Impact of the ambulatory blood pressure monitoring profile on cognitive and imaging findings of cerebral small-vessel disease in older adults with cognitive complaints

Abstract

We investigated ambulatory blood pressure (BP) monitoring (ABPM) profiles and magnetic resonance imaging (MRI) findings of cerebral small-vessel disease (cSVD) in older adults with cognitive complaints who were grouped as follows: subjective cognitive decline, mild cognitive impairment, and dementia of Alzheimer’s type. Group comparisons and correlation analyses among demographic characteristics, cognitive and MRI findings, and ABPM profiles were performed. Furthermore, multivariate logistic regression analyses for dependent variables of (1) dementia or not and (2) MRI criteria of subcortical vascular dementia (SVaD) or not were conducted with independent variables of dichotomized ABPM profiles. A total of 174 subjects (55 males and 119 females) were included: mean age 75.36 ± 7.13 years; Mini-Mental State Examination (MMSE) score 20.51 ± 6.23. No MRI and ABPM findings except medial temporal atrophy were different between three groups. Twenty-four-hour systolic BP (sBP) was correlated with MMSE score (r = –0.182; p = 0.022) and the severity of white matter hyperintensity (WMH) (r = 0.157; p = 0.048). A higher daytime sBP was associated with dementia (odds ratio (OR): 3.734; 95% confidence interval (CI): 1.041–13.390; p = 0.043) and MRI finding of SVaD (OR: 10.543; 95% CI: 1.161–95.740; p = 0.036). Although there were no differences in ABPM profiles between three groups, a higher BP—especially a higher sBP—correlated with cognitive dysfunction and severity of WMH in older adults. Only higher daytime sBP was an independent predictor for dementia and MRI findings of SVaD. Among various ABPM profiles in this study, a higher BP, especially a higher sBP, may be considered the most important for clinical and MRI findings of cSVD.

Dementia Prevalence, Comorbidities, and Lifestyle Among Jatinangor Elders

“…Furthermore, the increase of 24-h ambulatory blood pressure variability was associated with lower cognitive function in elderly hypertension with well-controlled blood pressure (59). Higher daytime systolic blood pressure was associated with a 3.73 risk of dementia and a 10.54 risk of MRI finding of subcortical vascular dementia (60). All these data highlight the need for the early management of these risk factors, particularly the blood pressure, even in the absence of clinical hypertension to prevent the risk of cognitive decline typically associated with aging.…”

Association between ambulatory blood pressure monitoring patterns with cognitive function and risk of dementia: a systematic review and meta-analysis

“…Eighteen studies (fifteen cross-sectional and three cohort studies) examined the risk of abnormal cognitive function among dipping groups in four thousand nine hundred and fifty-five patients (mean age 72.8 ± 9.1) [ 25 – 27 , 44 – 57 ]. Ten studies reported on 2918 patients (mean age 65.6 ± 11.2) global function neuropsychological tests stratified by dipping patterns [ 40 , 47 , 49 , 53 , 58 – 65 ].…”

“…Cani et al examined the incidence of supine hypertension in a cohort of patients with idiopathic autonomic failure (IAF) [ 66 ]. Eight studies did not comment on hypertension history status of their population cohort [ 25 , 27 , 46 , 51 , 52 , 60 , 62 , 67 ] while five [ 25 , 27 , 51 , 52 , 67 ] of them stated that some patients received antihypertensive treatment. Guo and Ohya et al reported that none of the patients included received any antihypertensive treatment [ 46 , 62 ].…”

“…With regard to dementia and cognitive impairment, cross-sectional investigations of ABPM and cognition have produced inconsistent results [ 23 , 24 ]. Some of the relevant studies suggest that dipping status was associated with increased risk of dementia or cognitive impairment [ 25 , 26 ], while others failed to prove any association [ 27 , 28 ]. The objective of this systematic review and meta-analysis is to elucidate whether different circadian BP patterns, determined by 24 h ABPM, represent a risk factor of dementia or cognitive impairment incidence.…”

Association between Blood Pressure, Blood Pressure Variability, and Post-Stroke Cognitive Impairment

“…Regarding BP and dementia risk, population-based studies showed that, from midlife to the geriatric stage, hypertension is correlated with future dementia, including both AD and VaD [100][101][102][103][104][105][106][107][108][109][110]. Another large review comprising 17 different systemic reviews concluded that hypertension leads to a higher risk of VaD and cognitive decline but to less AD [111].…”