Vascular and cognitive functions associated with cardiovascular disease in the elderly

Abstract

This study examines the relationship between systemic vascular function, neurocognitive performance, and structural brain abnormalities on magnetic resonance imaging (MRI) among geriatric outpatients with treated, stable cardiovascular disease and no history of neurological illness (n = 88, ages 56-85 years). Vascular function was assessed by cardiac ejection fraction and output, sequential systolic and diastolic blood pressures, flow mediated brachial artery reactivity (BAR), and carotid intima media thickness (IMT). White matter hyperintensities (WMH) on MRI were quantified and examined relative to cognitive and vascular function. Principal component analysis revealed two primary vascular components: one associated with cardiac function, the other with atherosclerotic burden/endothelial dysfunction. Both factors were significantly associated with cognitive function and WMH volume. Reduced systolic variability and increased IMT were most strongly related to reduced attention, executive function, and information-processing speed. These findings suggest the possibility that systemic vascular indices may provide proxy measures of cerebrovascular dysfunction and reinforce the importance of achieving greater understanding of interaction between systemic vascular disease and brain dysfunction among elderly people with cardiovascular disease.Address correspondence to Ronald A. Cohen, Centers for Behavioral and Preventive Medicine, The CORO Building, 5th Floor, One Hoppin Street, Providence, RI 02903, USA (RCohen@lifespan.org). Vascular cognitive impairments (VCI) occur on a continuum ranging from mild deficits among patients with vascular risk factors such as cardiovascular disease (CVD) to the severe cognitive dysfunction characteristic of vascular dementia (Bowler, Steenhuis, & Hachinski, 1999;Rockwood, 2002;Roman, Erkinjuntti, Wallin, Pantoni, & Chui, 2002). Cardiovascular disease was once thought to convey little risk to the brain given its capacity for vascular autoregulation and sustained cerebral perfusion even under adverse hemodynamic conditions (Lassen, 1964). Brain dysfunction secondary to cardiovascular disease was usually attributed to acute stroke during cardiac surgery (Newman et al., 2001), or in response to cardiac events (e.g., arrhythmia). Yet, patients with severe cardiovascular disease frequently exhibit cognitive problems in the absence of clinically identified stroke (Moser et al., 1999;Paul et al., 2005), particularly in cases of heart failure (Bennett & Sauve, 2003;Bornstein, Starling, Myerowitz, & Haas, 1995), presumably reflecting the impact of reduced cardiac function on the aging brain (Roman, 2004). We have previously shown that both cognitive dysfunction and structural brain abnormalities on magnetic resonance imaging (MRI) are associated with reduced cardiac output among patients with severe cardiovascular disease (Jefferson, Poppas, Paul, & Cohen, 2007a;Jefferson et al., 2007b) and abnormalities of systemic vascular function (Gunstad et al., 2006a;Gunstad et al., 2005;Gunstad e...

Functional MR Imaging Evidence of Altered Functional Activation in Metabolic Syndrome

“…The system is involved in regulating attention, switching attentional focus, and task preparation 42 and is known to be affected early in the development of vascular cognitive impairment. [43][44][45] This interpretation is supported by our present finding that greater task-related BOLD response in these regions was associated with better task performance and faster reaction times. The cross-sectional nature of our study limits our ability to infer future cognitive trajectories from the observed functional activation changes.…”

“…Support is provided by a growing body of literature documenting that peripheral cardiovascular dysfunction is related to poor cerebrovascular health and diminished cognitive function in older patients with cardiovascular disease. [43][44][45][51][52][53][54][55] Due to the multifaceted nature of MetS, further research is necessary to explore the contributions of frank vascular disease to the observed cognitive taskϪrelated BOLD response changes in midlife. Further exploration of other potential mechanisms such as alterations in cerebral glucose metabolism and inflammation will also be valuable.…”

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Treatment of limited disease small cell lung cancer: the multidisciplinary team

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