Natriuretic Peptides, Cognitive Impairment and Dementia: An Intriguing Pathogenic Link with Implications in Hypertension

Gallo, Giovanna; Bianchi, Franca; Cotugno, Maria; Volpe, Massimo; Rubattu, Speranza

doi:10.3390/jcm9072265

Cited by 10 publications

(4 citation statements)

References 66 publications

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“…Publications in the last few years have also reported a link between BNP levels and the development of dementia. In these observations, BNP appears as a marker of cardiac dysfunction underlying subclinical brain damage and, consequently, dementia [15]. We also observed that patients presenting with peri-infarct CI scored significantly higher on the SYNTAX scale assessing the complexity of atherosclerotic lesions in the coronary arteries.…”

Section: Discussionsupporting

confidence: 63%

Cognitive Impairment in Cardiovascular Patients after Myocardial Infarction: Prospective Clinical Study

Kasprzak,

Kaczmarek-Majer,

Rzeźniczak

et al. 2023

JCM

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(1) Background: Assessment of cognitive function is not routine in cardiac patients, and knowledge on the subject remains limited. The aim of this study was to assess post-myocardial infarction (MI) cognitive functioning in order to determine the frequency of cognitive impairment (CI) and to identify factors that may influence it. (2) Methods: A prospective study included 468 patients hospitalized for MI. Participants were assessed twice: during the first hospitalization and 6 months later. The Mini-Mental State Examination was used to assess the occurrence of CI. (3) Results: Cognitive dysfunction based on the MMSE was found in 37% (N-174) of patients during the first hospitalization. After 6 months, the prevalence of deficits decreased significantly to 25% (N-91) (p < 0.001). Patients with CI significantly differed from those without peri-infarction deficits in the GFR, BNP, ejection fraction and SYNTAX score, while after 6 months, significant differences were observed in LDL and HCT levels. There was a high prevalence of non-cognitive mental disorders among post-MI patients. (4) Conclusions: There is a high prevalence of CI and other non-cognitive mental disorders, such as depression, sleep disorders and a tendency to aggression, among post-MI patients. The analysis of the collected material indicates a significant impact of worse cardiac function expressed as EF and BNP, greater severity of coronary atherosclerosis expressed by SYNTAX results, and red blood cell parameters and LDL levels on the occurrence of CI in the post-MI patient population.

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Section: Discussionsupporting

confidence: 63%

Cognitive Impairment in Cardiovascular Patients after Myocardial Infarction: Prospective Clinical Study

Kasprzak,

Kaczmarek-Majer,

Rzeźniczak

et al. 2023

JCM

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“…Moreover, HRF added predictive value to models that in addition to the variables mentioned above also included serum concentration of NT-proBNP. This analyte has been reported to be associated with incident dementia in MESA (Ostovaneh et al, 2020) and other studies (Nagata et al, 2019), with MRI measures of cognitive function and structure (Zonneveld et al, 2017;Ferguson et al, 2018), as well as, with overall or some domains of cognitive impairment (Kerola et al, 2010;Ferguson et al, 2018;Gallo et al, 2020).…”

Section: Discussionmentioning

confidence: 75%

Prediction of Cognitive Decline Using Heart Rate Fragmentation Analysis: The Multi-Ethnic Study of Atherosclerosis

Costa

Redline

Hughes

et al. 2021

Front. Aging Neurosci.

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Background: Heart rate fragmentation (HRF), a new non-invasive metric quantifying cardiac neuroautonomic function, is associated with increasing age and cardiovascular disease. Since these are risk factors for cognitive decline and dementia, in the Multi-Ethnic Study of Atherosclerosis (MESA), we investigated whether disrupted cardiac neuroautonomic function, evidenced by increased HRF, would be associated with worse cognitive function assessed concurrently and at a later examination, and with greater cognitive decline.Methods: HRF was derived from the ECG channel of the polysomnographic recordings obtained in an ancillary study (n = 1,897) conducted in conjunction with MESA exam 5 (2010–2012). Cognitive function was assessed at exam 5 and 6.4 ± 0.5 years later at exam 6 (2016–2018) with tests of global cognitive performance (the Cognitive Abilities Screening Instrument, CASI), processing speed (Digit Symbol Coding, DSC) and working memory (Digit Span). Multivariable regression models were used to quantify the associations between HRF indices and cognitive scores.Results: The participants’ mean age was 68 ± 9 years (54% female). Higher HRF at baseline was independently associated with lower cognitive scores at both exams 5 and 6. Specifically, in cross-sectional analyses, a one-standard deviation (SD) (13.7%) increase in HRF was associated with a 0.51 (95% CI: 0.17–0.86) points reduction in CASI and a 1.12 (0.34–1.90) points reduction in DSC. Quantitatively similar effects were obtained in longitudinal analyses. A one-SD increase in HRF was associated with a 0.44 (0.03–0.86) and a 1.04 (0.28–1.81) points reduction in CASI and DSC from exams 5 to 6, respectively. HRF added predictive value to the Cardiovascular Risk Factors, Aging, and Incidence of Dementia (CAIDE-APOE-ε4) risk score and to models adjusted for serum concentration of NT-proBNP, an analyte associated with cognitive impairment and dementia.Conclusion: Increased HRF assessed during sleep was independently associated with diminished cognitive performance (concurrent and future) and with greater cognitive decline. These findings lend support to the links between cardiac neuroautonomic regulation and cognitive function. As a non-invasive, repeatable and inexpensive probe, HRF technology may be useful in monitoring cognitive status, predicting risk of dementia and assessing therapeutic interventions.

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“…48 Other possible mechanisms linking LAV to cognition include an adaptive response to endothelial dysfunction 47 and increased levels of atrial natriuretic peptide. 49 Our study has some limitations that are worth noting. Echocardiograms were performed 25 years apart using slightly different procedures and equipment, which may affect the comparability of the echocardiographic parameters.…”

Section: Discussionmentioning

confidence: 93%

“…48 Other possible mechanisms linking LAV to cognition include an adaptive response to endothelial dysfunction 47 and increased levels of atrial natriuretic peptide. 49…”

Section: Discussionmentioning

confidence: 99%

Twenty-Five–Year Change in Cardiac Structure and Function and Midlife Cognition

et al. 2022

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Objective:To determine whether midlife cardiac structure and function and their 25-year change from early to middle adulthood are associated with lower midlife cognition.Methods:We studied 2,653 participants from the CARDIA (Coronary Artery Risk Development in Young Adults) Study (57% women, 46% black). Echocardiograms were obtained at Years 5, 25 and 30 visits (participant mean age 30, 50 and 55 years) to assess left ventricular (LV) mass (LVMi); LV systolic function with LV ejection fraction (LVEF); LV diastolic function with left atrial volume (LAVi) and early peak mitral velocity (E)/early peak mitral annular velocity (e’) ratio. At Year 30, five cognitive domains were measured: global cognition, processing speed, executive function, delayed verbal memory, and verbal fluency. We investigated the association between midlife (Year 30) and 25-year change in cardiac structure and function on midlife cognition using linear regressions.Results:Over 25 years, LVMi and LAVi increased with mean change (SD) per year of 0.27 g/m2 (0.28) and 0.42 mL/m2 (0.15) while LVEF decreased by 0.11% (0.02). After adjustment for demographics and education, 25-year increase (≥ 1-SD) in LVMi was associated with lower cognition on most tests (p ≤ 0.02); 25-year increase in LAVi was associated with lower global cognition (p=0.04) but 25-year decrease in LVEF was not associated with cognition. Further adjustment for cardiovascular risk factors led to similar results. In addition, unlike Year 30 E/e’ ratio and LVEF, higher Year 30 LVMi and LAVi were significantly associated with worse cognition on most cognitive tests.Conclusions:Midlife cardiac structure and its change from early to middle adulthood are associated with lower midlife cognition even after accounting for confounders. Unlike systolic function, midlife LV diastolic function and its 25-year change were also linked to cognition. Our results provide novel information linking early to midlife cardiac structure and function to cognition.

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Natriuretic Peptides, Cognitive Impairment and Dementia: An Intriguing Pathogenic Link with Implications in Hypertension

Cited by 10 publications

References 66 publications

Cognitive Impairment in Cardiovascular Patients after Myocardial Infarction: Prospective Clinical Study

Cognitive Impairment in Cardiovascular Patients after Myocardial Infarction: Prospective Clinical Study

Prediction of Cognitive Decline Using Heart Rate Fragmentation Analysis: The Multi-Ethnic Study of Atherosclerosis

Twenty-Five–Year Change in Cardiac Structure and Function and Midlife Cognition

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