Association between arterial stiffness, cerebral small vessel disease and cognitive impairment: A systematic review and meta-analysis

Sloten, Thomas T. van; Protogerou, Athanase D.; Henry, Ronald M.A.; Schram, Miranda T.; Launer, Lenore J.; Stehouwer, Coen D. A.

doi:10.1016/j.neubiorev.2015.03.011

Cited by 208 publications

(203 citation statements)

References 81 publications

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“…Several studies, including meta‐analyses, report that arterial stiffness is a risk factor for cognitive impairment 10, 11, 12, 13. Recent observations in the Framingham cohort suggest that aortic stiffness is associated with white‐matter injury and cognitive function in midlife,13 consistent with our hypotheses.…”

Section: Discussionsupporting

confidence: 88%

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Muscle mass decline, arterial stiffness, white matter hyperintensity, and cognitive impairment: Japan Shimanami Health Promoting Program study

Kohara

Okada

Ochi

et al. 2017

J cachexia sarcopenia muscle

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BackgroundThere is a close association between frailty and cognitive impairment. However, the underlying contribution of sarcopenia to the development of cognitive impairment is unclear. We investigated the possible association between muscle mass decline and cognitive impairment in a cross‐sectional study of 1518 subjects aged 55 years or above. We also evaluated arterial stiffness and white matter hyperintensities (WMHs) as possible underlying mechanisms for this association.MethodsTwo sarcopenic indices were measured: thigh muscle cross‐sectional area (CSA; calculated by computed tomography) and skeletal muscle mass (bioelectric impedance). Muscle mass decline was defined as either the bottom 10% or 20% of participants for each sex. Cognitive function was assessed using the Touch Panel‐type Dementia Assessment Scale, and brachial–ankle pulse wave velocity was measured as an index of arterial stiffness.ResultsBoth sarcopenic indices were modestly but significantly associated with brachial–ankle pulse wave velocity in male and female subjects. The presence of WMHs was significantly associated with low thigh muscle CSA in men and with low skeletal muscle mass in women. The Touch Panel‐type Dementia Assessment Scale score was modestly but significantly and positively associated with thigh muscle CSA in men and skeletal muscle mass in women. Muscle mass decline in the bottom 10% of participants on both sarcopenic indices was significantly and independently related to cognitive impairment in women.ConclusionsLower sarcopenic indices are significantly related to lower cognitive scores. Arterial stiffness and WMHs could account, at least in part, for this association.

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Section: Discussionsupporting

confidence: 88%

“…Arterial stiffness has been demonstrated as a risk factor for cognitive decline 10, 11. We have demonstrated that muscle mass showed a significant but modest association with baPWV, which may explain the non‐linear relationship between muscle mass decline and higher baPWV.…”

Section: Discussionmentioning

confidence: 67%

Muscle mass decline, arterial stiffness, white matter hyperintensity, and cognitive impairment: Japan Shimanami Health Promoting Program study

Kohara

Okada

Ochi

et al. 2017

J cachexia sarcopenia muscle

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“…No such in vivo test has been specifically developed to provide insight into cerebrovascular function, physiology, and risk, but it is conceivable that ICA shear-mediated dilation may provide a window on the health of the cerebrovascular endothelium. Indeed, there is a positive association between greater arterial stiffness and microvascular brain disease and cognitive impairment, [40][41][42] and a lower ICA dilation in response to a standardized, shear-mediated stimulus may therefore provide a useful marker of cerebrovascular function and future risk. Future studies will be necessary to test this proposal.…”

Section: Sex Differencesmentioning

confidence: 99%

Evidence for Shear Stress–Mediated Dilation of the Internal Carotid Artery in Humans

et al. 2016

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S mall cerebral arteries and arterioles (eg, pial vessels) respond rapidly to changes in their metabolic milieu and are highly sensitive to the partial pressure of arterial carbon dioxide (PaCO 2 ).1 Vasomotor responsiveness to PaCO 2 , termed CO 2 reactivity, is integral to stabilizing blood pH levels, and previous studies have associated lower CO 2 reactivity to increased cardiovascular and all-cause mortality.2 Recent magnetic resonance imaging studies in humans have revealed that vasomotor changes also occur in the middle cerebral artery (MCA) 3-5 and basilar artery 6 across the hypo-and hypercapnic range. These studies demonstrate the involvement of larger cerebral arteries in the PaCO 2 reactivity response, 7 findings consistent with well-controlled, animal studies. 8 Other recent studies using Duplex ultrasound have investigated extracranial artery responses during hypo-and hypercapnia.9,10 These studies provide direct evidence that changes in end-tidal CO 2 (PETCO 2 ) are associated with directionally similar, and dosedependent, changes in internal carotid artery (ICA) diameter. The mechanism(s), however, mediating these changes in extracranial ICA diameter remain unclear.Significant and rapid changes in extracranial artery blood flow occur across the hypo-and hypercapnic range. [9][10][11] In peripheral conduits such as the radial and brachial arteries, such changes in flow and attendant arterial shear stress represent potent vasoactive stimuli.12,13 Although Pohl et al 14 and Rubanyi et al 15 were the first to identify that flow-mediated dilation (FMD) is endothelium dependent, it is now well established that this phenomenon occurs in humans and that NO plays a significant role. [16][17][18][19] The widely used FMD test 13 relies on dilation of small arteries and arterioles in the limbs, as a consequence of cuff-induced ischemia, to induce an increase in upstream conduit artery shear stress and dilation. In the context of these studies, it is conceivable that rapid and profound dilation of intracranial vessels in response to hypercapnia induces extracranial (ICA) dilation as a consequence of increased shear stress. The aim of this study was to identify whether hypercapnia induces shear-mediated dilation in the carotid arteries. Using high-resolution Duplex ultrasound combined with novel, edge-detection software, we assessed simultaneous common Abstract-Increases in arterial carbon dioxide tension (hypercapnia) elicit potent vasodilation of cerebral arterioles. Recent studies have also reported vasodilation of the internal carotid artery during hypercapnia, but the mechanism(s) mediating this extracranial vasoreactivity are unknown. Hypercapnia increases carotid shear stress, a known stimulus to vasodilation in other conduit arteries. To explore the hypothesis that shear stress contributes to hypercapnic internal carotid dilation in humans, temporal changes in internal and common carotid shear rate and diameter, along with changes in middle cerebral artery velocity, were simultaneously assessed in 18 su...

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“…For instance, decreased arterial wall compliance with hypertension likely contributes to OH by diminishing baroreceptor sensitivity [36]. Arterial stiffness and OH are both associated with increased burden of cerebral white matter lesions and vascular disease including stroke [9,28,37,38]. As these are established risk factors for dementia, these conditions may act as mediators or indicate shared aetiology between diseases.…”

Section: Discussionmentioning

confidence: 99%

O2‐09‐03: Orthostatic Hypotension and the Long‐Term Risk of Dementia: A Population‐Based Study

Wolters

Raso

Koudstaal

et al. 2016

Alzheimer's & Dementia

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Association between arterial stiffness, cerebral small vessel disease and cognitive impairment: A systematic review and meta-analysis

Cited by 208 publications

References 81 publications

Muscle mass decline, arterial stiffness, white matter hyperintensity, and cognitive impairment: Japan Shimanami Health Promoting Program study

Muscle mass decline, arterial stiffness, white matter hyperintensity, and cognitive impairment: Japan Shimanami Health Promoting Program study

Evidence for Shear Stress–Mediated Dilation of the Internal Carotid Artery in Humans

O2‐09‐03: Orthostatic Hypotension and the Long‐Term Risk of Dementia: A Population‐Based Study

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