also risk factors for cognitive decline and Alzheimer's disease. Activation of the angiotensin system could be a common mechanism that links these disorders.

Systolic Blood Pressure and Cognition in the Elderly: The Northern Manhattan Study

BACKGROUND

Increasing evidence suggests that hypertension is a risk factor for cognitive impairment and dementia. The relationship between blood pressure and cognition in a racially and ethnically diverse population remains unclear.

OBJECTIVE

To study association of blood pressure with cognition cross-sectionally and longitudinally in the elderly.

METHODS

Participants are stroke-free individuals from the racially and ethnically diverse Northern Manhattan Study (NOMAS) (n = 1215). General linear models are constructed to examine blood pressure in relation to cognition cross-sectionally and longitudinally at a five-year follow-up.

RESULTS

We found a cross-sectional association of systolic blood pressure (SBP) with word fluency/semantic memory, executive function, and processing speed/visual motor integration (VMI) function. This association was independent of demographics, vascular risk factors, white matter hyperintensity volume (WMHV), and carotid intima-media thickness (cIMT). The cross-sectional association of SBP with processing speed/VMI and executive function was attenuated after adjusting anti-hypertension medications in the models. Baseline SBP was associated with the change of processing speed/VMI function after adjusting vascular risk factors, WMHV, and cIMT at a 5-year follow-up. This longitudinal association was not found after adjusting anti-hypertension medications in the models. Further analyses revealed that individuals with category SBP from < 120 mmHg to≥140 mmHg had a linear decline in processing speed/VMI function at a 5-year follow-up.

CONCLUSION

We show that SBP is negatively associated with cognition cross-sectionally and longitudinally in the elderly. Anti-hypertension treatment eliminates the negative association of SBP with processing speed/VMI function longitudinally. Our findings support the treatment of stage 1 systolic hypertension in the elderly.

Effects of Blood Pressure on Cognitive Performance in Aging: A Systematic Review

INTRODUCTION

Cognitive functions play a crucial role in daily functioning. Unfortunately, some cognitive abilities decline in the process of healthy aging. An increasing body of evidence has highlighted the role of lifestyle habits and cardiovascular diseases, such as high blood pressure, in increasing the risk of cognitive decline. Surprisingly, although hypertension is a modifiable risk factor for cerebrovascular damage, the role of hypertension on cognitive impairment development is not still clear. Several key questions remain unresolved, and there are many inconsistent results in studies considering this topic. This review is aimed to systematically analyze the results found by the studies that investigated whether high blood pressure, in both hypertensive and healthy people, is related to cognitive performance. Furthermore, it points to evaluate the role of age in this relationship. Method: The review process was conducted according to the PRISMA statement. Restrictions were made, selecting the studies in English and published in peer-review journals, including at least one cognitive measure and blood pressure measurement. Studies that included participants with medical conditions, dementia, psychiatric disorders, strokes, and brain injury were excluded. Cross-sectional and longitudinal studies were analyzed separately. Finally, blood pressure measured at young life (18-39 years), midlife (age 40-64 years), elderly (65-74 years), and old age (≥75 years) were considered. Results: The review allows 68 studies to be selected, which include 154,935 participants. The results provided evidence of an adverse effect of exposure to high blood pressure on cognitive performance. High blood pressure in midlife was linked with poorer cognitive functioning; this evidence was found in cross-sectional and longitudinal studies. However, this association declines with increasing age and tends to become inconsistent. In older people, the relationship between blood pressure and cognitive performance is non-linear, highlighting a beneficial effect of high blood pressure on cognition. Conclusions: Despite some limitations, this review showed that cardiovascular and neuro-cognitive systems do not operate in isolation, but they are related. Blood pressure can be considered an early biomarker of cognitive impairment, and the necessity of early blood pressure measurement and control was underlined.

Blood Pressure in Different Dementia Disorders, Mild Cognitive Impairment, and Subjective Cognitive Decline

The aim of the study was to investigate whether blood pressure (BP) differed among people with different dementia diagnoses, mild cognitive impairment, and subjective cognitive decline and whether BP differences were observed across age and sex. Our study population comprised clinical data from 6,236 patients (53.5% women) aged 45–97 years (Mean = 73.9, SD = 9.6) referred to dementia assessment in 42 outpatient clinics across Norway during 2009–2019. Patients with the following diagnoses were included: Subjective cognitive decline (SCD), Mild cognitive impairment (MCI), dementia due to Alzheimer’s disease (AD), Vascular dementia (VaD), mixed AD and VaD, and dementia in Parkinson’s disease/Lewy body disease (PDD/LBD). For all diagnostic groups, SBP increased with age until about 80 years, after which it trended downward, whereas DBP declined after 60 years of age for all diagnostic groups. Patients aged 65 years and younger with SCD had lower SBP compared to AD patients at the same age, but SBP increased rapidly with increasing age, resulting in a substantially higher SBP at 80 + years compared with all other diagnostic groups. No other differences in SBP or diastolic blood pressure (DBP) were found among patients with the different dementia diagnosis. Neither SBP nor DBP differed between MCI and AD groups. An interaction between age and gender was found for SBP at younger ages, as women started out with a lower pressure than men did but ended up with higher SBP.

Potential health benefits of (poly)phenols derived from fruit and 100% fruit juice

(Poly)phenol-rich diets have been associated with reduced risk of various diseases. Coffee and tea are typically identified as dietary sources of chlorogenic acid and flavan-3-ols; however, 100% fruit juice greatly contributes to anthocyanin, flavonol, flavan-3-ols, and flavanone intake, making them complementary sources of dietary (poly)phenols. Thus, the aim of this narrative review was to provide an overview of fruit (poly)phenols and their potential health benefits. Fruit (poly)phenols have been associated with several health benefits (eg, reduced risk of cardiovascular disease and neurocognitive benefits). Although perspectives on 100% fruit juice consumption are controversial due to the perception of sugar content, growing evidence supports the role of fruit in whole and 100% juice forms to provide consumer benefits in alignment with dietary guidance. However, differences in (poly)phenol profiles and bioavailability likely exist between whole fruit and 100% fruit juice due to processing and the presence/absence of fiber. Ongoing studies are better defining similarities and differences between whole fruit and 100% fruit juice to elucidate protective mechanisms and align with processing and consumer products.

Diurnal blood pressure loads are associated with lower cognitive performances in controlled-hypertensive elderly individuals

INTRODUCTION

Hypertension in midlife adults is associated with cognitive decline later in life. In individuals treated for hypertension, blood pressure (BP) loads have been associated with end organ damages. This study examines whether BP load inversely correlates with performance in cognitive tasks in normotensive or controlled hypertensive (CHT) individuals.

METHODS

Participants between 60 and 75 years old were divided into normotensive participants who did not receive antihypertensive treatment (n = 49) and CHT patients (n = 28). They were evaluated for BP using ambulatory blood pressure monitoring and cognitive functions with tests assessing cognitive flexibility, working and episodic memory, and processing speed.

RESULTS

Analysis of covariance between normotensive and CHT participants revealed lower cognitive performances on immediate and delayed recall and total number of words of the Rey Auditory Verbal Learning Test (P < 0.001). Spearman's correlations between BP loads and cognitive performances revealed inversed associations between diurnal systolic (SBP) loads and performances on the Trail Making Test Part B (TMTB) (P = 0.009), the TMTB-TMT Part A (P = 0.013), the Switching Cost of the color-word interference test (P = 0.020) and the Digit-Symbol Substitution Score tests (P = 0.018) in CHT. Diurnal diastolic (DBP) loads were inversely correlated to the TMTB (P = 0.014) and TMTB-TMT Part A (P = 0.006). In normotensive subjects, diurnal SBP loads were associated with the delayed recall of the Rey Auditory Verbal Learning Test (P = 0.031) and to the three components of the digit span (P < 0.05).

CONCLUSION

Diurnal BP loads are associated with lower cognitive performances in CHT individuals. These results suggest a lowering of target levels of diurnal BPs and/or its variability.

The Effect of Blood Pressure on Cognitive Performance. An 8-Year Follow-Up of the Tromsø Study, Comprising People Aged 45-74 Years

Background

The relationship between blood pressure (BP) and cognition is complex were age appears to be an intervening variable. High and low BP have been associated with cognitive deficits as part of the aging process, but more studies are needed, especially in more recent birth cohorts.

Methods

The study sample comprised 4,465 participants, with BP measured at baseline in the Tromsø Study, Wave 6 in 2007–2008 (T0), and cognition assessed at follow-up 8 years later, in 2015–2016 in Tromsø Study 7 (T1). Age at T0 was 45–74 years, and at T1 it was 53–82 years. Cognition was assessed with three tests: The Mini Mental State Examination (MMSE), the Digit Symbol Test, and the Twelve-word Test. The associations between BP and cognition were examined specifically for age and sex using linear regression analysis adjusted for baseline BP medication use, education and body mass index (kg/m²).

Results

BP was associated with cognition at the 8-year follow-up, but the association differed according to age and sex. In men, higher systolic blood pressure (SBP) and diastolic blood pressure (DBP) at a young age (45–55 years of age) was associated with poorer cognition; the association was reversed at older ages, especially for those above 65 years of age. In women, the associations were generally weaker than for men, and sometimes in the opposite direction: For women, a higher SBP was associated with better cognition at a younger age and higher SBP poorer cognition at older ages – perhaps due to an age delay in women compared to men. Digit Symbol Test results correlated best with BP in a three-way interaction: BP by age by sex was significant for both SBP (p = 0.005) and DBP (p = 0.005).

Conclusion

Increased SBP and DBP at the younger age was clearly associated with poorer cognitive function in men 8 years later; in women the associations were weaker and sometimes in the opposite direction. Our findings clearly indicate that interactions between age and sex related to BP can predict cognitive performance over time. Men and women have different age trajectories regarding the influence of BP on cognition.

Effect of Combined Antihypertensive and Lipid-Lowering Therapies on Cognitive Function: A New Treatment Strategy?

Risk factors for cardiovascular disease such as hypertension and hyperlipidemia are associated with cognitive decline. However, there is still no clear evidence that the use of antihypertensive or lipid-lowering therapy can prevent or delay cognitive decline or development of dementia. To provide a reference for clinical treatment, we analyzed the potential mechanisms of cognitive dysfunction induced by hypertension and hyperlipidemia, the clinical research and controversy of antihypertensive and lipid-lowering therapies on cognitive function, and the clinical value of combined antihypertensive and lipid-lowering therapy. It is currently believed that hypertension and elevated blood cholesterol levels in middle-aged people may be related to cognitive impairment or dementia in the elderly. Some studies suggest that intensive antihypertensive or lipid-lowering therapies are better than standard antihypertensive or lipid-lowering therapy, yet further tests are needed to confirm their effects on cognitive function. Actively controlling potential risk factors from middle age may be important for Alzheimer's disease (AD) prevention.

Cumulative Blood Pressure Exposure, Basal Ganglia, and Thalamic Morphology in Midlife

High blood pressure (BP) negatively affects brain structure and function. Hypertension is associated with white matter hyperintensities, cognitive and mobility impairment in late-life. However, the impact of BP exposure from young adulthood on brain structure and function in mid-life is unclear. Identifying early brain structural changes associated with BP exposure, before clinical onset of cognitive dysfunction and mobility impairment, is essential for understanding mechanisms and developing interventions. We examined the effect of cumulative BP exposure from young adulthood on brain structure in a substudy of 144 (61 female) individuals from the CARDIA (Coronary Artery Risk Development in Young Adults) study. At year 30 (Y₃₀, ninth visit), participants (56±4 years old) completed brain magnetic resonance imaging and gait measures (pace, rhythm, and postural control). Cumulative systolic and diastolic BP (cumulative systolic blood pressure, cDBP) over 9 visits were calculated, multiplying mean values between 2 consecutive visits by years between visits. Surface-based analysis of basal ganglia and thalamus was achieved using FreeSurfer-initiated Large Deformation Diffeomorphic Metric Mapping. Morphometric changes were regressed onto cumulative BP to localize regions of shape variation. Y₃₀ white matter hyperintensity volumes were small and positively correlated with cumulative BP but not gait. Negative morphometric associations with cumulative systolic blood pressure were seen in the caudate, putamen, nucleus accumbens, pallidum, and thalamus. A concave right medial putamen shape mediated the relationship between cumulative systolic blood pressure and stride width. Basal ganglia and thalamic morphometric changes, rather than volumes, may be earlier manifestation of gray matter structural signatures of BP exposure that impact midlife gait.

Long-Term Blood Pressure Variability Across the Clinical and Biomarker Spectrum of Alzheimer's Disease

BACKGROUND

Elevated blood pressure is linked to cognitive impairment and Alzheimer's disease (AD) biomarker abnormality. However, blood pressure levels vary over time. Less is known about the role of long-term blood pressure variability in cognitive impairment and AD pathophysiology.

OBJECTIVE

Determine whether long-term blood pressure variability is elevated across the clinical and biomarker spectrum of AD.

METHODS

Alzheimer's Disease Neuroimaging Initiative participants (cognitively normal, mild cognitive impairment, AD [n = 1,421]) underwent baseline exam, including blood pressure measurement at 0, 6, and 12 months. A subset (n = 318) underwent baseline lumbar puncture to determine cerebrospinal fluid amyloid-β and phosphorylated tau levels. Clinical groups and biomarker-confirmed AD groups were compared on blood pressure variability over 12 months.

RESULTS

Systolic blood pressure variability was elevated in clinically diagnosed AD dementia (VIM: F2,1195 = 6.657, p = 0.001, η2 = 0.01) compared to cognitively normal participants (p = 0.001), and in mild cognitive impairment relative to cognitively normal participants (p = 0.01). Findings were maintained in biomarker-confirmed AD (VIM: F2,850 = 5.216, p = 0.006, η2 = 0.01), such that systolic blood pressure variability was elevated in biomarker-confirmed dementia due to AD relative to cognitively normal participants (p = 0.005) and in biomarker-confirmed mild cognitive impairment due to AD compared to cognitively normal participants (p = 0.04).

CONCLUSION

Long-term systolic blood pressure variability is elevated in cognitive impairment due to AD. Blood pressure variability may represent an understudied aspect of vascular dysfunction in AD with potential clinical implications.

Effects of Blood Pressure on Cognitive Performance: A Systematic Review

Background: High blood pressure has been associated with an increased risk of developing cognitive impairment. However, this relationship is unclear. This study aims to systematically review the effects of blood pressure on executive functioning, language, memory, attention and processing speed. Methods: The review process was conducted according to the PRISMA-Statement, using the PubMed, PsycINFO, PsycARTICLES and MEDLINE databases. Restrictions were made by selecting studies, which included one or more cognitive measures and reported blood pressure recordings. Studies that included participants with medical conditions or people diagnosed with dementia, psychiatric disorders, stroke and head trauma were excluded. The review allows selecting fifty studies that included 107,405 participants. The results were reported considering different cognitive domains separately: global cognitive functioning, attention, processing speed, executive functions, memory and visuospatial abilities. Results: Higher blood pressure appears to influence cognitive performance in different domains in the absence of dementia and severe cardiovascular diseases, such as strokes. This relationship seems to be independent of demographic factors (gender and education), medical co-morbidity (diabetes), and psychiatric disorders (depression). Furthermore, it presents different patterns considering ageing. In the elderly, a sort of “cardiovascular paradox” is highlighted, which allows considering higher blood pressure as a protective factor for cognitive functioning. Conclusions: The results underline that higher blood pressure is associated with a higher risk of cognitive decline in people without dementia or stroke. These findings highlight the need to introduce early management of blood pressure, even in the absence of clinical hypertension, to prevent the risk of a decline of cognitive functioning typically associated with ageing.

Association of Midlife to Late-Life Blood Pressure Patterns With Incident Dementia

Importance

The association between late-life blood pressure (BP) and cognition may depend on the presence and chronicity of past hypertension. Late-life declines in blood pressure following prolonged hypertension may be associated with poor cognitive outcomes.

Objective

To examine the association of midlife to late-life BP patterns with subsequent dementia, mild cognitive impairment, and cognitive decline.

Design, Setting, and Participants

The Atherosclerosis Risk in Communities prospective population-based cohort study enrolled 4761 participants during midlife (visit 1, 1987-1989) and followed-up over 6 visits through 2016-2017 (visit 6). BP was examined over 24 years at 5 in-person visits between visits 1 and 5 (2011-2013). During visits 5 and 6, participants underwent detailed neurocognitive evaluation. The setting was 4 US communities: Washington County, Maryland; Forsyth County, North Carolina; Jackson, Mississippi; and Minneapolis, Minnesota. Follow-up ended on December 31, 2017.

Exposures

Five groups based on longitudinal patterns of normotension, hypertension (>140/90 mm Hg), and hypotension (<90/60 mm Hg) at visits 1 to 5.

Main Outcomes and Measures

Primary outcome was dementia onset after visit 5, based on Ascertain Dementia-8 informant questionnaires, Six-Item Screener telephone assessments, hospital discharge and death certificate codes, and the visit 6 neurocognitive evaluation. Secondary outcome was mild cognitive impairment at visit 6, based on the neurocognitive evaluation.

Results

Among 4761 participants (2821 [59%] women; 979 [21%] black race; visit 5 mean [SD] age, 75 [5] years; visit 1 mean age range, 44-66 years; visit 5 mean age range, 66-90 years), there were 516 (11%) incident dementia cases between visits 5 and 6. The dementia incidence rate for participants with normotension in midlife (n = 833) and late life was 1.31 (95% CI, 1.00-1.72 per 100 person-years); for midlife normotension and late-life hypertension (n = 1559), 1.99 (95% CI, 1.69-2.32 per 100 person-years); for midlife and late-life hypertension (n = 1030), 2.83 (95% CI, 2.40-3.35 per 100 person-years); for midlife normotension and late-life hypotension (n = 927), 2.07 (95% CI, 1.68-2.54 per 100 person-years); and for midlife hypertension and late-life hypotension (n = 389), 4.26 (95% CI, 3.40-5.32 per 100 person-years). Participants in the midlife and late-life hypertension group (hazard ratio [HR], 1.49 [95% CI, 1.06-2.08]) and in the midlife hypertension and late-life hypotension group (HR, 1.62 [95% CI, 1.11-2.37]) had significantly increased risk of subsequent dementia compared with those who remained normotensive. Irrespective of late-life BP, sustained hypertension in midlife was associated with dementia risk (HR, 1.41 [95% CI, 1.17-1.71]). Compared with those who were normotensive in midlife and late life, only participants with midlife hypertension and late-life hypotension had higher risk of mild cognitive impairment (37 affected individuals (odds ratio, 1.65 [95% CI, 1.01-2.69]). There was no significant association of BP patterns with late-life cognitive change.

Conclusions and Relevance

In this community-based cohort with long-term follow-up, sustained hypertension in midlife to late life and a pattern of midlife hypertension and late-life hypotension, compared with midlife and late-life normal BP, were associated with increased risk for subsequent dementia.

LRRTM4 and PCSK5 Genetic Polymorphisms as Markers for Cognitive Impairment in A Hypotensive Aging Population: A Genome-Wide Association Study in Taiwan

Hypotension can affect cerebral perfusion and worsen cognitive outcomes. The prevalence of low blood pressure (BP) rises with increasing age. To our knowledge, no study has examined the genetic biomarkers for hypotension-related cognitive impairment (CI) yet. Utilizing the population-based genome-wide study of the Taiwan Biobank containing the data of 2533 healthy aging subjects, we found after adjustments for age, sex, education years, and principal components at a suggestive level of 1 × 10⁻⁵ that minor alleles of leucine rich repeat transmembrane neuronal 4 (LRRTM4) (rs13388459, rs1075716, rs62171995, rs17406146, rs2077823, and rs62170897), proprotein convertase subtilisin/kexin type 5 (PCSK5) (rs10521467), and the intergenic variation rs117129097 (the nearby gene: TMEM132C) are risk factors for CI in hypotensive subjects. Except for rs117129097, these single nucleotide polymorphisms (SNPs) were not markers per se for CI or for BP regulation. However, we found a suggestive interaction effect between each of the eight SNPs and hypotension on CI risk. In the hypotensive participants, those carrying minor alleles were associated with a higher incidence of CI in an additive manner than were those carrying major alleles (2 × 10⁻⁴ to 9 × 10⁻⁷). Intensive BP lowering in elderly patients carrying a minor allele of the eight identified SNPs should raise cautions to prevent a potential treatment-induced neurodegeneration.

Hypertension and Cognitive Decline: Implications of Obstructive Sleep Apnea

Hypertension and dementia are highly prevalent in the general population. Hypertension has been shown to be a risk factor for Alzheimer's dementia and vascular dementia. Sleep apnea, another common disorder, is strongly associated with hypertension and recent evidence suggests that it may also be linked with cognitive decline and dementia. It is possible that sleep apnea is the final common pathway linking hypertension to the development of dementia. This hypothesis merits further exploration as sleep apnea is readily treatable and such therapy could foreseeably delay or prevent the onset of dementia. At present, there is a paucity of therapeutic modalities that can prevent or arrest cognitive decline. In this review, we describe the associations between hypertension, dementia and sleep apnea, the pathophysiologic mechanisms underlying these associations, and the literature examining the impact of treatment of hypertension and sleep apnea on cognition. Potential areas of future investigation that may help advance our understanding of the magnitude and direction of the interaction between these conditions and the effects of treatment of high blood pressure and sleep apnea on cognition are highlighted.

Executive function in systemic arterial hypertension: A systematic review

Systemic arterial hypertension (SAH) may be associated with worse cognitive performance, especially in tasks that evaluate the executive functions (EF).

OBJECTIVE

we aimed to review the evidence regarding which components of executive functions are most affected in adults with SAH.

METHODS

this systematic review used the PRISMA statement for searching Pubmed, Scielo and Lilacs databases with the keywords "executive function OR executive functioning AND hypertension".

RESULTS

EF tasks were divided into shifting, inhibitory control and updating. A total of 9 cross-sectional and 3 longitudinal studies were selected. Only 3 studies did not report worse performance among SAH patients on EF tasks when compared to normotensive controls. The measures of shifting and inhibitory control were the most frequently investigated and reported as altered among SAH individuals, assessed mainly by the Stroop Test and Trail-Making Test part B, respectively.

CONCLUSION

inhibitory control and shifting are the EF components most influenced by SAH. The results of this review may contribute to the devising of hypotheses about mechanisms underlying these cognitive impairments.

Maternal Blood Pressure, Cord Glucocorticoids, and Child Neurodevelopment at 2 Years of Age: A Birth Cohort Study

BACKGROUND

Pregnancy hypertensive disorders have impaired neurodevelopment in offspring. We aimed to explore the association of normal range maternal blood pressure (BP) with child neurodevelopment, as well as the possible role of placental 11-beta-hydroxysteroid dehydrogenase type 2 (11β-HSD2) therein.

METHODS

Among 1,008 mother-child pairs recruited in Wuhan, China, in 2013-2015, we measured maternal third-trimester BP (systolic BP (SBP) and diastolic BP (DBP)) and cord glucocorticoids (cortisol and cortisone), a marker reflecting placental 11β-HSD2 activity. We evaluated child neurodevelopment using the Bayley Scales of Infant Development (BSID) with obtaining the Mental and Psychomotor Development Index (MDI and PDI). Multiple regression and mediation analysis were performed to estimate the effect.

RESULTS

Each 5 mm Hg increase in maternal third-trimester SBP was associated with 1.54 points decrease in MDI (95% confidence interval (CI) = -2.60, -0.48) and 1.23 points decrease in PDI (95% CI = -2.14, -0.31); similar association was observed between DBP and BSID (adjusted β = -1.32; 95% CI = -2.53, -0.10 for MDI and -1.37; 95% CI = -2.42, -0.33 for PDI). Also, we found significant associations between cord cortisol/cortisone ratio and PDI (adjusted β = 2.95; 95% CI = 0.91, 4.99), as well as between maternal BP and cord cortisol/cortisone ratio (adjusted β = -0.03; 95% CI = -0.06, -0.01 for both SBP and DBP). Mediation analysis revealed that cord cortisol/cortisone ratio explained 6.29% of the association between SBP and PDI, and 6.85% between DBP and PDI.

CONCLUSIONS

Increased maternal normal range BP may affect child neurodevelopment. Furthermore, placental 11β-HSD2 activity might be involved in the process.

Prevalence of hypotension and its association with cognitive function among older adults

BACKGROUND AND OBJECTIVE

The negative effect of hypertension has overshadowed possible health problems associated with hypotension. The purposes of this study were to describe the prevalence of hypotension in older adults and to determine the association between hypotension and cognitive function, after adjusting for possible covariates.

METHODOLOGY

The data for the study consisting of 1067 community-dwelling older adults were obtained from a national survey entitled "Identifying Psychosocial and Identifying Economic Risk Factor of Cognitive Impairment among Elderly", conducted in Malaysia. The hypotension was considered as blood pressure <120/75 mm Hg, measuring by standard mercury manometer. Data analysis was performed using the SPSS Version 22.0.

RESULTS

The mean age of the respondents was 68.27 (SD = 5.93). Mean score of cognitive function as measured by MMSE was 22.70 (SD = 4.95). The prevalence of hypotension was 29.3%. The prevalence of cognitive impairment for hypotension group was 25.6%. Results of multiple linear regression analysis revealed that hypotension is negatively associated with cognitive function (Beta = -0.11, p<.01), after adjusting for age, gender, education, marital status, employment status, diabetes, heart disease, stroke and gastritis.

CONCLUSION

The study showing hypotension is significantly associated with decreased cognitive function in later life, implies more attention to low blood pressure in old age.

Blood Pressure Variability and Cognitive Function Among Older African Americans: Introducing a New Blood Pressure Variability Measure

BACKGROUND

Although blood pressure (BP) variability has been reported to be associated with cognitive impairment, whether this relationship affects African Americans has been unclear. We sought correlations between systolic and diastolic BP variability and cognitive function in community-dwelling older African Americans, and introduced a new BP variability measure that can be applied to BP data collected in clinical practice.

METHODS

We assessed cognitive function in 94 cognitively normal older African Americans using the Mini-Mental State Examination (MMSE) and the Computer Assessment of Mild Cognitive Impairment (CAMCI). We used BP measurements taken at the patients' three most recent primary care clinic visits to generate three traditional BP variability indices, range, standard deviation, and coefficient of variation, plus a new index, random slope, which accounts for unequal BP measurement intervals within and across patients.

RESULTS

MMSE scores did not correlate with any of the BP variability indices. Patients with greater diastolic BP variability were less accurate on the CAMCI verbal memory and incidental memory tasks. Results were similar across the four BP variability indices.

CONCLUSIONS

In a sample of cognitively intact older African American adults, BP variability did not correlate with global cognitive function, as measured by the MMSE. However, higher diastolic BP variability correlated with poorer verbal and incidental memory. By accounting for differences in BP measurement intervals, our new BP variability index may help alert primary care physicians to patients at particular risk for cognitive decline.

Blood pressure from mid- to late life and risk of incident dementia

OBJECTIVE

To determine the association between blood pressure during midlife (40-64 years) to late life (≥65 years) and risk of incident dementia.

METHODS

This study included 1,440 (758 women, mean age 69 ± 6 years) Framingham Offspring participants who were free of dementia and attended 5 consecutive examinations at 4-year intervals starting at midlife (1983-1987, mean age 55 years) until late life (1998-2001, mean 69 years) and subsequently were followed up for incident dementia (mean 8 years). We determined the effect of midlife hypertension (≥140/90 mm Hg), late life hypertension, lower late life blood pressure (<100/70 mm Hg), persistence of hypertension during mid- to late life, and steep decline in blood pressure from mid- to late life over an 18-year exposure period.

RESULTS

During the follow-up period, 107 participants (71 women) developed dementia. Using multivariable Cox proportional hazards models, we found that midlife systolic hypertension (hazard ratio [HR] 1.57, 95% confidence interval [CI] 1.05-2.35) and persistence of systolic hypertension into late life (HR 1.96, 95% CI 1.25-3.09) were associated with an elevated risk of incident dementia. However, in individuals with low to normal blood pressure (≤140/90 mm Hg) at midlife, a steep decline in systolic blood pressure during mid- to late life was also associated with a >2-fold increase in dementia risk (HR 2.40, 95% CI 1.39-4.15).

CONCLUSIONS

Elevated blood pressure during midlife, persistence of elevated blood pressure into late life, and, among nonhypertensives, a steep decline in blood pressure during mid- to late life were associated with an increased dementia risk in a community-based cohort. Our data highlight the potential sustained cognitive benefits of lower blood pressures in midlife but also suggest that declining blood pressure in older adults with prehypertension or normotension, but not in those with hypertension, may be a risk marker for dementia.

Neurocognitive, psychosocial, and quality-of-life outcomes in adult survivors of childhood non-Hodgkin lymphoma

BACKGROUND

Children with non-Hodgkin lymphoma (NHL) undergo treatment with central nervous system-directed therapy, the potentially neurotoxic effects of which have not been reported in NHL survivors.

METHODS

NHL survivors (n = 187) participating in the St. Jude Lifetime Cohort who were 10 or more years from their diagnosis and were 18 years old or older underwent neurocognitive, emotional distress (Brief Symptom Inventory 18), and health-related quality of life (HRQOL) assessments (36-Item Short Form Health Survey). Age-adjusted z scores were compared with community controls (n = 181) and normative data. Treatment exposures were abstracted from medical records. Models adjusted for the age, sex, and time from diagnosis were used to calculate the risk of impairment.

RESULTS

The mean ages at evaluation were similar for the survivors and the controls (35.7 ± 8.9 vs 35.5 ± 11.0 years; P = .86). Survivors were 25.2 ± 8.8 years from their diagnosis: 43 (23%) received cranial radiation, 70 (37%) received high-dose methotrexate, 40 (21%) received high-dose cytarabine, and 151 (81%) received intrathecal chemotherapy. Survivors' intelligence and attention were within normal limits; however, their memory, executive function, processing speed, and academics were impaired in comparison with both population norms and community controls (P values < .05). Treatment-related exposures were not associated with neurocognitive function; however, neurocognitive impairment was associated with lower educational attainment, unemployment, and occupational status (P values < .03). Slower processing speed and worse self-reported executive function were associated with symptoms of depression (P values ≤ .003) and poorer HRQOL (P values < .05).

CONCLUSIONS

Adult survivors of childhood NHL experience impaired neurocognitive function, which is associated with lower social attainment and poor HRQOL. Early-detection and intervention strategies are recommended. Cancer 2017. © 2017 American Cancer Society.

Defining the Relationship Between Hypertension, Cognitive Decline, and Dementia: a Review

Hypertension is a highly prevalent condition which has been established as a risk factor for cardiovascular and cerebrovascular disease. Although the understanding of the relationship between cardiocirculatory dysfunction and brain health has improved significantly over the last several decades, it is still unclear whether hypertension constitutes a potentially treatable risk factor for cognitive decline and dementia. While it is clear that hypertension can affect brain structure and function, recent findings suggest that the associations between blood pressure and brain health are complex and, in many cases, dependent on factors such as age, hypertension chronicity, and antihypertensive medication use. Whereas large epidemiological studies have demonstrated a consistent association between high midlife BP and late-life cognitive decline and incident dementia, associations between late-life blood pressure and cognition have been less consistent. Recent evidence suggests that hypertension may promote alterations in brain structure and function through a process of cerebral vessel remodeling, which can lead to disruptions in cerebral autoregulation, reductions in cerebral perfusion, and limit the brain's ability to clear potentially harmful proteins such as β-amyloid. The purpose of the current review is to synthesize recent findings from epidemiological, neuroimaging, physiological, genetic, and translational research to provide an overview of what is currently known about the association between blood pressure and cognitive function across the lifespan. In doing so, the current review also discusses the results of recent randomized controlled trials of antihypertensive therapy to reduce cognitive decline, highlights several methodological limitations, and provides recommendations for future clinical trial design.

Association of Blood Pressure Trajectory With Mortality, Incident Cardiovascular Disease, and Heart Failure in the Cardiovascular Health Study

BACKGROUND

Common blood pressure (BP) trajectories are not well established in elderly persons, and their association with clinical outcomes is uncertain.

METHODS

We used hierarchical cluster analysis to identify discrete BP trajectories among 4,067 participants in the Cardiovascular Health Study using repeated BP measures from years 0 to 7. We then evaluated associations of each BP trajectory cluster with all-cause mortality, incident cardiovascular disease (CVD, defined as stroke or myocardial infarction) (N = 2,837), and incident congestive heart failure (HF) (N = 3,633) using Cox proportional hazard models.

RESULTS

Median age was 77 years at year 7. Over a median 9.3 years of follow-up, there were 2,475 deaths, 659 CVD events, and 1,049 HF events. The cluster analysis identified 3 distinct trajectory groups. Participants in cluster 1 (N = 1,838) had increases in both systolic (SBP) and diastolic (DBP) BPs, whereas persons in cluster 2 (N = 1,109) had little change in SBP but declines in DBP. Persons in cluster 3 (N = 1,120) experienced declines in both SBP and DBP. After multivariable adjustment, clusters 2 and 3 were associated with increased mortality risk relative to cluster 1 (hazard ratio = 1.21, 95% confidence interval: 1.06-1.37 and hazard ratio = 1.20, 95% confidence interval: 1.05-1.36, respectively). Compared to cluster 1, cluster 3 had higher rates of incident CVD but associations were not statistically significant in demographic-adjusted models (hazard ratio = 1.16, 95% confidence interval: 0.96-1.39). Findings were similar when stratified by use of antihypertensive therapy.

CONCLUSIONS

Among community-dwelling elders, distinct BP trajectories were identified by integrating both SBP and DBP. These clusters were found to have differential associations with outcomes.

Association between blood pressure and Alzheimer disease measured up to 27 years prior to diagnosis: the HUNT Study

Background

A lot of attention has been paid to the relationship of blood pressure and dementia because epidemiological research has reported conflicting evidence. Observational data has shown that midlife hypertension is a risk factor for cognitive decline and dementia later in life, whereas there is evidence that low blood pressure is predictive in later life. The aim of the present study was to examine the association between dementia and blood pressure measured up to 27 years (mean 17.6 years) prior to ascertainment.

Methods

In Nord-Trøndelag County, Norway, incident dementia data were collected during 1995–2011, and the diagnoses were validated by a panel of experts in the field. By using the subjects’ personal identification numbers, the dementia data were linked to data from the Nord-Trøndelag Health Study (the HUNT Study), a large, population-based health study performed in 1984–1986 (HUNT 1) and 1995–1997 (HUNT 2). A total of 24,638 participants of the HUNT Study were included in the present study, 579 of whom were diagnosed with Alzheimer disease, mixed Alzheimer/vascular dementia, or vascular dementia. Multiple logistic regression analyses were conducted to analyze the association between dementia and blood pressure data from HUNT 1 and HUNT 2.

Results

Over the age of 60 years, consistent inverse associations were observed between systolic blood pressure and all-cause dementia, mixed Alzheimer/vascular dementia, and Alzheimer disease, but not with vascular dementia, when adjusting for age, sex, education, and other relevant covariates. This was observed for systolic blood pressure in both HUNT 1 and HUNT 2, regardless of antihypertensive medication use. There was an adverse association between systolic blood pressure, pulse pressure, and Alzheimer disease in individuals treated with antihypertensive medication under the age of 60 years.

Conclusions

Our data are in line with those in previous studies demonstrating an inverse association between dementia and systolic blood pressure in individuals over the age of 60 years. We cannot exclude a survival effect, however. Among middle-aged subjects (<60 years), elevated systolic blood pressure and pulse pressure were associated with eventual Alzheimer disease in individuals who reported using antihypertensive medication.

Electronic supplementary material

The online version of this article (doi:10.1186/s13195-017-0262-x) contains supplementary material, which is available to authorized users.

Prehypertensive Blood Pressures and Regional Cerebral Blood Flow Independently Relate to Cognitive Performance in Midlife

Background

High blood pressure is thought to contribute to dementia in late life, but our understanding of the relationship between individual differences in blood pressure (BP) and cognitive functioning is incomplete. In this study, cognitive performance in nonhypertensive midlife adults was examined as a function of resting BP and regional cerebral blood flow (rCBF) responses during cognitive testing. We hypothesized that BP would be negatively related to cognitive performance and that cognitive performance would also be related to rCBF responses within areas related to BP control. We explored whether deficits related to systolic BP might be explained by rCBF responses to mental challenge.

Methods and Results

Healthy midlife participants (n=227) received neuropsychological testing and performed cognitive tasks in a magnetic resonance imaging scanner. A pseudocontinuous arterial spin labeling sequence assessed rCBF in brain areas related to BP in prior studies. Systolic BP was negatively related to 4 of 5 neuropsychological factors (standardized β>0.13): memory, working memory, executive function, and mental efficiency. The rCBF in 2 brain regions of interest was similarly related to memory, executive function, and working memory (standardized β>0.17); however, rCBF responses did not explain the relationship between resting systolic BP and cognitive performance.

Conclusions

Relationships at midlife between prehypertensive levels of systolic BP and both cognitive and brain function were modest but suggested the possible value of midlife intervention.

Impact of Hypertension on Cognitive Function: A Scientific Statement From the American Heart Association

BACKGROUND

Age-related dementia, most commonly caused by Alzheimer disease or cerebrovascular factors (vascular dementia), is a major public health threat. Chronic arterial hypertension is a well-established risk factor for both types of dementia, but the link between hypertension and its treatment and cognition remains poorly understood. In this scientific statement, a multidisciplinary team of experts examines the impact of hypertension on cognition to assess the state of the knowledge, to identify gaps, and to provide future directions.

METHODS

Authors with relevant expertise were selected to contribute to this statement in accordance with the American Heart Association conflict-of-interest management policy. Panel members were assigned topics relevant to their areas of expertise, reviewed the literature, and summarized the available data.

RESULTS

Hypertension disrupts the structure and function of cerebral blood vessels, leads to ischemic damage of white matter regions critical for cognitive function, and may promote Alzheimer pathology. There is strong evidence of a deleterious influence of midlife hypertension on late-life cognitive function, but the cognitive impact of late-life hypertension is less clear. Observational studies demonstrated a cumulative effect of hypertension on cerebrovascular damage, but evidence from clinical trials that antihypertensive treatment improves cognition is not conclusive.

CONCLUSIONS

After carefully reviewing the literature, the group concluded that there were insufficient data to make evidence-based recommendations. However, judicious treatment of hypertension, taking into account goals of care and individual characteristics (eg, age and comorbidities), seems justified to safeguard vascular health and, as a consequence, brain health.

Alzheimer Disease and Its Growing Epidemic: Risk Factors, Biomarkers, and the Urgent Need for Therapeutics

Alzheimer disease (AD) represents one of the greatest medical challenges of this century; the condition is becoming increasingly prevalent worldwide and no effective treatments have been developed for this terminal disease. Because the disease manifests at a late stage after a long period of clinically silent neurodegeneration, knowledge of the modifiable risk factors and the implementation of biomarkers is crucial in the primary prevention of the disease and presymptomatic detection of AD, respectively. This article discusses the growing epidemic of AD and antecedent risk factors in the disease process. Disease biomarkers are discussed, and the implications that this may have for the treatment of this currently incurable disease.

Prehypertension in midlife is associated with worse cognition a decade later in middle-aged and older women

BACKGROUND

previous studies raised the possibility that adverse health effects associated with elevated blood pressure (BP) begin at prehypertension levels (BP = 120-139/80-89 mmHg), yet few studies have examined the effects of prehypertension on cognitive functioning.

OBJECTIVE

to examine the relationship between BP categories and cognitive functions in middle-aged and older women.

SUBJECTS AND METHODS

two hundred and forty-seven women from the Women's Healthy Ageing Project had their BP measured twice, at mean ages 50 and 60 years. Tests of executive function, processing speed and verbal episodic memory were also administered at follow-up. Analyses of co-variance were performed to evaluate the associations between BP categories and cognitive performance.

RESULTS

prehypertensive BP at age 50 years is a significant predictor of reduced processing speed and verbal episodic memory a decade later. Cross-sectional measurements at age 60 years showed that untreated hypertensive women performed significantly worse on verbal episodic memory compared with their prehypertensive peers.

CONCLUSION

hypertension is a modifiable cardiovascular risk factor, and our results suggest that reducing midlife BP, even at prehypertensive levels, may be an effective prevention strategy to reduce risk for subsequent cognitive decline in middle-aged and older women.

Midlife Hypertension Risk and Cognition in the Non-Demented Oldest Old: Framingham Heart Study

Midlife cardiovascular risk, hypertension (HTN) in particular, has been related cross-sectionally to poorer neuropsychological (NP) performance in middle age and older adults. This study investigated whether a similar relationship persists between midlife HTN or systolic blood pressure (SBP) and NP performance approximately 30 years later. 378 Framingham stroke and dementia-free Original cohort participants, with HTN and SBP ascertained between 50-60 years of age (mean age 55 ± 1, 65% women), were administered a NP assessment at age ≥80 years. Tests included Logical Memory, Visual Reproduction, Paired Associate, Hooper Visual Organization Test, Trail Making A & B, Digit Span Forward and Backward, Controlled Word Association Test (COWAT), and Similarities. Multivariable linear regression, adjusted for age, time interval between risk factor and NP testing, gender, and premorbid intelligence, assessed association between midlife HTN/SBP and NP outcomes. Midlife HTN was not significantly associated with NP outcome measures. Midlife SBP was associated with poorer Digit Span Forward and COWAT performance (p <  0.05). No significant interaction of age on HTN/SBP to NP associations was found. There was a significant interaction between ApoE4 status and SBP in their effects on COWAT (pinteraction = 0.074); SBP was negatively associated with COWAT only in those with the ApoE4 allele (p = 0.025). While midlife HTN is not associated with late life cognitive impairment, midlife SBP is related to late life attention and verbal fluency impairments, particularly among ApoE4+ individuals. These results offer insight into processes that are operative in the absence of overt cognitive impairment and dementia.

Orthostatic intolerance predicts mild cognitive impairment: incidence of mild cognitive impairment and dementia from the Swedish general population cohort Good Aging in Skåne

INTRODUCTION

Contradictory results have been reported on the relationship between orthostatic hypotension (OH) and mild cognitive impairment (MCI).

OBJECTIVE

To study the incidence of MCI and dementia and their relationship to OH and subclinical OH with orthostatic symptoms (orthostatic intolerance).

STUDY DESIGN AND SETTING

This study used a prospective general population cohort design and was based on data from the Swedish Good Aging in Skåne study (GÅS-SNAC), they were studied 6 years after baseline of the present study, with the same study protocol at baseline and at follow-up. The study sample comprised 1,480 randomly invited subjects aged 60 to 93 years, and had a participation rate of 82% at follow-up. OH test included assessment of blood pressure and symptoms of OH.

RESULTS

The 6-year incidence of MCI was 8%, increasing from 12.1 to 40.5 per 1,000 person-years for men and 6.9 to 16.9 per 1,000 person-years for women aged 60 to >80 years. The corresponding 6-year incidence of dementia was 8%. Orthostatic intolerance during uprising was related to risk for MCI at follow-up (odds ratio [OR] =1.84 [1.20-2.80][95% CI]), adjusted for age and education independently of blood pressure during testing. After stratification for hypertension (HT), the corresponding age-adjusted OR for MCI in the non-HT group was 1.71 (1.10-2.31) and 1.76 (1.11-2.13) in the HT group. Among controls, the proportion of those with OH was 16%; those with MCI 24%; and those with dementia 31% (age-adjusted OR 1.93 [1.19-3.14]).

CONCLUSION

Not only OH, but also symptoms of OH, seem to be a risk factor for cognitive decline and should be considered in the management of blood pressure among the elderly population.

The Importance of Cultivating Mindfulness for Cognitive and Emotional Well-Being in Late Life

The cultivation of mindfulness has received increasing attention over the past 2 decades because of its association with increased psychological well-being and reduced stress-related health disorders. Given the robust positive association between perceived stress and cognitive impairment in late life, the current study evaluated the association between trait mindfulness, psychological well-being, and cognitive function in 73 healthy community-dwelling older adults. Controlling for a priori covariates, multivariate regression analyses showed a significant association between trait mindfulness and measures of psychological well-being, including self-reported depressive symptoms, quality of life, and stress profile. Analyses further showed a significant association between trait mindfulness and executive function, namely set shifting. No association was found for declarative memory. Mediation analyses showed that the association between mindfulness and cognitive function is mediated by perceived stress. This research supports the importance of cultivating mindfulness in late life to ensure cognitive and emotional well-being.

Midlife cardiovascular risk impacts executive function: Framingham offspring study

INTRODUCTION

Novel error scores and traditional indices of executive function (EF) were related to cardiovascular risk factors measured 10 to 15 years earlier.

METHODS

From 1991 to 1995, the Framingham Stroke Risk Profile (FSRP), a composite score of cardiovascular risk, was ascertained in 1755 Framingham Offspring participants (54% women, mean age=54±9 y). Participants were administered EF tests, which included: FAS and Animals Fluency tests, Trail Making Test B (TrB), and Digit Span-Backwards (DS-B), from 2005 to 2009. Linear and logistic regression were used to relate the FSRP and its components to both error responses and traditional scores.

RESULTS

Consistent with previous findings, the FSRP and the individual components, diabetes and sex, were associated with several traditional measures of EF. Of interest were relationships between the FSRP score and TrB Total Errors (P=0.04), DS-B% Total Errors (P=0.02) and DS-B Capacity Score (P=0.03), and prevalent CVD related to making FAS Perseverations in the 75th percentile (P=0.03). By comparison, FSRP and CVD were not related to the traditional DS-B or FAS scores. In addition, age was associated with higher Animals % Total Errors and % Perseverations among ApoE4+ individuals and with higher TrB Total Errors among ApoE4- individuals.

CONCLUSIONS

For those middle-aged and healthy, including those who are ApoE4+, cardiovascular risk factors are related to impairments in EF as ascertained by novel errors and traditional measures.

Blood pressure and cognitive function: a prospective analysis among adolescents in Seychelles

OBJECTIVE

An inverse relationship between blood pressure (BP) and cognitive function has been found in adults, but limited data are available in adolescents and young adults. We examined the prospective relation between BP and cognitive function in adolescence.

METHODS

We examined the association between BP measured at the ages of 12-15 years in school surveys and cognitive endpoints measured in the Seychelles Child Development Study at ages 17 (n = 407) and 19 (n = 429) years, respectively. We evaluated multiple domains of cognition based on subtests of the Cambridge Neurological Test Automated Battery (CANTAB), the Woodcock Johnson Test of Scholastic Achievement (WJTA), the Finger Tapping test (FT) and the Kaufman Brief Intelligence Test (K-BIT). We used age, sex and height-specific z-scores of SBP, DBP and mean arterial pressure (MAP).

RESULTS

Six out of the 21 cognitive endpoints tested were associated with BP. However, none of these associations were found to hold for both males and females or for different subtests within the same neurodevelopmental domain or for both SBP and DBP. Most of these associations disappeared when analyses were adjusted for selected potential confounding factors such as socio-economic status, birth weight, gestational age, BMI, alcohol consumption, blood glucose, and total n-3 and n-6 polyunsaturated fats.

CONCLUSIONS

Our findings do not support a consistent association between BP and subsequent performance on tests assessing various cognitive domains in adolescents.

Impaired cognitive executive dysfunction in adult treated hypertensives with a confirmed diagnosis of poorly controlled blood pressure

BACKGROUND

High blood pressure (BP) poses a major risk for cognitive decline. Aim of the study was to highlight the relationship between cognitive assessment scores and an effective therapeutic BP control.

METHODS

By medical visit and ambulatory BP monitoring (ABPM), we studied 302 treated hypertensives, subdivided according to office/daytime BP values into 120 with good (GC) and 98 poor (PC) BP control, 40 with "white coat hypertension" (WCH) and 44 a "masked-hypertension" phenomenon (MH). Patients underwent neuropsychological assessment to evaluate global cognitive scores at the Mini Mental State Examination (MMSE) and Frontal Assessment Battery (FAB) and attention/executive functions (Delayed Recall, Digit Span Forwards, Digit Span Backwards, Selective Attention, Verbal Fluency, Stroop Test and Clock Drawing). Carotid intima-media thickness (IMT) served as the index of vascular damage.

RESULTS

There were no differences among the groups in terms of gender, age, education, metabolic assessment, clinical history and hypertension treatment. GC presented lower office and ambulatory BP values and IMT. PC performed worse than GC on global executive and attention functions, especially executive functions. In PC, office systolic BP (SBP) was significantly associated to the MMSE and FAB scores and, in particular, to Verbal Fluency, Stroop Errors and Clock Drawing tests. Office diastolic BP (DBP) was associated to Selective attention, nocturnal SBP to Digit Span backwards and Verbal Fluency. Worse cognitive assessment scores were obtained in WCH than GC.

CONCLUSIONS

The findings showed that in adult treated hypertensives, a poor BP control, as both doctor's office and daytime scores, is associated to impaired global cognitive and especially executive/attention functions.