High Systolic and Pulse Pressure Levels Are Associated with Better Cognitive Performance in Patients with Probable Alzheimer’s Disease: A Cross-Sectional Observational Study in a Geriatric Outpatient Population

Abstract

Background: The prevalence of cardiovascular disease and Alzheimer’s disease (AD) increases with age. A number of studies have demonstrated an association between AD and cardiovascular risk factors and disease. However, data are inconsistent. Methods: Cross-sectional observational study in a geriatric outpatient population. Analysis of data from 327 patients diagnosed with probable AD in a geriatric outpatient clinic. Comparison of blood pressure levels, cardiovascular diagnoses, and Mini-Mental State Examination (MMSE) score between the patients. Results: MMSE score decreased with age (β = –0.25; 95% CI: –0.35 to 0.15), and a positive correlation was found with systolic blood pressure (β = 0.03; 95% CI: 0.003–0.06), pulse pressure (β = 0.05; 95% CI: 0.01–0.08) and hypertension (β = 1.56; 95% CI: 0.05–3.07). An increase in cardiovascular disease load had a negative effect on cognitive performance. After adjustment for duration of dementia (data present for 216 patients), results were slightly changed. Conclusions: Higher systolic blood pressure and pulse pressure were associated with a better cognitive test performance. Patients with probable AD and 2 or more cardiovascular diagnoses had lower MMSE scores.

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

“…The reported standardized regression coefficients ranged from −0.02 to 0.16. In contrast, three studies (Davis et al, 2003; Molander et al, 2010; van Bruchem-Visser et al, 2009) found a statistically significant association, but in the opposite direction, i.e. between higher PP and better (global and(or) domain-specific) cognitive function (Table 3).…”

“…between higher PP and better (global and(or) domain-specific) cognitive function (Table 3). These studies were done in individuals with Alzheimer’s disease (Davis et al, 2003; van Bruchem-Visser et al, 2009) or in the oldest old (i.e. individuals ≥85 years) (Molander et al, 2010).…”

“…higher PP was associated with better cognitive function. These studies (Davis et al, 2003; Molander et al, 2010; Sabayan et al, 2012; van Bruchem-Visser et al, 2009) were all done in (biologically) older individuals. The presence of an inverted association in these individuals may have several explanations.…”

Associations of Blood Pressure with Functional and Cognitive Changes in Patients with Alzheimer's Disease

“…The OPTIMA Longitudinal Study showed that high and low pulse pressure and diastolic BP levels were associated with faster cognitive decline in patients with AD [32]. Contrariwise, a cross-sectional study showed an association between higher systolic BP and pulse pressure with better performance in the MMSE for patients with AD [4]. In our prospective sample of patients in variable dementia stages, pulse pressure variations did not affect any test score variations, a result that might be due to the short follow-up with variations in pulse pressure that would not be enough to interfere with neurodegenerative mechanisms.…”

“…Neurodegenerative mechanisms result in loss of noradrenergic cell bodies in the locus ceruleus that may lead to hypotension due to decreased concentration of norepinephrine in the brain [4]; thus, mildly elevated blood pressure (BP) seems to benefit mental and physical functions in older people, while low and higher BP values are associated with poorer performance [5]. …”