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Rizvi B, Lao PJ, Sathishkumar M, Taylor L, Queder N, McMillan L, Edwards NC, Keator DB, Doran E, Hom C, Nguyen D, Rosas HD, Lai F, Schupf N, Gutierrez J, Silverman W, Lott IT, Mapstone M, Wilcock DM, Head E, Yassa MA, Brickman AM. A pathway linking pulse pressure to dementia in adults with Down syndrome. Brain Commun 2024; 6:fcae157. [PMID: 38764776 PMCID: PMC11099660 DOI: 10.1093/braincomms/fcae157] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/07/2023] [Revised: 04/03/2024] [Accepted: 05/08/2024] [Indexed: 05/21/2024] Open
Abstract
Adults with Down syndrome are less likely to have hypertension than neurotypical adults. However, whether blood pressure measures are associated with brain health and clinical outcomes in this population has not been studied in detail. Here, we assessed whether pulse pressure is associated with markers of cerebrovascular disease and is linked to a diagnosis of dementia in adults with Down syndrome via structural imaging markers of cerebrovascular disease and atrophy. The study included participants with Down syndrome from the Alzheimer's Disease - Down Syndrome study (n = 195, age = 50.6 ± 7.2 years, 44% women, 18% diagnosed with dementia). Higher pulse pressure was associated with greater global, parietal and occipital white matter hyperintensity volume but not with enlarged perivascular spaces, microbleeds or infarcts. Using a structural equation model, we found that pulse pressure was associated with greater white matter hyperintensity volume, which in turn was related to increased neurodegeneration, and subsequent dementia diagnosis. Pulse pressure is an important determinant of brain health and clinical outcomes in individuals with Down syndrome despite the low likelihood of frank hypertension.
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Affiliation(s)
- Batool Rizvi
- Center for the Neurobiology of Learning and Memory, University of California, Irvine, Irvine, CA 92697, USA
- Department of Neurobiology and Behavior, University of California, Irvine, Irvine, CA 92697, USA
| | - Patrick J Lao
- Taub Institute for Research on Alzheimer’s Disease and the Aging Brain, College of Physicians and Surgeons, Columbia University, New York, NY 10032, USA
- Department of Neurology, College of Physicians and Surgeons, Columbia University, New York, NY 10032, USA
- Gertrude H. Sergievsky Center, College of Physicians and Surgeons, Columbia University, New York, NY 10032, USA
| | - Mithra Sathishkumar
- Center for the Neurobiology of Learning and Memory, University of California, Irvine, Irvine, CA 92697, USA
- Department of Neurobiology and Behavior, University of California, Irvine, Irvine, CA 92697, USA
| | - Lisa Taylor
- Center for the Neurobiology of Learning and Memory, University of California, Irvine, Irvine, CA 92697, USA
- Department of Neurobiology and Behavior, University of California, Irvine, Irvine, CA 92697, USA
| | - Nazek Queder
- Center for the Neurobiology of Learning and Memory, University of California, Irvine, Irvine, CA 92697, USA
- Department of Neurobiology and Behavior, University of California, Irvine, Irvine, CA 92697, USA
| | - Liv McMillan
- Center for the Neurobiology of Learning and Memory, University of California, Irvine, Irvine, CA 92697, USA
- Department of Neurobiology and Behavior, University of California, Irvine, Irvine, CA 92697, USA
| | - Natalie C Edwards
- Taub Institute for Research on Alzheimer’s Disease and the Aging Brain, College of Physicians and Surgeons, Columbia University, New York, NY 10032, USA
- Department of Neurology, College of Physicians and Surgeons, Columbia University, New York, NY 10032, USA
- Gertrude H. Sergievsky Center, College of Physicians and Surgeons, Columbia University, New York, NY 10032, USA
| | - David B Keator
- Department of Psychiatry and Human Behavior, University of California, Irvine, Irvine, CA 92697, USA
| | - Eric Doran
- Department of Pediatrics, University of California, Irvine, Orange, CA 92688, USA
| | - Christy Hom
- Department of Pediatrics, University of California, Irvine, Orange, CA 92688, USA
| | - Dana Nguyen
- Department of Pediatrics, University of California, Irvine, Orange, CA 92688, USA
| | - H Diana Rosas
- Department of Neurology, Massachusetts General Hospital, Harvard University, Boston, MA 02114, USA
- Department of Radiology, Athinoula Martinos Center, Massachusetts General Hospital, Harvard University, Charlestown, MA 02129, USA
| | - Florence Lai
- Department of Neurology, Massachusetts General Hospital, Harvard University, Boston, MA 02114, USA
| | - Nicole Schupf
- Taub Institute for Research on Alzheimer’s Disease and the Aging Brain, College of Physicians and Surgeons, Columbia University, New York, NY 10032, USA
- Department of Neurology, College of Physicians and Surgeons, Columbia University, New York, NY 10032, USA
- Gertrude H. Sergievsky Center, College of Physicians and Surgeons, Columbia University, New York, NY 10032, USA
- Department of Epidemiology, Mailman School of Public Health, Columbia University, New York, NY 10032, USA
| | - Jose Gutierrez
- Department of Neurology, College of Physicians and Surgeons, Columbia University, New York, NY 10032, USA
| | - Wayne Silverman
- Department of Pediatrics, University of California, Irvine, Orange, CA 92688, USA
| | - Ira T Lott
- Department of Pediatrics, University of California, Irvine, Orange, CA 92688, USA
| | - Mark Mapstone
- Department of Neurology, University of California, Irvine, Irvine, CA 92697, USA
| | - Donna M Wilcock
- Department of Neurology, Indiana University School of Medicine, Indianapolis, IN 46202, USA
| | - Elizabeth Head
- Department of Pathology and Laboratory Medicine, University of California, Irvine, Irvine, CA 92697, USA
| | - Michael A Yassa
- Center for the Neurobiology of Learning and Memory, University of California, Irvine, Irvine, CA 92697, USA
- Department of Neurobiology and Behavior, University of California, Irvine, Irvine, CA 92697, USA
| | - Adam M Brickman
- Taub Institute for Research on Alzheimer’s Disease and the Aging Brain, College of Physicians and Surgeons, Columbia University, New York, NY 10032, USA
- Department of Neurology, College of Physicians and Surgeons, Columbia University, New York, NY 10032, USA
- Gertrude H. Sergievsky Center, College of Physicians and Surgeons, Columbia University, New York, NY 10032, USA
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Rizvi B, Lao PJ, Sathishkumar M, Taylor L, Queder N, McMillan L, Edwards N, Keator DB, Doran E, Hom C, Nguyen D, Rosas HD, Lai F, Schupf N, Gutierrez J, Silverman W, Lott IT, Mapstone M, Wilcock DM, Head E, Yassa MA, Brickman AM. Pathways linking pulse pressure to dementia in adults with Down syndrome. MEDRXIV : THE PREPRINT SERVER FOR HEALTH SCIENCES 2023:2023.10.26.23297625. [PMID: 37961444 PMCID: PMC10635215 DOI: 10.1101/2023.10.26.23297625] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/15/2023]
Abstract
Individuals with Down syndrome (DS) are less likely to have hypertension than neurotypical adults. However, whether blood pressure measures are associated with brain health and clinical outcomes in this population has not been studied in detail. Here, we assessed whether pulse pressure is associated with markers of cerebrovascular disease, entorhinal cortical atrophy, and diagnosis of dementia in adults with DS. Participants with DS from the Biomarkers of Alzheimer's Disease in Adults with Down Syndrome study (ADDS; n=195, age=50.6±7.2 years, 44% women, 18% diagnosed with dementia) were included. Higher pulse pressure was associated with greater global, parietal, and occipital WMH volume. Pulse pressure was not related to enlarged PVS, microbleeds, infarcts, entorhinal cortical thickness, or dementia diagnosis. However, in a serial mediation model, we found that pulse pressure was indirectly related to dementia diagnosis through parieto-occipital WMH and, subsequently through entorhinal cortical thickness. Higher pulse pressure may be a risk factor for dementia in people with DS by promoting cerebrovascular disease, which in turn affects neurodegeneration. Pulse pressure is an important determinant of brain health and clinical outcomes in individuals with Down syndrome despite the low likelihood of frank hypertension.
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Affiliation(s)
- Batool Rizvi
- Center for the Neurobiology of Learning and Memory, University of California, Irvine, CA
- Department of Neurobiology and Behavior, University of California, Irvine, CA
| | - Patrick J. Lao
- Taub Institute for Research on Alzheimer’s Disease and the Aging Brain, College of Physicians and Surgeons, Columbia University, New York, NY, USA
- Department of Neurology, College of Physicians and Surgeons, Columbia University, New York, NY, USA
- Gertrude H. Sergievsky Center, College of Physicians and Surgeons, Columbia University, New York, NY, USA
| | - Mithra Sathishkumar
- Center for the Neurobiology of Learning and Memory, University of California, Irvine, CA
- Department of Neurobiology and Behavior, University of California, Irvine, CA
| | - Lisa Taylor
- Center for the Neurobiology of Learning and Memory, University of California, Irvine, CA
- Department of Neurobiology and Behavior, University of California, Irvine, CA
| | - Nazek Queder
- Center for the Neurobiology of Learning and Memory, University of California, Irvine, CA
- Department of Neurobiology and Behavior, University of California, Irvine, CA
| | - Liv McMillan
- Center for the Neurobiology of Learning and Memory, University of California, Irvine, CA
- Department of Neurobiology and Behavior, University of California, Irvine, CA
| | - Natalie Edwards
- Taub Institute for Research on Alzheimer’s Disease and the Aging Brain, College of Physicians and Surgeons, Columbia University, New York, NY, USA
- Department of Neurology, College of Physicians and Surgeons, Columbia University, New York, NY, USA
- Gertrude H. Sergievsky Center, College of Physicians and Surgeons, Columbia University, New York, NY, USA
| | - David B. Keator
- Department of Psychiatry and Human Behavior, University of California, Irvine, CA, USA
| | - Eric Doran
- Department of Pediatrics, University of California, Irvine, CA, USA
| | - Christy Hom
- Department of Pediatrics, University of California, Irvine, CA, USA
| | - Dana Nguyen
- Department of Pediatrics, University of California, Irvine, CA, USA
| | - H. Diana Rosas
- Department of Neurology, Massachusetts General Hospital, Harvard University, Boston, MA, USA
- Department of Radiology, Athinoula Martinos Center, Massachusetts General Hospital, Harvard University, Charlestown, MA, USA
| | - Florence Lai
- Department of Neurology, Massachusetts General Hospital, Harvard University, Boston, MA, USA
| | - Nicole Schupf
- Taub Institute for Research on Alzheimer’s Disease and the Aging Brain, College of Physicians and Surgeons, Columbia University, New York, NY, USA
- Department of Neurology, College of Physicians and Surgeons, Columbia University, New York, NY, USA
- Gertrude H. Sergievsky Center, College of Physicians and Surgeons, Columbia University, New York, NY, USA
- Department of Epidemiology, Mailman School of Public Health, Columbia University, New York, NY, USA
| | - Jose Gutierrez
- Department of Neurology, College of Physicians and Surgeons, Columbia University, New York, NY, USA
| | - Wayne Silverman
- Department of Pediatrics, University of California, Irvine, CA, USA
| | - Ira T. Lott
- Department of Pediatrics, University of California, Irvine, CA, USA
| | - Mark Mapstone
- Department of Neurology, University of California, Irvine, CA, USA
| | - Donna M. Wilcock
- Sanders-Brown Center on Aging, College of Medicine, University of Kentucky, Lexington, KY, USA
| | - Elizabeth Head
- Department of Pathology & Laboratory Medicine, University of California, Irvine, CA, USA
| | - Michael A. Yassa
- Center for the Neurobiology of Learning and Memory, University of California, Irvine, CA
- Department of Neurobiology and Behavior, University of California, Irvine, CA
| | - Adam M. Brickman
- Taub Institute for Research on Alzheimer’s Disease and the Aging Brain, College of Physicians and Surgeons, Columbia University, New York, NY, USA
- Department of Neurology, College of Physicians and Surgeons, Columbia University, New York, NY, USA
- Gertrude H. Sergievsky Center, College of Physicians and Surgeons, Columbia University, New York, NY, USA
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Jiang R, Calhoun VD, Noble S, Sui J, Liang Q, Qi S, Scheinost D. A functional connectome signature of blood pressure in >30 000 participants from the UK biobank. Cardiovasc Res 2023; 119:1427-1440. [PMID: 35875865 PMCID: PMC10262183 DOI: 10.1093/cvr/cvac116] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/26/2022] [Revised: 06/07/2022] [Accepted: 07/01/2022] [Indexed: 11/12/2022] Open
Abstract
AIMS Elevated blood pressure (BP) is a prevalent modifiable risk factor for cardiovascular diseases and contributes to cognitive decline in late life. Despite the fact that functional changes may precede irreversible structural damage and emerge in an ongoing manner, studies have been predominantly informed by brain structure and group-level inferences. Here, we aim to delineate neurobiological correlates of BP at an individual level using machine learning and functional connectivity. METHODS AND RESULTS Based on whole-brain functional connectivity from the UK Biobank, we built a machine learning model to identify neural representations for individuals' past (∼8.9 years before scanning, N = 35 882), current (N = 31 367), and future (∼2.4 years follow-up, N = 3 138) BP levels within a repeated cross-validation framework. We examined the impact of multiple potential covariates, as well as assessed these models' generalizability across various contexts.The predictive models achieved significant correlations between predicted and actual systolic/diastolic BP and pulse pressure while controlling for multiple confounders. Predictions for participants not on antihypertensive medication were more accurate than for currently medicated patients. Moreover, the models demonstrated robust generalizability across contexts in terms of ethnicities, imaging centres, medication status, participant visits, gender, age, and body mass index. The identified connectivity patterns primarily involved the cerebellum, prefrontal, anterior insula, anterior cingulate cortex, supramarginal gyrus, and precuneus, which are key regions of the central autonomic network, and involved in cognition processing and susceptible to neurodegeneration in Alzheimer's disease. Results also showed more involvement of default mode and frontoparietal networks in predicting future BP levels and in medicated participants. CONCLUSION This study, based on the largest neuroimaging sample currently available and using machine learning, identifies brain signatures underlying BP, providing evidence for meaningful BP-associated neural representations in connectivity profiles.
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Affiliation(s)
- Rongtao Jiang
- Department of Radiology and Biomedical Imaging, Yale School of Medicine, New Haven, CT 06510, USA
| | - Vince D Calhoun
- Tri-institutional Center for Translational Research in Neuroimaging and Data Science (TReNDS), Georgia Institute of Technology, Emory University and Georgia State University, Atlanta, GA 30303, USA
| | - Stephanie Noble
- Department of Radiology and Biomedical Imaging, Yale School of Medicine, New Haven, CT 06510, USA
| | - Jing Sui
- Tri-institutional Center for Translational Research in Neuroimaging and Data Science (TReNDS), Georgia Institute of Technology, Emory University and Georgia State University, Atlanta, GA 30303, USA
| | - Qinghao Liang
- Department of Biomedical Engineering, Yale University, New Haven, CT 06520, USA
| | - Shile Qi
- Tri-institutional Center for Translational Research in Neuroimaging and Data Science (TReNDS), Georgia Institute of Technology, Emory University and Georgia State University, Atlanta, GA 30303, USA
| | - Dustin Scheinost
- Department of Radiology and Biomedical Imaging, Yale School of Medicine, New Haven, CT 06510, USA
- Department of Biomedical Engineering, Yale University, New Haven, CT 06520, USA
- Interdepartmental Neuroscience Program, Yale University, New Haven, CT 06520, USA
- Department of Statistics & Data Science, Yale University, New Haven, CT 06520, USA
- Child Study Center, Yale School of Medicine, New Haven, CT 06510, USA
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Kandil H, Soliman A, Alghamdi NS, Jennings JR, El-Baz A. Using Mean Arterial Pressure in Hypertension Diagnosis versus Using Either Systolic or Diastolic Blood Pressure Measurements. Biomedicines 2023; 11:biomedicines11030849. [PMID: 36979828 PMCID: PMC10046034 DOI: 10.3390/biomedicines11030849] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/13/2023] [Revised: 03/03/2023] [Accepted: 03/08/2023] [Indexed: 03/14/2023] Open
Abstract
Hypertension is a severe and highly prevalent disease. It is considered a leading contributor to mortality worldwide. Diagnosis guidelines for hypertension use systolic and diastolic blood pressure (BP) together. Mean arterial pressure (MAP), which refers to the average of the arterial blood pressure through a single cardiac cycle, can be an alternative index that may capture the overall exposure of the person to a heightened pressure. A clinical hypothesis, however, suggests that in patients over 50 years old in age, systolic BP may be more predictive of adverse events, while in patients under 50 years old, diastolic BP may be slightly more predictive. In this study, we investigated the correlation between cerebrovascular changes, (impacted by hypertension), and MAP, systolic BP, and diastolic BP separately. Several experiments were conducted using real and synthetic magnetic resonance angiography (MRA) data, along with corresponding BP measurements. Each experiment employs the following methodology: First, MRA data were processed to remove noise, bias, or inhomogeneity. Second, the cerebrovasculature was delineated for MRA subjects using a 3D adaptive region growing connected components algorithm. Third, vascular features (changes in blood vessel’s diameters and tortuosity) that describe cerebrovascular alterations that occur prior to and during the development of hypertension were extracted. Finally, feature vectors were constructed, and data were classified using different classifiers, such as SVM, KNN, linear discriminant, and logistic regression, into either normotensives or hypertensives according to the cerebral vascular alterations and the BP measurements. The initial results showed that MAP would be more beneficial and accurate in identifying the cerebrovascular impact of hypertension (accuracy up to 95.2%) than just using either systolic BP (accuracy up to 89.3%) or diastolic BP (accuracy up to 88.9%). This result emphasizes the pathophysiological significance of MAP and supports prior views that this simple measure may be a superior index for the definition of hypertension and research on hypertension.
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Affiliation(s)
- Heba Kandil
- Bioengineering Department, University of Louisville, Louisville, KY 40292, USA
- Information Technology Department, Faculty of Computers and Informatics, Mansoura University, Mansoura 35516, Egypt
| | - Ahmed Soliman
- Bioengineering Department, University of Louisville, Louisville, KY 40292, USA
| | - Norah Saleh Alghamdi
- Department of Computer Sciences, College of Computer and Information Sciences, Princess Nourah Bint Abdulrahman University, P.O. Box 84428, Riyadh 11671, Saudi Arabia
| | - J. Richard Jennings
- Departments of Psychiatry and Psychology, University of Pittsburgh, Pittsburgh, PA 15260, USA
| | - Ayman El-Baz
- Bioengineering Department, University of Louisville, Louisville, KY 40292, USA
- Correspondence:
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The Dose-Response Relationships of Different Dimensions of Physical Activity with Daily Physical Function and Cognitive Function in Chinese Adults with Hypertension: A Cross-Sectional Study. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2021; 18:ijerph182312698. [PMID: 34886423 PMCID: PMC8657437 DOI: 10.3390/ijerph182312698] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 10/18/2021] [Revised: 11/19/2021] [Accepted: 11/30/2021] [Indexed: 11/17/2022]
Abstract
OBJECTIVE The purpose of this study was to explore the dose-response relationships of different dimensions of physical activity (intensity, time, frequency, capacity, and metabolic equivalent) with daily physical function (DPF) and cognitive function (CF) in Chinese adults with hypertension. METHODS The 6216 hypertensive patients included in this study were from the China Health and Retirement Longitudinal Study (CHARLS), which was conducted in 2015. Physical activity (PA) was divided into vigorous PA (VPA), moderate PA (MPA), and light PA (LPA). Linear regression models and binary logistic regression models were established to assess the associations with indicators. RESULTS Patients with VPA have a lower probability of impaired DPF; however, patients with VPA had lower CF scores. Patients with nearly all the aspects of MPA have lower rates of impaired DPF and higher CF scores (p < 0.05). Patients with LPA have a lower probability of impaired DPF and higher CF scores. In addition, patients with between 1800 and 2999 MET-minutes per week had the lowest rates of impaired DPF (OR = 0.10, 95% CI 0.02, 0.39) and the highest CF scores (β = 3.28, 95% CI 2.25, 4.31). CONCLUSIONS This study found that patients with hypertension with moderate-intensity physical activity (nearly all aspects) and LPA had better DPF and CF. The best daily physical function and CF was with METs of 1800-2999 min per week. However, VPA should be recommended with caution in Chinese adults with hypertension.
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Alateeq K, Walsh EI, Cherbuin N. Higher Blood Pressure is Associated with Greater White Matter Lesions and Brain Atrophy: A Systematic Review with Meta-Analysis. J Clin Med 2021; 10:637. [PMID: 33562359 PMCID: PMC7915964 DOI: 10.3390/jcm10040637] [Citation(s) in RCA: 23] [Impact Index Per Article: 7.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/19/2020] [Revised: 01/22/2021] [Accepted: 01/23/2021] [Indexed: 02/07/2023] Open
Abstract
BACKGROUND To summarise and quantify the evidence on the association between Blood pressure (BP), white matter lesions (WMLs), and brain volumes. METHOD Electronic databases PubMed, Scopus, and Clarivate were searched in February 2020 using an established methodology and pre-determined search terms. Studies were eligible for inclusion if they reported on the association between BP and WMLs or brain volume in cognitively healthy individuals, while adjusting for age and intra-cranial volume. RESULTS Searches yielded 7509 articles, of which 52 (26 longitudinal and 33 cross-sectional), were eligible and had a combined sample size of 343,794 individuals. Analyses found that 93.7% of studies reported that higher BP was associated with poorer cerebral health (higher WMLs and lower brain volumes). Meta-analysis of compatible results indicated a dose-dependent relationship with every one standard deviation increase in systolic BP (SBP) above 120 mmHg being associated with a 11.2% (95% CI 2.3, 19.9, p = 0.0128) increase in WMLs and -0.13% (95% CI -0.25, -0.023, p = 0.0183) smaller hippocampal volume. CONCLUSION The association between BP and brain volumes appears across the full range of BP measurements and is not limited to hypertensive individuals. Higher BP in community-residing individuals is associated with poorer cerebral health.
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Affiliation(s)
- Khawlah Alateeq
- Centre for Research on Ageing, Health and Wellbeing, The Australian National University, Canberra, ACT 2601, Australia; (E.I.W.); (N.C.)
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Langeard A, Cloutier SO, Olmand M, Saillant K, Gagnon C, Grégoire CA, Fortier A, Lacroix M, Lalongé J, Gayda M, Besnier F, Gagnon D, Bherer L, Nigam A. High-intensity interval training vs. hydrochlorothiazide on blood pressure, cardiovascular health and cognition: Protocol of a non-inferiority trial. Contemp Clin Trials 2021; 102:106286. [PMID: 33484896 DOI: 10.1016/j.cct.2021.106286] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/21/2020] [Revised: 01/05/2021] [Accepted: 01/15/2021] [Indexed: 10/22/2022]
Abstract
BACKGROUND While the number of people with hypertension (HBP) continues to increase, the therapeutic target for optimal blood pressure (BP) has been revised to a lower level. Studies have suggested that High-Intensity Interval Training (HIIT) could be as efficient as BP-lowering drugs, but no study has compared their efficacy in a randomized trial. The aim of this protocol is to determine if HIIT is as efficient as Hydrochlorothiazide (HCTZ) in lowering 24 h ambulatory BP in prehypertensive older adults. Moreover, the secondary aim is to determine if HIIT is associated with greater cardiovascular and cognitive benefits than HCTZ. METHODS This study is an interventional, single-center, non-inferiority trial, with two randomized parallel groups of prehypertensive participants aged 60 years or more. One group will be prescribed daily doses of 12.5 mg of HCTZ for 12 weeks, and the other group will follow thrice-weekly HIIT for 12 weeks. Each group will be composed of 30 participants. The primary outcome is 24 h ambulatory BP. Secondary outcomes are scores on neuropsychological assessments, balance and gait performances, maximal oxygen uptake, peripheral endothelial function, and arterial stiffness. Non-inferiority tests will be performed on the primary outcome, and secondary outcomes will be compared using independent t-tests. CONCLUSION This study will determine if HIIT is at least as efficient as HCTZ in lowering BP in prehypertensive older adults. This study will also determine if HIIT provides greater benefits in terms of cardiovascular and cognitive status (NCT04103411).
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Affiliation(s)
- Antoine Langeard
- Department of Medicine, Université de Montréal, Montréal, Québec, Canada; Preventive Medicine and Physical Activity Center (centre EPIC), Canada; Research Center, Montreal Heart Institute, Montréal, Québec, Canada; Research Center, Institut Universitaire de Gériatrie de Montréal, Montréal, Québec, Canada.
| | - Simon-Olivier Cloutier
- Department of Psychology, Université de Montréal, Montréal, Québec, Canada; Preventive Medicine and Physical Activity Center (centre EPIC), Canada
| | - Miloudza Olmand
- Department of Psychology, Université de Montréal, Montréal, Québec, Canada; Preventive Medicine and Physical Activity Center (centre EPIC), Canada
| | - Kathia Saillant
- Preventive Medicine and Physical Activity Center (centre EPIC), Canada; Research Center, Institut Universitaire de Gériatrie de Montréal, Montréal, Québec, Canada; Department of Psychology, Université du Québec à Montréal, Montréal, Québec, Canada
| | - Christine Gagnon
- Preventive Medicine and Physical Activity Center (centre EPIC), Canada; Research Center, Montreal Heart Institute, Montréal, Québec, Canada
| | - Catherine-Alexandra Grégoire
- Preventive Medicine and Physical Activity Center (centre EPIC), Canada; Research Center, Montreal Heart Institute, Montréal, Québec, Canada
| | - Annick Fortier
- Montreal Health Innovations Coordinating Center (MHICC), Canada
| | - Martine Lacroix
- Research Center, Montreal Heart Institute, Montréal, Québec, Canada
| | - Julie Lalongé
- Preventive Medicine and Physical Activity Center (centre EPIC), Canada
| | - Mathieu Gayda
- Preventive Medicine and Physical Activity Center (centre EPIC), Canada
| | - Florent Besnier
- Department of Medicine, Université de Montréal, Montréal, Québec, Canada; Preventive Medicine and Physical Activity Center (centre EPIC), Canada; Research Center, Montreal Heart Institute, Montréal, Québec, Canada
| | - Daniel Gagnon
- Department of Kinesiology and Exercise Science, Université de Montréal, Québec, Canada; Preventive Medicine and Physical Activity Center (centre EPIC), Canada
| | - Louis Bherer
- Department of Medicine, Université de Montréal, Montréal, Québec, Canada; Preventive Medicine and Physical Activity Center (centre EPIC), Canada; Research Center, Montreal Heart Institute, Montréal, Québec, Canada; Research Center, Institut Universitaire de Gériatrie de Montréal, Montréal, Québec, Canada.
| | - Anil Nigam
- Preventive Medicine and Physical Activity Center (centre EPIC), Canada; Research Center, Montreal Heart Institute, Montréal, Québec, Canada
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de Menezes ST, Giatti L, Brant LCC, Griep RH, Schmidt MI, Duncan BB, Suemoto CK, Ribeiro ALP, Barreto SM. Hypertension, Prehypertension, and Hypertension Control: Association With Decline in Cognitive Performance in the ELSA-Brasil Cohort. Hypertension 2020; 77:672-681. [PMID: 33307849 DOI: 10.1161/hypertensionaha.120.16080] [Citation(s) in RCA: 51] [Impact Index Per Article: 12.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/21/2022]
Abstract
Hypertension, particularly in middle age, has been associated with worse cognitive function, but evidence is inconclusive. This study investigated whether hypertension, prehypertension, age, and duration of diagnosis, as well as blood pressure control, are associated with a decline in cognitive performance in ELSA-Brasil participants. This longitudinal study included 7063 participants, mean age 58.9 years at baseline (2008-2010), who attended visit 2 (2012-2014). Cognitive performance was measured in both visits and evaluated by the standardized scores of the memory, verbal fluency, trail B tests, and global cognitive score. The associations were investigated using linear mixed models. Hypertension and prehypertension at baseline were associated with decline in global cognitive score; being hypertension associated with reduction in memory test; and prehypertension with reduction in fluency test. Hypertension diagnose ≥55 years was associated with lower global cognitive and memory test scores, and hypertension diagnose <55 years with lower memory test scores. Duration of hypertension diagnoses was not associated with any marker of cognitive function decline. Among treated individuals, blood pressure control at baseline was inversely associated with the decline in both global cognitive and memory test scores. In this relatively young cohort, hypertension, prehypertension, and blood pressure control were independent predictors of cognitive decline in distinct abilities. Our findings suggest that both lower and older age of hypertension, but not duration of diagnosis, were associated with cognitive decline in different abilities. In addition to hypertension, prehypertension and pressure control might be critical for the preservation of cognitive function.
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Affiliation(s)
- Sara Teles de Menezes
- From the Medical School and Clinical Hospital (S.T.d.M., L.G., L.C.C.B., S.M.B.), Universidade Federal de Minas Gerais, Belo Horizonte, Brazil
| | - Luana Giatti
- From the Medical School and Clinical Hospital (S.T.d.M., L.G., L.C.C.B., S.M.B.), Universidade Federal de Minas Gerais, Belo Horizonte, Brazil
| | - Luisa Campos Caldeira Brant
- From the Medical School and Clinical Hospital (S.T.d.M., L.G., L.C.C.B., S.M.B.), Universidade Federal de Minas Gerais, Belo Horizonte, Brazil
| | - Rosane Harter Griep
- Laboratory of Education in Environment and Health, Oswaldo Cruz Institute, Oswaldo Cruz Foundation, Rio de Janeiro, Brazil (R.H.G.)
| | - Maria Inês Schmidt
- Postgraduate Program in Epidemiology and Hospital de Clinicas de Porto Alegre, Universidade Federal do Rio Grande do Sul, Porto Alegre, Brazil (M.I.S., B.B.D)
| | - Bruce Bartholow Duncan
- Postgraduate Program in Epidemiology and Hospital de Clinicas de Porto Alegre, Universidade Federal do Rio Grande do Sul, Porto Alegre, Brazil (M.I.S., B.B.D)
| | - Claudia Kimie Suemoto
- Division of Geriatrics, Faculdade de Medicina, Universidade de São Paulo, Brazil (C.K.S.)
| | - Antonio Luiz Pinho Ribeiro
- Centro de Telessaúde/Hospital das Clínicas and Department of Internal Medicine/Faculdade de Medicina (A.L.P.R.), Universidade Federal de Minas Gerais, Belo Horizonte, Brazil
| | - Sandhi Maria Barreto
- From the Medical School and Clinical Hospital (S.T.d.M., L.G., L.C.C.B., S.M.B.), Universidade Federal de Minas Gerais, Belo Horizonte, Brazil
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Midlife vulnerability and food insecurity: Findings from low-income adults in the US National Health Interview Survey. PLoS One 2020; 15:e0233029. [PMID: 32658927 PMCID: PMC7357765 DOI: 10.1371/journal.pone.0233029] [Citation(s) in RCA: 14] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/09/2019] [Accepted: 04/27/2020] [Indexed: 11/19/2022] Open
Abstract
Background Food insecurity, limited access to adequate food, in adulthood is associated with poor health outcomes that suggest a pattern of accelerated aging. However, little is known about factors that impact food insecurity in midlife which in turn could help to identify potential pathways of accelerated aging. Methods Low-income adults (n = 17,866; 2014 National Health Interview Survey), ages 18 to 84, completed a 10-item food security module and answered questions regarding health challenges (chronic conditions and functional limitations) and financial worry. We used multinomial logistic regression for complex samples to assess the association of health challenges and financial worry with food insecurity status and determine whether these associations differed by age group, while adjusting for poverty, sex, race/ethnicity, education, family structure, social security, and food assistance. Results Food insecurity rates were highest in late- (37.5%) and early- (36.0%) midlife, relative to younger (33.7%) and older (20.2%) age groups and, furthermore, age moderated the relationship between food insecurity and both risk factors (interaction p-values < .05, for both). The effects of poor health were stronger in midlife relative to younger and older ages. Unlike younger and older adults, however, adults in midlife showed high levels of food insecurity regardless of financial worry. Conclusions Findings suggest that food insecurity in midlife may be more severe than previously thought. Greater efforts are needed to identify those at greatest risk and intervene early to slow premature aging.
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10
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Jennings JR, Muldoon MF, Sved AF. Is the Brain an Early or Late Component of Essential Hypertension? Am J Hypertens 2020; 33:482-490. [PMID: 32170317 DOI: 10.1093/ajh/hpaa038] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/01/2019] [Revised: 02/17/2020] [Accepted: 03/11/2020] [Indexed: 11/13/2022] Open
Abstract
The brain's relationship to essential hypertension is primarily understood to be that of an end-organ, damaged late in life by stroke or dementia. Emerging evidence, however, shows that heightened blood pressure (BP) early in life and prior to traditionally defined hypertension, relates to altered brain structure, cerebrovascular function, and cognitive processing. Deficits in cognitive function, cerebral blood flow responsivity, volumes of brain areas, and white matter integrity all relate to increased but prehypertensive levels of BP. Such relationships may be observed as early as childhood. In this review, we consider the basis of these relationships by examining the emergence of putative causative factors for hypertension that would impact or involve brain function/structure, e.g., sympathetic nervous system activation and related endocrine and inflammatory activation. Currently, however, available evidence is not sufficient to fully explain the specific pattern of brain deficits related to heightened BP. Despite this uncertainty, the evidence reviewed suggests the value that early intervention may have, not only for reducing BP, but also for maintaining brain function.
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Affiliation(s)
- John Richard Jennings
- Department of Psychiatry and Psychology, University of Pittsburgh, Pittsburgh, Pennsylvania, USA
| | - Matthew F Muldoon
- Division of Cardiology, University of Pittsburgh School of Medicine, Pittsburgh, Pennsylvania, USA
- Heart and Vascular Institute, Hypertension Center, UPMC Medical Center, Pittsburgh, Pennsylvania, USA
| | - Alan F Sved
- Center for Neuroscience, University of Pittsburgh, Pennsylvania, USA
- Department of Neuroscience, University of Pittsburgh, Pennsylvania, USA
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11
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Kandil H, Soliman A, Taher F, Ghazal M, Khalil A, Giridharan G, Keynton R, Jennings JR, El-Baz A. A novel computer-aided diagnosis system for the early detection of hypertension based on cerebrovascular alterations. NEUROIMAGE-CLINICAL 2019; 25:102107. [PMID: 31830715 PMCID: PMC6926373 DOI: 10.1016/j.nicl.2019.102107] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 07/12/2019] [Revised: 10/31/2019] [Accepted: 11/19/2019] [Indexed: 01/21/2023]
Abstract
3-D CNN segmentation succeeded in delineating cerebrovasculature accurately. Segmentation approach is automatic and applicable on healthy/pathological vessels. Blood flow variability challenge was addressed by processing MRA scans locally. Proposed vascular features were efficient to quantify cerebral changes. Proposed CAD system could help clinicians predict hypertension before its onset.
Hypertension is a leading cause of mortality in the USA. While simple tools such as the sphygmomanometer are widely used to diagnose hypertension, they could not predict the disease before its onset. Clinical studies suggest that alterations in the structure of human brains’ cerebrovasculature start to develop years before the onset of hypertension. In this research, we present a novel computer-aided diagnosis (CAD) system for the early detection of hypertension. The proposed CAD system analyzes magnetic resonance angiography (MRA) data of human brains to detect and track the cerebral vascular alterations and this is achieved using the following steps: i) MRA data are preprocessed to eliminate noise effects, correct the bias field effect, reduce the contrast inhomogeneity using the generalized Gauss-Markov random field (GGMRF) model, and normalize the MRA data, ii) the cerebral vascular tree of each MRA volume is segmented using a 3-D convolutional neural network (3D-CNN), iii) cerebral features in terms of diameters and tortuosity of blood vessels are estimated and used to construct feature vectors, iv) feature vectors are then used to train and test various artificial neural networks to classify data into two classes; normal and hypertensive. A balanced data set of 66 subjects were used to test the CAD system. Experimental results reported a classification accuracy of 90.9% which supports the efficacy of the CAD system components to accurately model and discriminate between normal and hypertensive subjects. Clinicians would benefit from the proposed CAD system to detect and track cerebral vascular alterations over time for people with high potential of developing hypertension and to prepare appropriate treatment plans to mitigate adverse events.
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Affiliation(s)
- Heba Kandil
- Bioimaging Laboratory, J.B Speed School of Engineering, University of Louisville, KY, USA; Information Technology Department, Faculty of Computer Science and Information, Mansoura University, Egypt
| | - Ahmed Soliman
- Bioimaging Laboratory, J.B Speed School of Engineering, University of Louisville, KY, USA
| | | | - Mohammed Ghazal
- Electrical and Computer Engineering Department, Abu Dhabi University, UAE
| | - Ashraf Khalil
- Electrical and Computer Engineering Department, Abu Dhabi University, UAE
| | - Guruprasad Giridharan
- Bioimaging Laboratory, J.B Speed School of Engineering, University of Louisville, KY, USA
| | - Robert Keynton
- Bioimaging Laboratory, J.B Speed School of Engineering, University of Louisville, KY, USA
| | - J Richard Jennings
- Department of Psychiatry and Psychology, University of Pittsburgh, PA, USA
| | - Ayman El-Baz
- Bioimaging Laboratory, J.B Speed School of Engineering, University of Louisville, KY, USA.
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12
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Nunley KA, Karp JF, Orchard TJ, Costacou T, Aizenstein HJ, Jennings JR, Rosano C. Depressive symptoms and cerebral microvascular disease in adults with Type 1 diabetes mellitus. Diabet Med 2019; 36:1168-1175. [PMID: 30552772 PMCID: PMC6571066 DOI: 10.1111/dme.13879] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 12/13/2018] [Indexed: 12/29/2022]
Abstract
AIM To assess the prevalence of, and risk factors for, depressive symptoms, comparing a sample of middle-aged adults with and without juvenile-onset Type 1 diabetes mellitus, and to determine if depressive symptoms were associated with white matter hyperintensity volume among those with Type 1 diabetes. METHODS Depressive symptoms and white matter hyperintensities were compared between adults (age range 30-65 years) with juvenile-onset Type 1 diabetes (n=130) and adults without Type 1 diabetes (n=133). The association of Type 1 diabetes with depression was computed before and after adjustment for white matter hyperintensities. Among the Type 1 diabetes group, the primary associations of interest were between depressive symptoms (Beck Depression Inventory score ≥10) and white matter hyperintensities (n=71), hyperglycaemia and physical activity. Associations between depressive symptoms and diabetes-related complications, cognitive impairment, smoking and self-reported disability were examined. Analyses were controlled for education, sex, age and antidepressant use. RESULTS Depressive symptoms were more prevalent among those with vs those without Type 1 diabetes (28% vs 3%; P<0.001). White matter hyperintensities explained 40% of the association of Type 1 diabetes with depressive symptoms, while Type 1 diabetes had a direct effect of 68% on depressive symptoms. Among those with Type 1 diabetes, depressive symptoms were related to white matter hyperintensity volume, a 16-year average HbA1c ≥58 mmol/mol (7.5%), and lower physical activity levels. Associations with other characteristics were not significant. CONCLUSION These findings suggest a cerebrovascular origin for depressive symptoms in adults with Type 1 diabetes, perhaps triggered by hyperglycaemia. Future longitudinal studies should investigate whether targeting hyperglycaemia and physical inactivity alleviates depressive symptoms, possibly by slowing the development of cerebral microvascular disease, in people with Type 1 diabetes.
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Affiliation(s)
- K A Nunley
- Department of Epidemiology, Graduate School of Public Health, University of Pittsburgh, Pittsburgh, PA, USA
| | - J F Karp
- Department of Psychiatry, University of Pittsburgh, Pittsburgh, PA, USA
| | - T J Orchard
- Department of Epidemiology, Graduate School of Public Health, University of Pittsburgh, Pittsburgh, PA, USA
| | - T Costacou
- Department of Epidemiology, Graduate School of Public Health, University of Pittsburgh, Pittsburgh, PA, USA
| | - H J Aizenstein
- Department of Psychiatry, University of Pittsburgh, Pittsburgh, PA, USA
| | - J R Jennings
- Department of Psychiatry, University of Pittsburgh, Pittsburgh, PA, USA
- Department of Psychology, University of Pittsburgh, Pittsburgh, PA, USA
| | - C Rosano
- Department of Epidemiology, Graduate School of Public Health, University of Pittsburgh, Pittsburgh, PA, USA
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13
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Arterial Hemodynamics in Prehypertensives. Int J Hypertens 2019; 2019:3961723. [PMID: 31057958 PMCID: PMC6463591 DOI: 10.1155/2019/3961723] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/15/2018] [Accepted: 02/14/2019] [Indexed: 12/11/2022] Open
Abstract
Compared to age-matched normotensive adults, those with essential hypertension have been shown to have distinct arterial hemodynamic abnormalities consisting of increased peripheral resistance, pulse wave velocity, and wave reflection magnitude as well as decreased wave reflection time and aortic compliance. These abnormalities are further exacerbated by beta-adrenergic blockade. To see if there are similar hemodynamic abnormalities that antedate the onset of fixed hypertension, we compared age-matched normotensives with prehypertensives selected from patients undergoing diagnostic cardiac catheterization. Ascending aortic pressure and flow were measured with a micromanometer and flow velocity sensor in the baseline state and after beta-adrenergic blockade. In the baseline state the prehypertensive compared to the normotensive group had elevated blood pressure, resistance, left ventricular end-diastolic pressure (LVEDP), and wave reflections. Beta-adrenergic blockade increased resistance, LVEDP, and wave reflections in both groups. Some of these findings are the same as those we previously reported in young persons with established, essential hypertension. The differences in LVEDP and wave reflections, both in the baseline state and after beta-blockade, were still present in subgroups with no differences in blood pressure. Hence, the elevated wave reflections in prehypertensives do not appear to be directly related to the level of blood pressure. These results support the notion that the elevated blood pressure in hypertension may represent a later manifestation of an already abnormal vascular system rather than the vascular abnormalities resulting from hypertension. Consequently, even before blood pressure becomes elevated, early diagnosis and treatment of the vascular abnormalities in prehypertensives may be warranted.
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14
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De Vis JB, Peng SL, Chen X, Li Y, Liu P, Sur S, Rodrigue KM, Park DC, Lu H. Arterial-spin-labeling (ASL) perfusion MRI predicts cognitive function in elderly individuals: A 4-year longitudinal study. J Magn Reson Imaging 2018; 48:449-458. [PMID: 29292540 DOI: 10.1002/jmri.25938] [Citation(s) in RCA: 57] [Impact Index Per Article: 9.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/13/2017] [Accepted: 12/12/2017] [Indexed: 12/26/2022] Open
Abstract
BACKGROUND With the disappointing outcomes of clinical trials on patients with Alzheimer's disease or mild cognitive impairment (MCI), there is increasing attention to understanding cognitive decline in normal elderly individuals, with the goal of identifying subjects who are most susceptible to imminent cognitive impairment. PURPOSE/HYPOTHESIS To evaluate the potential of cerebral blood flow (CBF) as a biomarker by investigating the relationship between CBF at baseline and cognition at follow-up. STUDY TYPE Prospective longitudinal study with a 4-year time interval. POPULATION 309 healthy subjects aged 20-89 years old. FIELD STRENGTH/SEQUENCE 3T pseudo-continuous-arterial-spin-labeling MRI. ASSESSMENT CBF at baseline and cognitive assessment at both baseline and follow-up. STATISTICAL TESTS Linear regression analyses with age, systolic blood pressure, physical activity, and baseline cognition as covariates. RESULTS Linear regression analyses revealed that whole-brain CBF at baseline was predictive of general fluid cognition at follow-up. This effect was observed in the older group (age ≥54 years, β = 0.221, P = 0.004), but not in younger or entire sample (β = 0.018, P = 0.867 and β = 0.089, P = 0.098, respectively). Among major brain lobes, frontal CBF had the highest sensitivity in predicting future cognition, with a significant effect observed for fluid cognition (β = 0.244 P = 0.001), episodic memory (β = 0.294, P = 0.001), and reasoning (β = 0.186, P = 0.027). These associations remained significant after accounting for baseline cognition. Voxelwise analysis revealed that medial frontal cortex and anterior cingulate cortex, part of the default mode network (DMN), are among the most important regions in predicting fluid cognition. DATA CONCLUSION In a healthy aging cohort, CBF can predict general cognitive ability as well as specific domains of cognitive function. LEVEL OF EVIDENCE 1 Technical Efficacy: Stage 3 J. MAGN. RESON. IMAGING 2018;48:449-458.
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Affiliation(s)
- Jill B De Vis
- Department of Radiology, Johns Hopkins University School of Medicine, Baltimore, Maryland, USA
| | - Shin-Lei Peng
- Department of Radiology, Johns Hopkins University School of Medicine, Baltimore, Maryland, USA.,Department of Biomedical Imaging and Radiological Science, China Medical University, Taichung, Taiwan
| | - Xi Chen
- Center for Vital Longevity, School of Behavioral and Brain Sciences, University of Texas at Dallas, Texas, USA
| | - Yang Li
- Department of Radiology, Johns Hopkins University School of Medicine, Baltimore, Maryland, USA
| | - Peiying Liu
- Department of Radiology, Johns Hopkins University School of Medicine, Baltimore, Maryland, USA
| | - Sandeepa Sur
- Department of Radiology, Johns Hopkins University School of Medicine, Baltimore, Maryland, USA
| | - Karen M Rodrigue
- Center for Vital Longevity, School of Behavioral and Brain Sciences, University of Texas at Dallas, Texas, USA
| | - Denise C Park
- Center for Vital Longevity, School of Behavioral and Brain Sciences, University of Texas at Dallas, Texas, USA
| | - Hanzhang Lu
- Department of Radiology, Johns Hopkins University School of Medicine, Baltimore, Maryland, USA.,Department of Biomedical Engineering, Johns Hopkins University School of Medicine, Baltimore, Maryland, USA
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15
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Lin CH, Cheng HM, Chuang SY, Chen CH. Vascular Aging and Cognitive Dysfunction: Silent Midlife Crisis in the Brain. Pulse (Basel) 2017; 5:127-132. [PMID: 29761088 DOI: 10.1159/000481734] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/04/2017] [Accepted: 09/22/2017] [Indexed: 11/19/2022] Open
Abstract
Background Vascular aging may cause cerebral microvascular damage and cognitive dysfunction. There is incremental evidence that consistently implicates arterial stiffness being involved in the manifestation of cognitive impairment in the elderly. However, few investigations have examined the relationship between arterial stiffness and cognitive impairment in midlife. Summary Past studies inconsistently showed improved cognitive outcomes after antihypertensive therapy in elderly populations. Nevertheless, recent findings revealed that blood-pressure-lowering treatment in young adults might eliminate or halt the progression of the detrimental effects related to arterial stiffness, indicating that younger adults may have more favorable outcomes in cognition than their older counterparts if early intervention is conducted at the subclinical stage. Stiffening of the aorta may lead to an excessive flow pulsatility in the brain that may cause microvascular structural brain damage and worse cognitive performance. Recent investigations have suggested that arterial stiffness is likely to trigger initial silent brain damage, possibly preceding midlife, while the manifestation of cognitive decline and deterioration can be foreseen in the subsequent life span. Key Message Despite the recent novel findings, definite conclusions on causality between vascular aging and cognitive dysfunction cannot be drawn at present. Further well-powered longitudinal studies with superior neuroimaging indicator, vascular mechanical biomarkers, and sensitive cognitive assessment tools that examine a broad range of age populations may help extend our understanding of the association between vascular aging and cognitive dysfunction throughout the life span.
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Affiliation(s)
- Chen-Hua Lin
- Institute of Public Health, National Yang-Ming University, Taipei, ROC
| | - Hao-Min Cheng
- Institute of Public Health, National Yang-Ming University, Taipei, ROC.,Faculty of Medicine, National Yang-Ming University, Taipei, ROC.,Center for Evidence-Based Medicine, Taipei Veterans General Hospital, Taipei, ROC.,Department of Medical Education, Taipei Veterans General Hospital, Taipei, ROC.,Department of Internal Medicine, Taipei Veterans General Hospital, Taipei, ROC
| | | | - Chen-Huan Chen
- Institute of Public Health, National Yang-Ming University, Taipei, ROC.,Faculty of Medicine, National Yang-Ming University, Taipei, ROC.,Department of Medical Education, Taipei Veterans General Hospital, Taipei, ROC.,Department of Internal Medicine, Taipei Veterans General Hospital, Taipei, ROC
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16
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Jennings JR, Heim AF, Sheu LK, Muldoon MF, Ryan C, Gach HM, Schirda C, Gianaros PJ. Brain Regional Blood Flow and Working Memory Performance Predict Change in Blood Pressure Over 2 Years. Hypertension 2017; 70:1132-1141. [PMID: 29038202 DOI: 10.1161/hypertensionaha.117.09978] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/06/2017] [Revised: 07/27/2017] [Accepted: 09/14/2017] [Indexed: 12/27/2022]
Abstract
Hypertension is a presumptive risk factor for premature cognitive decline. However, lowering blood pressure (BP) does not uniformly reverse cognitive decline, suggesting that high BP per se may not cause cognitive decline. We hypothesized that essential hypertension has initial effects on the brain that, over time, manifest as cognitive dysfunction in conjunction with both brain vascular abnormalities and systemic BP elevation. Accordingly, we tested whether neuropsychological function and brain blood flow responses to cognitive challenges among prehypertensive individuals would predict subsequent progression of BP. Midlife adults (n=154; mean age, 49; 45% men) with prehypertensive BP underwent neuropsychological testing and assessment of regional cerebral blood flow (rCBF) response to cognitive challenges. Neuropsychological performance measures were derived for verbal and logical memory (memory), executive function, working memory, mental efficiency, and attention. A pseudo-continuous arterial spin labeling magnetic resonance imaging sequence compared rCBF responses with control and active phases of cognitive challenges. Brain areas previously associated with BP were grouped into composites for frontoparietal, frontostriatal, and insular-subcortical rCBF areas. Multiple regression models tested whether BP after 2 years was predicted by initial BP, initial neuropsychological scores, and initial rCBF responses to cognitive challenge. The neuropsychological composite of working memory (standardized beta, -0.276; se=0.116; P=0.02) and the frontostriatal rCBF response to cognitive challenge (standardized beta, 0.234; se=0.108; P=0.03) significantly predicted follow-up BP. Initial BP failed to significantly predict subsequent cognitive performance or rCBF. Changes in brain function may precede or co-occur with progression of BP toward hypertensive levels in midlife.
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Affiliation(s)
- J Richard Jennings
- From the Departments of Psychiatry and Psychology, University of Pittsburgh, PA (J.R.J., A.F.H., L.K.S., M.F.M., C.R., C.S., P.J.G.); and Department of Radiation Oncology (H.M.G.), Department of Radiology (H.M.G.), and Department of Biomedical Engineering (H.M.G.),Washington University in St. Louis, MO (H.M.G.).
| | - Alicia F Heim
- From the Departments of Psychiatry and Psychology, University of Pittsburgh, PA (J.R.J., A.F.H., L.K.S., M.F.M., C.R., C.S., P.J.G.); and Department of Radiation Oncology (H.M.G.), Department of Radiology (H.M.G.), and Department of Biomedical Engineering (H.M.G.),Washington University in St. Louis, MO (H.M.G.)
| | - Lei K Sheu
- From the Departments of Psychiatry and Psychology, University of Pittsburgh, PA (J.R.J., A.F.H., L.K.S., M.F.M., C.R., C.S., P.J.G.); and Department of Radiation Oncology (H.M.G.), Department of Radiology (H.M.G.), and Department of Biomedical Engineering (H.M.G.),Washington University in St. Louis, MO (H.M.G.)
| | - Matthew F Muldoon
- From the Departments of Psychiatry and Psychology, University of Pittsburgh, PA (J.R.J., A.F.H., L.K.S., M.F.M., C.R., C.S., P.J.G.); and Department of Radiation Oncology (H.M.G.), Department of Radiology (H.M.G.), and Department of Biomedical Engineering (H.M.G.),Washington University in St. Louis, MO (H.M.G.)
| | - Christopher Ryan
- From the Departments of Psychiatry and Psychology, University of Pittsburgh, PA (J.R.J., A.F.H., L.K.S., M.F.M., C.R., C.S., P.J.G.); and Department of Radiation Oncology (H.M.G.), Department of Radiology (H.M.G.), and Department of Biomedical Engineering (H.M.G.),Washington University in St. Louis, MO (H.M.G.)
| | - H Michael Gach
- From the Departments of Psychiatry and Psychology, University of Pittsburgh, PA (J.R.J., A.F.H., L.K.S., M.F.M., C.R., C.S., P.J.G.); and Department of Radiation Oncology (H.M.G.), Department of Radiology (H.M.G.), and Department of Biomedical Engineering (H.M.G.),Washington University in St. Louis, MO (H.M.G.)
| | - Claudiu Schirda
- From the Departments of Psychiatry and Psychology, University of Pittsburgh, PA (J.R.J., A.F.H., L.K.S., M.F.M., C.R., C.S., P.J.G.); and Department of Radiation Oncology (H.M.G.), Department of Radiology (H.M.G.), and Department of Biomedical Engineering (H.M.G.),Washington University in St. Louis, MO (H.M.G.)
| | - Peter J Gianaros
- From the Departments of Psychiatry and Psychology, University of Pittsburgh, PA (J.R.J., A.F.H., L.K.S., M.F.M., C.R., C.S., P.J.G.); and Department of Radiation Oncology (H.M.G.), Department of Radiology (H.M.G.), and Department of Biomedical Engineering (H.M.G.),Washington University in St. Louis, MO (H.M.G.)
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Prehypertension is real and can be associated with target organ damage. ACTA ACUST UNITED AC 2017; 11:704-708. [PMID: 28965768 DOI: 10.1016/j.jash.2017.09.005] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/23/2017] [Revised: 08/02/2017] [Accepted: 09/10/2017] [Indexed: 01/11/2023]
Abstract
Prehypertension (systolic blood pressure 120-139 or diastolic blood pressure 80-89 mm Hg) confers a risk of progression to hypertension, impairment of cognitive function, increased left ventricular mass, risk of end-stage renal disease, and an association with arteriosclerosis. Recent studies provide data that could support the rationale for treating prehypertensives subjects with antihypertensive medications in addition to lifestyle modification, especially if they have concomitant cardiovascular risk factors.
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