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Li X, Xing J, Hui Y, Shi H, Li R, Zhang S, Chen S, Li J, Liang X, Wu Y, Zhao P, Wu S, Wang Z. Hippocampal volume mediates the association of arterial stiffness with cognitive impairment in adult population. J Hypertens 2024; 42:1566-1572. [PMID: 38747362 PMCID: PMC11296271 DOI: 10.1097/hjh.0000000000003760] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/17/2023] [Revised: 04/06/2024] [Accepted: 04/16/2024] [Indexed: 08/03/2024]
Abstract
OBJECTIVES To investigate the association of arterial stiffness with brain perfusion, brain tissue volume and cognitive impairment in the general adult population. MATERIALS AND METHODS This prospective study included 1488 adult participants (age range: 22.8-83.9 years) from the Kailuan study. All participants underwent brachial-ankle pulse wave velocity (PWV) measurement, brain MRI, and Montreal Cognitive Assessment (MoCA). The association of PWV with cerebral blood flow (CBF), brain tissue volume and MoCA score was investigated. Mediation analysis was used to determine whether CBF and brain tissue volume changes mediated the associations between PWV and MoCA score. RESULTS A 1 standard deviation (SD) increase in PWV was associated with lower total brain CBF [ β (95% CI) -0.67 (-1.2 to -0.14)], total gray matter CBF [β (95% CI) -0.7 [-1.27 to -0.13)], frontal lobe CBF [ β (95% CI) -0.59 (-1.17 to -0.01)], parietal lobe CBF [ β (95% CI) -0.8 (-1.43 to -0.18)], and temporal lobe CBF [ β (95% CI) -0.68 (-1.24 to -0.12)]. Negative associations were found for PWV and total brain volume [ β (95% CI) -4.8 (-7.61 to -1.99)] and hippocampus volume [ β (95% CI) -0.08 (-0.13 to -0.04)]. A 1 SD increase PWV was significantly associated with elevated odds of developing cognitive impairment [odds ratio (95% CI) 1.21 (1.01-1.45)]. Mediation analysis showed that hippocampal volume partially mediated the negative association between PWV and MoCA scores (proportion: 14.173%). CONCLUSION High arterial stiffness was associated with decreased total and regional CBF, brain tissue volume, and cognitive impairment. Hippocampal volume partially mediated the effects of arterial stiffness on cognitive impairment.
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Affiliation(s)
- Xiaoshuai Li
- Department of Radiology, Beijing Friendship Hospital, Capital Medical University
| | - Jie Xing
- Department of Ultrasound, Beijing Aerospace General Hospital, Beijing
| | | | - Huijing Shi
- Department of Rheumatology and Immunology, Kailuan General Hospital
| | - Rui Li
- Department of Radiology, Beijing Friendship Hospital, Capital Medical University
| | - Shun Zhang
- Department of Psychiatry, Kailuan Mental Health Center
| | - Shuohua Chen
- Department of Cardiology, Kailuan General Hospital, Tangshan, Hebei Province, China
| | - Jing Li
- Department of Radiology, Beijing Tsinghua Changgung Hospital, Tsinghua University
| | | | - Yuntao Wu
- Department of Cardiology, Kailuan General Hospital, Tangshan, Hebei Province, China
| | - Pengfei Zhao
- Department of Radiology, Beijing Friendship Hospital, Capital Medical University
| | - Shouling Wu
- Department of Cardiology, Kailuan General Hospital, Tangshan, Hebei Province, China
| | - Zhenchang Wang
- Department of Radiology, Beijing Friendship Hospital, Capital Medical University
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Allison EY, Al-Khazraji BK. Association of Arterial Stiffness Index and Brain Structure in the UK Biobank: A 10-Year Retrospective Analysis. Aging Dis 2024; 15:1872-1884. [PMID: 37307821 PMCID: PMC11272205 DOI: 10.14336/ad.2023.0419] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/15/2023] [Accepted: 04/19/2023] [Indexed: 06/14/2023] Open
Abstract
Arterial stiffening and changes in brain structure both occur with normal aging and can be exacerbated via acquired health conditions. While cross-sectional associations exist, the longitudinal relationship between arterial stiffness and brain structure remains unclear. In this study, we investigated 1) associations between baseline arterial stiffness index (ASI) and brain structure (global and regional grey matter volumes (GMV), white matter hyperintensities (WMH)) 10-years post-baseline (10.4±0.8 years) and 2) associations between the 10-year change in ASI from baseline and brain structure 10-years post-baseline in 650 healthy middle- to older-aged adults (53.4±7.5 years) from the UK Biobank. We observed significant associations between baseline ASI and GMV (p<0.001) and WMH (p=0.0036) 10-years post-baseline. No significant associations between 10-year change in ASI and brain structure (global GMV p=0.24; WMH volume p=0.87) were observed. There were significant associations of baseline ASI in 2 of 60 regional brain volumes analyzed (right posterior superior temporal gyrus p=0.001; left superior lateral occipital cortex p<0.001). Strong associations with baseline ASI, but not changes in ASI over 10-years, suggest arterial stiffness at the entry point of older adulthood is more impactful on brain structure 10-years later compared to age-related stiffening. Based on these associations, we suggest clinical monitoring and potential intervention for reducing arterial stiffness should occur in midlife to reduce vascular contributions to structural changes in the brain, supporting a healthy trajectory of brain aging. Our findings also support use of ASI as a surrogate for gold standard measures in showing overall relationships between arterial stiffness and brain structure.
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Affiliation(s)
- Elric Y Allison
- Department of Kinesiology, Faculty of Science, McMaster University, Hamilton, ON, Canada
| | - Baraa K Al-Khazraji
- Department of Kinesiology, Faculty of Science, McMaster University, Hamilton, ON, Canada
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Coverdale NS, Champagne AA, Allen MD, Tremblay JC, Ethier TS, Fernandez-Ruiz J, Marshall RA, MacPherson REK, Pyke KE, Cook DJ, Olver TD. Brain atrophy, reduced cerebral perfusion, arterial stiffening, and wall thickening with aging coincide with stimulus-specific changes in fMRI-BOLD responses. Am J Physiol Regul Integr Comp Physiol 2024; 326:R346-R356. [PMID: 38406844 DOI: 10.1152/ajpregu.00270.2023] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/04/2023] [Revised: 02/07/2024] [Accepted: 02/16/2024] [Indexed: 02/27/2024]
Abstract
The aim of this study was to investigate how aging affects blood flow and structure of the brain. It was hypothesized older individuals would have lower gray matter volume (GMV), resting cerebral blood flow (CBF0), and depressed responses to isometabolic and neurometabolic stimuli. In addition, increased carotid-femoral pulse-wave velocity (PWV), carotid intima-media thickness (IMT), and decreased brachial flow-mediated dilation (FMD) would be associated with lower CBF0, cerebrovascular reactivity (CVR), and GMV. Brain scans (magnetic resonance imaging) and cardiovascular examinations were conducted in young (age = 24 ± 3 yr, range = 22-28 yr; n = 13) and old (age = 71 ± 4 yr; range = 67-82 yr, n = 14) participants, and CBF0, CVR [isometabolic % blood oxygen level-dependent (BOLD) in response to a breath hold (BH)], brain activation patterns during a working memory task (neurometabolic %BOLD response to N-back trial), GMV, PWV, IMT, and FMD were measured. CBF0 and to a lesser extent CVRBH were lower in the old group (P ≤ 0.050); however, the increase in the %BOLD response to the memory task was not blunted (P ≥ 0.2867). Age-related differential activation patterns during the working memory task were characterized by disinhibition of the default mode network in the old group (P < 0.0001). Linear regression analyses revealed PWV, and IMT were negatively correlated with CBF0, CVRBH, and GMV across age groups, but within the old group alone only the relationships between PWV-CVRBH and IMT-GMV remained significant (P ≤ 0.0183). These findings suggest the impacts of age on cerebral %BOLD responses are stimulus specific, brain aging involves alterations in cerebrovascular and possibly neurocognitive control, and arterial stiffening and wall thickening may serve a role in cerebrovascular aging.NEW & NOTEWORTHY Cerebral perfusion was lower in old versus young adults. %Blood oxygen level-dependent (BOLD) responses to an isometabolic stimulus and gray matter volume were decreased in old versus young adults and associated with arterial stiffening and wall thickening. The increased %BOLD response to a neurometabolic stimulus appeared unaffected by age; however, the old group displayed disinhibition of the default mode network during the stimulus. Thus, age-related alterations in cerebral %BOLD responses were stimulus specific and related to arterial remodeling.
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Affiliation(s)
- Nicole S Coverdale
- Centre for Neuroscience Studies, Queen's University, Kingston, Ontario, Canada
| | - Allen A Champagne
- Centre for Neuroscience Studies, Queen's University, Kingston, Ontario, Canada
- School of Medicine, Queen's University, Kingston, Ontario, Canada
| | - Matti D Allen
- Department of Physical Medicine and Rehabilitation, Queen's University, Kingston, Ontario, Canada
| | - Joshua C Tremblay
- School of Sport and Health Sciences, Cardiff Metropolitan University, Cardiff, United Kingdom
| | - Tarrah S Ethier
- School of Kinesiology and Health Studies, Queen's University, Kingston, Ontario, Canada
| | - Juan Fernandez-Ruiz
- Departamento de Fisiología, Facultad de Medicina, Universidad Nacional Autónoma de México, Mexico City, México
| | - Rory A Marshall
- Health and Exercise Sciences, University of British Columbia Okanagan, Kelowna, British Columbia, Canada
- Department of Biomedical Sciences, Western College of Veterinary Medicine, the University of Saskatchewan, Saskatoon, Saskatchewan, Canada
| | - Rebecca E K MacPherson
- Department of Health Sciences, Faculty of Applied Health Sciences, Brock University, St. Catharines, Ontario, Canada
| | - Kyra E Pyke
- School of Kinesiology and Health Studies, Queen's University, Kingston, Ontario, Canada
| | - Douglas J Cook
- Centre for Neuroscience Studies, Queen's University, Kingston, Ontario, Canada
- Department of Surgery, Queen's University, Kingston, Ontario, Canada
| | - T Dylan Olver
- Department of Biomedical Sciences, Western College of Veterinary Medicine, the University of Saskatchewan, Saskatoon, Saskatchewan, Canada
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Zhang Y, Wu F. Diagnostic value and cognitive regulatory roles of long non-coding RNA UCA1 in Alzheimer's disease. Neurosci Lett 2024; 829:137765. [PMID: 38583504 DOI: 10.1016/j.neulet.2024.137765] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/29/2023] [Revised: 04/03/2024] [Accepted: 04/04/2024] [Indexed: 04/09/2024]
Abstract
BACKGROUND To explore the diagnostic role and potential mechanism of serum lncRNA UCA1 in Alzheimer's disease (AD). METHODS UCA1 concentration was determined using quantitative RT-PCR. The receiver operating characteristic curve was plotted to assess the diagnostic value. Cell viability and apoptotic capacity were assessed by cell counting kit-8 (CCK-8) and flow cytometry. Water maze experiments were used to test cognitive function in mice. The target genes of UCA1 were identified with a dual luciferase reporter assay. Functional and pathway analysis of miR-342-3p target genes was determined using enrichment analysis. RESULTS The concentration of UCA1 was elevated in the AD group and represented a diagnostic possibility of AD. The silenced UCA1 reduced the roles of Aβ on viability and apoptosis of SH⁃SY5Y cells by sponging miR-342-3p. The impaired cognitive impairment was partly recovered by the knockdown of the UCA1/miR-342-3p axis. Potential targets of miR-342-3p were enriched in function and pathways related to AD progression. CONCLUSION The UCA1/miR-342-3p axis contributed to the occurrence of AD by regulating cognitive ability.
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Affiliation(s)
- Yongjin Zhang
- Department of Neurology, The First People's Hospital of Lianyungang, Xuzhou Medical University Affiliated Hospital of Lianyungang, The First Affiliated Hospital of Kangda College of Nanjing Medical University, Lianyungang 222000, China.
| | - Fangping Wu
- Department of Neurology, The First People's Hospital of Lianyungang, Xuzhou Medical University Affiliated Hospital of Lianyungang, The First Affiliated Hospital of Kangda College of Nanjing Medical University, Lianyungang 222000, China
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Reeve EH, Barnes JN, Moir ME, Walker AE. Impact of arterial stiffness on cerebrovascular function: a review of evidence from humans and preclincal models. Am J Physiol Heart Circ Physiol 2024; 326:H689-H704. [PMID: 38214904 PMCID: PMC11221809 DOI: 10.1152/ajpheart.00592.2023] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/25/2023] [Revised: 12/08/2023] [Accepted: 01/08/2024] [Indexed: 01/13/2024]
Abstract
With advancing age, the cerebral vasculature becomes dysfunctional, and this dysfunction is associated with cognitive decline. However, the initiating cause of these age-related cerebrovascular impairments remains incompletely understood. A characteristic feature of the aging vasculature is the increase in stiffness of the large elastic arteries. This increase in arterial stiffness is associated with elevated pulse pressure and blood flow pulsatility in the cerebral vasculature. Evidence from both humans and rodents supports that increases in large elastic artery stiffness are associated with cerebrovascular impairments. These impacts on cerebrovascular function are wide-ranging and include reductions in global and regional cerebral blood flow, cerebral small vessel disease, endothelial cell dysfunction, and impaired perivascular clearance. Furthermore, recent findings suggest that the relationship between arterial stiffness and cerebrovascular function may be influenced by genetics, specifically APOE and NOTCH genotypes. Given the strength of the evidence that age-related increases in arterial stiffness have deleterious impacts on the brain, interventions that target arterial stiffness are needed. The purpose of this review is to summarize the evidence from human and rodent studies, supporting the role of increased arterial stiffness in age-related cerebrovascular impairments.
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Affiliation(s)
- Emily H Reeve
- Department of Human Physiology, University of Oregon, Eugene, Oregon, United States
| | - Jill N Barnes
- Department of Kinesiology University of Wisconsin-Madison, Madison, Wisconsin, United States
| | - M Erin Moir
- Department of Kinesiology University of Wisconsin-Madison, Madison, Wisconsin, United States
| | - Ashley E Walker
- Department of Human Physiology, University of Oregon, Eugene, Oregon, United States
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Liao C, Chuang S, Cheng H, Lin C, Chen C. Aortic Characteristic Impedance and Suspected Mild Cognitive Impairment in a Community-Based Healthy Population. J Am Heart Assoc 2024; 13:e032268. [PMID: 38156549 PMCID: PMC10863810 DOI: 10.1161/jaha.123.032268] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/19/2023] [Accepted: 11/28/2023] [Indexed: 12/30/2023]
Abstract
BACKGROUND Aging of the proximal aorta can lead to increased pressure and flow pulsatility in the cerebral microcirculation, which may cause cognitive impairment. This study investigated the association between aortic characteristic impedance (Zc), an indicator of regional stiffness of the proximal aorta, and suspected mild cognitive impairment (MCI), compared with carotid-femoral pulse wave velocity (CFPWV). METHODS AND RESULTS A total of 1461 healthy community residents (46.4% men; age range, 35-96 years [mean±SD, 59.9±11.8 years]) without a history of cardiovascular events or stroke were included in the study. Zc was estimated using applanation tonometry and echocardiography. Cognitive function was assessed using the Mini-Mental State Examination. Education-adjusted cut points were used to define suspected MCI. Subjects with suspected MCI (n=493 [33.7%]) had significantly higher Zc and CFPWV than those without. In multivariable analysis, both Zc and CFPWV were inversely associated with Mini-Mental State Examination score. Zc (odds ratio per 1 SD, 1.22 [95% CI, 1.09-1.37] and CFPWV (odds ratio per 1 SD, 1.18 [95% CI, 1.01-1.38]) was also significantly associated with suspected MCI, after adjusting for age, sex, education level, mean arterial pressure, hypertension, diabetes, low-density lipoprotein cholesterol, and smoking status. In joint analysis, Zc was significantly associated with suspected MCI, but CFPWV was not. In the age subgroups of <50 years and 50 to 70 years, only Zc was significantly associated with suspected MCI. CONCLUSIONS This study found that Zc was significantly associated with Mini-Mental State Examination score and suspected MCI, especially in younger and middle-aged adults. These findings suggest that Zc may be a useful biomarker for identifying individuals at risk for MCI.
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Affiliation(s)
- Chao‐Feng Liao
- Institute of Public Health, National Yang Ming Chiao Tung University College of MedicineTaipeiTaiwan, R.O.C.
| | - Shao‐Yuan Chuang
- Institute of Population Health Science, National Health Research InstituteMiaoliTaiwan, R.O.C.
| | - Hao‐Min Cheng
- Program of Interdisciplinary MedicineNational Yang Ming Chiao Tung University College of MedicineTaipeiTaiwan, R.O.C.
- Division of Faculty Development, Department of Medical EducationTaipei Veterans General HospitalTaipeiTaiwan, R.O.C.
| | - Chen‐Hua Lin
- Institute of Public Health, National Yang Ming Chiao Tung University College of MedicineTaipeiTaiwan, R.O.C.
| | - Chen‐Huan Chen
- Institute of Public Health, National Yang Ming Chiao Tung University College of MedicineTaipeiTaiwan, R.O.C.
- Department of MedicineNational Yang Ming Chiao Tung University College of MedicineTaipeiTaiwan, R.O.C.
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Scheuermann BC, Parr SK, Schulze KM, Kunkel ON, Turpin VG, Liang J, Ade CJ. Associations of Cerebrovascular Regulation and Arterial Stiffness With Cerebral Small Vessel Disease: A Systematic Review and Meta-Analysis. J Am Heart Assoc 2023; 12:e032616. [PMID: 37930079 PMCID: PMC10727345 DOI: 10.1161/jaha.123.032616] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/12/2023] [Accepted: 10/24/2023] [Indexed: 11/07/2023]
Abstract
BACKGROUND Cerebral small vessel disease (cSVD) is a major contributing factor to ischemic stroke and dementia. However, the vascular pathologies of cSVD remain inconclusive. The aim of this systematic review and meta-analysis was to characterize the associations between cSVD and cerebrovascular reactivity (CVR), cerebral autoregulation, and arterial stiffness (AS). METHODS AND RESULTS MEDLINE, Web of Science, and Embase were searched from inception to September 2023 for studies reporting CVR, cerebral autoregulation, or AS in relation to radiological markers of cSVD. Data were extracted in predefined tables, reviewed, and meta-analyses performed using inverse-variance random effects models to determine pooled odds ratios (ORs). A total of 1611 studies were identified; 142 were included in the systematic review, of which 60 had data available for meta-analyses. Systematic review revealed that CVR, cerebral autoregulation, and AS were consistently associated with cSVD (80.4%, 78.6%, and 85.4% of studies, respectively). Meta-analysis in 7 studies (536 participants, 32.9% women) revealed a borderline association between impaired CVR and cSVD (OR, 2.26 [95% CI, 0.99-5.14]; P=0.05). In 37 studies (27 952 participants, 53.0% women) increased AS, per SD, was associated with cSVD (OR, 1.24 [95% CI, 1.15-1.33]; P<0.01). Meta-regression adjusted for comorbidities accounted for one-third of the AS model variance (R2=29.4%, Pmoderators=0.02). Subgroup analysis of AS studies demonstrated an association with white matter hyperintensities (OR, 1.42 [95% CI, 1.18-1.70]; P<0.01). CONCLUSIONS The collective findings of the present systematic review and meta-analyses suggest an association between cSVD and impaired CVR and elevated AS. However, longitudinal investigations into vascular stiffness and regulatory function as possible risk factors for cSVD remain warranted.
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Affiliation(s)
| | - Shannon K. Parr
- Department of KinesiologyKansas State UniversityManhattanKSUSA
| | | | | | | | - Jia Liang
- Department of Biostatistics, St. Jude Children’s Research HospitalMemphisTNUSA
| | - Carl J. Ade
- Department of KinesiologyKansas State UniversityManhattanKSUSA
- Department of Physician’s Assistant Studies, Kansas State UniversityManhattanKSUSA
- Johnson Cancer Research CenterKansas State UniversityManhattanKSUSA
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Sanjana F, Delgorio PL, DeConne TM, Hiscox LV, Pohlig RT, Johnson CL, Martens CR. Vascular determinants of hippocampal viscoelastic properties in healthy adults across the lifespan. J Cereb Blood Flow Metab 2023; 43:1931-1941. [PMID: 37395479 PMCID: PMC10676145 DOI: 10.1177/0271678x231186571] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/20/2022] [Revised: 06/14/2023] [Accepted: 06/16/2023] [Indexed: 07/04/2023]
Abstract
Arterial stiffness and cerebrovascular pulsatility are non-traditional risk factors of Alzheimer's disease. However, there is a gap in understanding the earliest mechanisms that link these vascular determinants to brain aging. Changes to mechanical tissue properties of the hippocampus (HC), a brain structure essential for memory encoding, may reflect the impact of vascular dysfunction on brain aging. We tested the hypothesis that arterial stiffness and cerebrovascular pulsatility are related to HC tissue properties in healthy adults across the lifespan. Twenty-five adults underwent measurements of brachial blood pressure (BP), large elastic artery stiffness, middle cerebral artery pulsatility index (MCAv PI), and magnetic resonance elastography (MRE), a sensitive measure of HC viscoelasticity. Individuals with higher carotid pulse pressure (PP) exhibited lower HC stiffness (β = -0.39, r = -0.41, p = 0.05), independent of age and sex. Collectively, carotid PP and MCAv PI significantly explained a large portion of the total variance in HC stiffness (adjusted R2 = 0.41, p = 0.005) in the absence of associations with HC volumes. These cross-sectional findings suggest that the earliest reductions in HC tissue properties are associated with alterations in vascular function.
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Affiliation(s)
- Faria Sanjana
- Department of Kinesiology and Applied Physiology, University of Delaware, Newark, DE, USA
| | - Peyton L Delgorio
- Department of Biomedical Engineering, University of Delaware, Newark, DE, USA
| | - Theodore M DeConne
- Department of Kinesiology and Applied Physiology, University of Delaware, Newark, DE, USA
| | - Lucy V Hiscox
- Cardiff University Brain Research Imaging Centre (CUBRIC), Cardiff University, Cardiff, UK
| | - Ryan T Pohlig
- Department of Epidemiology, University of Delaware, Newark, DE, USA
| | - Curtis L Johnson
- Department of Biomedical Engineering, University of Delaware, Newark, DE, USA
| | - Christopher R Martens
- Department of Kinesiology and Applied Physiology, University of Delaware, Newark, DE, USA
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Nowak N, De Looze C, O’Halloran A, Kenny RA, Sexton DJ. The association between kidney function, cognitive function, and structural brain abnormalities in community-dwelling individuals aged 50+ is mediated by age and biomarkers of cardiovascular disease. Cardiovasc Res 2023; 119:2106-2116. [PMID: 37052588 PMCID: PMC10683948 DOI: 10.1093/cvr/cvad060] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/14/2022] [Revised: 01/30/2023] [Accepted: 02/07/2023] [Indexed: 04/14/2023] Open
Abstract
AIMS Cognitive impairment has been associated with kidney function and chronic kidney disease. Whether this association is due to accelerated cardiovascular disease (CVD) or an independent specific kidney function effect related to toxins is unclear. We investigated the impact of an array of clinical factors, inflammatory biomarkers, and cardiovascular biomarkers on the association between kidney function, cognitive function, and structural brain abnormalities. METHODS AND RESULTS We used data from the first and third waves of the TILDA Study, a population-representative prospective cohort of Irish adults aged 50 years and over, based on stratified random sampling (n = 3774). The MRI sub-study included participants who consented to MRI brain imaging in addition to the health assessment. Multivariable linear and mixed-effect longitudinal regression models were fitted separately for each kidney marker/estimated glomerular filtration rate (eGFR) equation after adjusting for baseline age and demographics, clinical vascular risk factors, and biomarkers. Unadjusted analyses showed an association between low eGFR, cognitive dysfunction, and cognitive decline (P < 0.001 for all kidney markers). Kidney function markers were also associated with white matter disease [OR = 3.32 (95% CI: 1.11, 9.98)], total grey matter volume (β = -0.17, 95% CI -0.27 to -0.07), and regional grey matter volumes within areas particularly susceptible to hypoxia (P < 0.001 for all). All the associations decreased after adjusting for age and were also diminished after adjusting for CVD biomarkers. Age and CVD-biomarker score were significant mediators of the adjusted associations between eGFR and cognitive status. These results remained consistent for cross-sectional and longitudinal outcomes and specific cognitive domains. CONCLUSION Decreased kidney function was associated with cerebrovascular disease. The association appeared to be mediated predominantly by age and the combination of CVD markers [namely N-terminal pro-B-type natriuretic peptide (NT-proBNP) and Growth Differentiation Factor 15 (GDF15)], supporting the idea that shared biological pathways underline both diseases. Further mechanistic studies of the specific molecular mechanisms that lead to both kidney and cognitive decline are warranted.
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Affiliation(s)
- Natalia Nowak
- The Irish Longitudinal Study on Ageing, Trinity College Dublin, D02 R590, Dublin 2, Ireland
- School of Medicine, Trinity College Dublin, College Green, D02 PN40, Dublin 2, Ireland
| | - Celine De Looze
- The Irish Longitudinal Study on Ageing, Trinity College Dublin, D02 R590, Dublin 2, Ireland
- School of Medicine, Trinity College Dublin, College Green, D02 PN40, Dublin 2, Ireland
| | - Aisling O’Halloran
- The Irish Longitudinal Study on Ageing, Trinity College Dublin, D02 R590, Dublin 2, Ireland
- School of Medicine, Trinity College Dublin, College Green, D02 PN40, Dublin 2, Ireland
| | - Rose Anne Kenny
- The Irish Longitudinal Study on Ageing, Trinity College Dublin, D02 R590, Dublin 2, Ireland
- School of Medicine, Trinity College Dublin, College Green, D02 PN40, Dublin 2, Ireland
- Saint James Hospital, Dublin, D08 NYH1, Dublin 8, Ireland
| | - Donal J Sexton
- The Irish Longitudinal Study on Ageing, Trinity College Dublin, D02 R590, Dublin 2, Ireland
- School of Medicine, Trinity College Dublin, College Green, D02 PN40, Dublin 2, Ireland
- Saint James Hospital, Dublin, D08 NYH1, Dublin 8, Ireland
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McBride CA, Russom Z, Achenbach E, Bernstein IM, Dumas JA. Cardiovascular profiles associated with white matter hyperintensities in healthy young women. Front Physiol 2023; 13:979899. [PMID: 36714317 PMCID: PMC9880329 DOI: 10.3389/fphys.2022.979899] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/28/2022] [Accepted: 12/22/2022] [Indexed: 01/14/2023] Open
Abstract
Women who experience hypertension in pregnancy have increased risk of both chronic hypertension and dementia. High blood pressure is associated with increased evidence of white matter hyperintensities (WMH) in brain imaging. WMH are disruptions of the white matter of the brain that occur with demyelination and axonal degeneration, are associated with vascular disease, occur more frequently in people with hypertension, and are associated with cognitive impairment. We evaluated the relationship between WMH and subclinical cardiovascular function in healthy young nulliparous women and women with a history of early-onset preeclampsia. Sixty-two reproductive-aged women were assessed during the follicular phase of the menstrual cycle after a 3-day sodium/potassium-controlled diet. Half of participants had a history of early-onset preeclampsia, and half were nulliparous. Blood was drawn to assess inflammatory markers. Cardiovascular assessments included tonometric blood pressure monitoring, volume loading to assess vascular compliance, echocardiography to assess cardiac ejection time, brachial pulse wave velocity of the brachial artery, assessing cardiovascular stiffness, and brachial artery flow mediated vasodilation to assess endothelial mediated dilatory response. T2 fluid-attenuated inversion recovery (FLAIR) MRI imaging was obtained. Two raters, blinded to cardiovascular assessments and pregnancy history, reviewed MRI scans for evidence of WMH using the Fazekas rating scale. WMHs were detected in 17 women; 45 had normal white matter structure. Participants with Fazekas score>0 had exaggerated response to volume loading compared to women with a Fazekas score of 0 and longer cardiac ejection times. Fazekas scores >0 had lower brachial flow-mediated vasodilation and increased white blood count compared to those with no evidence of WMH. Women with WMH had reduced cardiovascular compliance, and a trend towards decreased endothelial responsiveness compared to those without WMH. These data demonstrated that the relationship between cardiovascular and brain health was detectable in young, healthy, reproductive-aged women, and may play a role in later development of clinical disease. These findings may help identify women who are at risk for cognitive decline and pathological aging.
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Affiliation(s)
- Carole A. McBride
- Department of Obstetrics, Gynecology and Reproductive Sciences, University of Vermont Larner College of Medicine, Burlington, VT, United States,*Correspondence: Carole A. McBride,
| | - Zane Russom
- Department of Psychiatry, University of Vermont Larner College of Medicine, Burlington, VT, United States
| | - Ella Achenbach
- Department of Psychiatry, University of Vermont Larner College of Medicine, Burlington, VT, United States
| | - Ira M. Bernstein
- Department of Obstetrics, Gynecology and Reproductive Sciences, University of Vermont Larner College of Medicine, Burlington, VT, United States
| | - Julie A. Dumas
- Department of Psychiatry, University of Vermont Larner College of Medicine, Burlington, VT, United States
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Del Brutto OH, Mera RM, Costa AF, Recalde BY, Rumbea DA, Sedler MJ. Arterial stiffness and progression of white matter hyperintensities of presumed vascular origin in community-dwelling older adults of Amerindian ancestry: The Atahualpa Project Cohort. Clin Neurol Neurosurg 2022; 221:107411. [PMID: 35987043 DOI: 10.1016/j.clineuro.2022.107411] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/28/2022] [Revised: 08/09/2022] [Accepted: 08/10/2022] [Indexed: 11/03/2022]
Abstract
OBJECTIVE Arterial stiffness - as measured by the aortic pulse wave velocity (aPWV) - has been associated with biomarkers of cerebral small vessel disease (cSVD), in particular with white matter hyperintensities (WMH) of presumed vascular origin. Most studies have been conducted in White and Asian populations, and information on this relationship in other ethnic groups is limited. We designed a longitudinal prospective study to assess the impact of aPWV on WMH progression in individuals of Amerindian ancestry. PATIENTS AND METHODS Participants of the Atahualpa Project Cohort were assessed at baseline with aPWV determinations, clinical interviews and brain MRIs. At the end of the study, brain MRIs were repeated in order to ascertain WMH progression. Poisson regression models adjusted for demographics and cardiovascular risk factors were fitted to assess WMH progression incidence rate by baseline levels of aPWV. RESULTS The study included 260 individuals aged ≥60 years (mean age: 65.6 ± 6.1 years; 57 % women). The mean aPWV was 9.9 ± 1.5 m/s. Follow-up MRIs revealed WMH progression in 102 (39 %) individuals after a mean follow-up of 6.5 ± 1.4 years. Unadjusted analysis showed a higher baseline aPWV among subjects that developed WMH progression compared with those who did not (p < 0.001). Multivariate Poisson regression models showed an increased WMH progression rate among individuals in the second (IRR: 2.06; 95 % C.I.: 1.09-3.88) and third (IRR: 2.75; 95 % C.I.: 1.29-5.87) tertiles of aPWV compared with those in the first tertile. CONCLUSIONS aPWV is associated with WMH progression, suggesting a link between atherosclerosis and cSVD in the study population.
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Affiliation(s)
- Oscar H Del Brutto
- School of Medicine and Research Center, Universidad Espíritu Santo - Ecuador, Samborondón, Ecuador.
| | - Robertino M Mera
- Biostatistics/Epidemiology, Freenome, Inc., South San Francisco, CA, USA
| | - Aldo F Costa
- Department of Neurology, Hospital Universitario Reina Sofía, Córdoba, Spain
| | - Bettsy Y Recalde
- School of Medicine and Research Center, Universidad Espíritu Santo - Ecuador, Samborondón, Ecuador
| | - Denisse A Rumbea
- School of Medicine and Research Center, Universidad Espíritu Santo - Ecuador, Samborondón, Ecuador
| | - Mark J Sedler
- Renaissance School of Medicine, Stony Brook University, New York, NY, USA
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