ASSOCIATION BETWEEN BLOOD PRESSURE AND COGNITIVE FUNCTION OF COMMUNITY-DWELLING OLDEST OLD IN OKINAWA, JAPAN

Abstract Background: Adults 80 years and older are the fastest-growing segment of the Japanese population and face a high risk of cognitive decline. There are some evidences connecting hypertension to cognitive decline. In mid-life hypertension is known to have influence the cognitive decline in older age. However, a few study have examined the association between hypertension or vascular stiffness and cognitive function among elderly over 80 years old. We analyzed the associations between vascular stiffness and cognitive function among relatively healthy community-dwelling non-demented oldest old. Method: Data came from the Keys to Optimal Cognitive Aging (KOCOA) study; an ongoing cohort of relatively healthy volunteers aged over 80 years old, living in Okinawa, Japan. In 2017, 105 non-demented (Clinical Dementia Rating < 1) subjects completed three kinds of examination for vascular function (75 % female, mean age (SD) 84.0 (3.0)). We categorized subjects into low and high cognitive function groups using Montreal Cognitive Assessment (MoCA) (25/26 as a cutpoint). Logistic regression models were used to examine the association between cognitive and vascular functions. Results: Narrower pulse pressure, an indicator of lower arterial stiffness, was associated with better cognitive function among subjects, after adjusting for gender, age, and education (p≦0.05), although systolic and diastolic blood pressure were not. Conclusion: Our findings suggest that narrower pulse pressure is related with cognitive preservation. The present study supports the hypothesis that lower arterial stiffness is related with better cognitive function even among the oldest old.

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Abstract 22: Visit-to-Visit Variability in Blood Pressure is Related to Late-Life Cognitive Decline

Circulation ◽

10.1161/circ.131.suppl_1.22 ◽

2015 ◽

Vol 131 (suppl_1) ◽

Author(s):

Bo Qin ◽

Anthony J Viera ◽

Linda S Adair ◽

Brenda L Plassman ◽

Lloyd J Edwards ◽

...

Keyword(s):

Blood Pressure ◽

Older Adults ◽

Cognitive Function ◽

Cognitive Decline ◽

Verbal Memory ◽

Repeated Measures ◽

Community Dwelling ◽

Cognitive Testing ◽

Cognitive Test ◽

Nutrition Survey

Introduction: Recent studies suggest higher visit-to-visit variability of blood pressure (BP) is associated with worse cognitive function, but evidence based on longitudinal cognitive testing has not been reported. Hypothesis: We assessed the hypothesis that higher visit-to-visit variability in BP, but not mean BP, would be associated with faster decline in cognitive function among community-dwelling older adults. Methods: This prospective cohort study comprised 1213 adults who had two or more waves of BP measurements as part of the China Health and Nutrition Survey from 1991, up to their first cognitive tests, and completed a cognitive screening test at two or more waves in 1997, 2000 or 2004. Mean (SD) age at first cognitive test was 64 (6) y. Outcomes were repeated measures of global cognitive scores (baseline mean ± SD: 19 ± 6 points), standardized composite cognitive and verbal memory scores (standardized units [SU]). Visit-to visit BP variability was expressed as the standard deviation [SD] or as the variation independent of mean (SD/mean^x, with x derived from curve fitting) in BP measures obtained at a mean interval of 3.6 years. Multivariable-adjusted linear mixed-effects models were used to determine the association of changes in cognitive scores with visit-to visit BP variability. Results: Higher visit-to-visit variability in systolic BP, but not mean systolic BP, was associated with a faster decline of cognitive function (adjusted mean difference [95% CI] for high vs. low tertile of SD in variability (Figure): global score -0.23 points/y [-0.41 to -0.04], composite scores -0.029 SU/y [-0.056 to -0.002] and verbal memory -0.044 SU/y [-0.075 to -0.012]). Higher visit-to-visit variability in diastolic BP was associated with a faster decline of global cognitive function only among adults 55-64 years, independent of mean diastolic BP. Conclusion: Higher long-term BP visit-to-visit variability predicted a faster rate of cognitive decline among older adults.

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Abstract MP88: Fetuin-A, a Vascular Biomarker of Cognitive Decline in Older Adults

Circulation ◽

10.1161/circ.129.suppl_1.mp88 ◽

2014 ◽

Vol 129 (suppl_1) ◽

Author(s):

Gail A Laughlin ◽

Linda K McEvoy ◽

Elizabeth Barrett-Connor ◽

Lori B Daniels ◽

Joachim H Ix

Keyword(s):

Older Adults ◽

Cognitive Function ◽

Cognitive Decline ◽

Vascular Disease ◽

Sex Education ◽

Cognitive Aging ◽

Community Dwelling ◽

Fetuin A ◽

High Functioning ◽

Age Related

Objectives: The contribution of vascular disease to neurocognitive decline is now widely recognized. Fetuin-A is an abundant plasma protein known to predict vascular disease. Prior studies have shown that fetuin-A levels are lower in patients with Alzheimer’s disease in direct proportion to the severity of cognitive impairment; however, their association with normal cognitive aging is unknown. We evaluated the association of serum fetuin-A levels with cognitive function in relatively high-functioning, community-dwelling older adults from the Rancho Bernardo Study. Methods: This is a population-based study of 1382 older adults (median age 75) who had plasma fetuin-A levels and cognitive function evaluated in 1992-96; 855 had repeat cognitive function assessment a median of 4 years later. Results: Adjusting for age, sex, education, and depression, higher levels of fetuin-A were associated with better baseline performance on the Mini-Mental Status Exam (MMSE) (P=0.012) and a tendency for better Trails Making B scores (P=0.066). In longitudinal analyses, the likelihood of a major decline (highest decile of change) in Trails B was 29% lower (P=0.010) for each SD higher baseline fetuin-A level; odds of major decline in MMSE was 42% lower (P=0.005) per SD higher fetuin-A for individuals with no known CVD, but were not related to fetuin-A in those with CVD (P=0.33). Fetuin-A was not related to Category Fluency performance. Results did not vary by sex and were not explained by numerous vascular risk factors and comorbidities. Conclusions: Higher plasma fetuin-A concentrations are associated with better performance on tests of global cognitive function and executive function and with reduced likelihood of major decline in these cognitive abilities over a 4-year period. These observations are consistent with the hypothesis that higher fetuin-A protects against cognitive decline in relatively high functioning older adults, although this may be less apparent in those with established vascular disease. Fetuin-A may serve as a biological link between vascular disease and normal age-related cognitive decline.

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High daytime and nighttime ambulatory pulse pressure predict poor cognitive function and mild cognitive impairment in hypertensive individuals

Journal of Cerebral Blood Flow & Metabolism ◽

10.1038/jcbfm.2015.90 ◽

2015 ◽

Vol 36 (1) ◽

pp. 253-263 ◽

Cited By ~ 8

Author(s):

Iolanda Riba-Llena ◽

Cristina Nafría ◽

Josefina Filomena ◽

José L Tovar ◽

Ernest Vinyoles ◽

...

Keyword(s):

Blood Pressure ◽

Cognitive Impairment ◽

Mild Cognitive Impairment ◽

Cognitive Function ◽

Pulse Wave Velocity ◽

Wave Velocity ◽

Pulse Pressure ◽

Cognitive Aging ◽

Pulse Wave ◽

Cognitive Status

High blood pressure accelerates normal aging stiffness process. Arterial stiffness (AS) has been previously associated with impaired cognitive function and dementia. Our aims are to study how cognitive function and status (mild cognitive impairment, MCI and normal cognitive aging, NCA) relate to AS in a community-based population of hypertensive participants assessed with office and 24-hour ambulatory blood pressure measurements. Six hundred ninety-nine participants were studied, 71 had MCI and the rest had NCA. Office pulse pressure (PP), carotid–femoral pulse wave velocity, and 24-hour ambulatory PP monitoring were collected. Also, participants underwent a brain magnetic resonance to study cerebral small–vessel disease (cSVD) lesions. Multivariate analysis–related cognitive function and cognitive status to AS measurements after adjusting for demographic, vascular risk factors, and cSVD. Carotid–femoral pulse wave velocity and PP at different periods were inversely correlated with several cognitive domains, but only awake PP measurements were associated with attention after correcting for confounders (beta = −0.22, 95% confidence interval (CI) −0.41, −0.03). All ambulatory PP measurements were related to MCI, which was independently associated with nocturnal PP (odds ratio (OR) = 2.552, 95% CI 1.137, 5.728) and also related to the presence of deep white matter hyperintensities (OR = 1.903, 1.096, 3.306). Therefore, higher day and night ambulatory PP measurements are associated with poor cognitive outcomes.

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Is the Association Between Cognitive Decline and Mortality Modified by High Blood Pressure Among the Oldest Old?

10.21203/rs.3.rs-841728/v1 ◽

2021 ◽

Author(s):

Jun Duan ◽

Napoleon Bellua Sam ◽

Gui-Ling Liang ◽

Shi-Jia Wang ◽

Han-Jie Chen ◽

...

Keyword(s):

Blood Pressure ◽

Cognitive Impairment ◽

Mild Cognitive Impairment ◽

Cognitive Function ◽

Cognitive Decline ◽

Oldest Old ◽

Potential Effect ◽

Mortality Risks ◽

Normal Cognitive Function ◽

Cvd Mortality

Abstract BackgroundFew studies have systematically explored the association between cognitive decline and mortality among the oldest old (above 80 years old) and also have limited evidence of the potential effect modifiers between them. The purpose of this study is to evaluate the association between cognitive decline, stratified by detailed levels, and mortality as well as the potential effect modifiers between them.MethodsThis study included 14,891 oldest old (mean age: 90.3±7.5 years) and 10,904 oldest old deaths with 34,486 person-years were observed. Cognitive decline was continuous and stratified into ten categories. Potential effect modifiers were identified as age, sex, blood pressure (BP) and high BP related diseases, including hypertension and cardiovascular disease (CVD) mortality. Cox proportional hazards model was used to evaluate the relationship between them after adjusting for demographic characteristics, socioeconomic status, lifestyle factors, leisure activities and health conditions.ResultsIn the ten categories, compared to those with maintained high normal cognitive function, participants who have declined to severe cognitive impairment from a high normal cognitive function, low normal cognitive function and mild cognitive impairment have 55%, 56% and 63% mortality risks respectively. Cognitive function declined to mild cognitive impairment from a high normal cognitive function and low normal cognitive function with mortality risks 25% and 17% respectively. The multivariable-adjusted model indicated that the oldest old with decreasing one more point in MMSE score per year, had around 4% higher risk of mortality. There was a significant association of interaction of cognitive decline-mortality and sex (P=0.013) as well as hypertension (P=0.004) but with no significant association among age (P=0.277), high BP (P=0.082), and CVD mortality (P=0.058).ConclusionsOur findings suggest that cognitive decline is associated with an elevated risk of all-cause mortality among the oldest old, even at a low level of cognitive decline. Low BP, non-hypertension and non-CVD mortality may be potentially beneficial in the cognitive decline-mortality association.

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Is The Association Between Cognitive Decline And Mortality Modified By High Blood Pressure Among The Oldest Old?

10.21203/rs.3.rs-841728/v2 ◽

2022 ◽

Author(s):

Jun Duan ◽

Napoleon Bellua Sam ◽

Shi-Jia Wang ◽

Yan Liu

Keyword(s):

Blood Pressure ◽

Cognitive Impairment ◽

Cognitive Function ◽

Cognitive Decline ◽

Proportional Hazards Model ◽

Oldest Old ◽

Potential Effect ◽

Cox Proportional Hazards Model ◽

Normal Cognitive Function ◽

Cvd Mortality

Abstract Few studies have systematically explored the association between cognitive decline and mortality among the aged (above 80 years old) and also have limited evidence of the potential effect modifiers between them. Therefore, this study included 14,891 aged (mean age: 90.3±7.5 years) and 10,904 aged deaths with 34,486 person-years were observed. Cognitive decline was continuous and stratified into ten categories. Potential effect modifiers were identified as age, sex, blood pressure (BP) and high BP related diseases, including hypertension and cardiovascular disease (CVD) mortality. Cox proportional hazards model was used to evaluate the relationship between them after adjusting for demographic characteristics, socioeconomic status, lifestyle factors, leisure activities and health conditions. Compared to those with maintained high normal cognitive function, participants who have declined to severe cognitive impairment from a high normal cognitive function, low normal cognitive function and mild cognitive impairment have 55%, 56% and 63% mortality risks respectively. The multivariable-adjusted model indicated that the aged with decreasing one more point in MMSE score per year, had around 4% higher risk of mortality. There was a significant association of interaction of cognitive decline-mortality and sex (P=0.013) as well as hypertension (P=0.004) but with no significant association among age (P=0.277), high BP (P=0.082), and CVD mortality (P=0.058). Our findings suggest that periodic screen cognitive decline and strengthen BP control may be necessary for public health.

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Biomarkers for Cognitive Aging Part I

Biological Research For Nursing ◽

10.1177/1099800411406433 ◽

2011 ◽

Vol 14 (2) ◽

pp. 124-132 ◽

Cited By ~ 13

Author(s):

Kathleen C. Insel ◽

Carrie J. Merkle ◽

Chao-Pin Hsiao ◽

Amy N. Vidrine ◽

David W. Montgomery

Keyword(s):

Blood Pressure ◽

Cognitive Function ◽

Telomere Length ◽

Cognitive Aging ◽

Quantitative Polymerase Chain Reaction ◽

Community Dwelling ◽

Physiological Age ◽

Chronological Age ◽

Mononuclear Leukocytes ◽

Cognitive Assessments

Chronological age is used as a marker for age-associated changes in cognitive function. However, there is great interindividual variability in cognitive ability among people of the same age. Physiological age rather than chronological age should be more closely associated with age-related cognitive changes because these changes are not universal and are likely dependent on several factors in addition to the number of years lived. Cognitive function is associated with successful self-management, and a biological marker that reflects physiological age and is associated with cognitive function could be used to identify risk for failure to self-manage. The purpose of this study was to investigate the association between telomere length, a known biomarker of age; blood pressure; cognitive assessments; and adherence to antihypertensive medication among community-dwelling middle-aged and older adults. The authors administered a battery of cognitive assessments to 42 participants ( M = 69 years of age), collected blood samples, and isolated peripheral blood mononuclear leukocytes for genomic DNA. The authors determined relative telomere length using Cawthon’s method for real-time quantitative polymerase chain reaction (RT-qPCR) and measured medication adherence using an electronic medication monitoring system (MEMS by Aardex) over 8 weeks. Findings indicate that telomere length was inversely associated with systolic blood pressure ( r = −.38, p < .01) and diastolic blood pressure ( r = −.42, p < .01) but not with cognitive assessments or adherence. The authors discuss the nonsignificant findings between telomere length and cognitive assessments including the potential modifying role of gender.

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SEX AND AGE DIFFERENCES IN THE ASSOCIATION OF BLOOD PRESSURE AND HYPERTENSION WITH COGNITIVE FUNCTION IN THE ELDERLY: THE RANCHO BERNARDO STUDY

Journal of Prevention of Alzheimer's Disease ◽

10.14283/jpad.2017.6 ◽

2017 ◽

pp. 1-9

Author(s):

D. Kritz-Silverstein ◽

G.A. Laughlin ◽

L.K. McEvoy ◽

E. Barrett-Connor

Keyword(s):

Blood Pressure ◽

Cognitive Function ◽

Age Differences ◽

Pulse Pressure ◽

Poor Performance ◽

The Elderly ◽

Community Dwelling ◽

Cross Sectional ◽

Function Tests ◽

Sex And Age Differences

Objectives: This study examines sex and age differences in associations of systolic and diastolic blood pressure (SBP, DBP), pulse pressure and hypertension with cognitive function in a community-dwelling population. Design: Cross-sectional study. Setting: Research clinic visit in 1988-91. Participants: Participants were 693 men and 1022 women aged 50-97 Measurements: Blood pressure was measured and 12 cognitive function tests were administered. Results: Average age was 73.8±9.9 in men and 73.2±9.3 in women; 62.6% of men and 63.4% of women were hypertensive (SBP≥140 mmHg, DBP≥90 mmHg, or antihypertensive medication use). Each 5-unit increment in SBP, DBP, or pulse pressure and categorical hypertension was associated with significantly increased odds of poor verbal fluency performance in men and poor Trails B performance in women, with strongest associations for hypertension (OR=1.97, CI:1.01,3.85 in men; OR=1.51, CI:1.01,2.26 in women). After age stratification, associations remained statistically significant in younger (<80 years ) but not older (≥80 years) participants. Conclusion: Blood pressure as a continuous or categorical variable was associated with poor performance on cognitive function tests, but domains varied by sex and associations were found only in those younger than 80 years. The absent associations in those aged 80 years and older could support the hypothesis that increased blood flow is required to maintain cerebral perfusion with advancing age, or could reflect a survivor effect.

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Arterial Stiffness Is Associated with White Matter Disruption and Cognitive Impairment: A Community-Based Cohort Study

Journal of Alzheimer s Disease ◽

10.3233/jad-201424 ◽

2021 ◽

Vol 80 (2) ◽

pp. 567-576

Author(s):

Fei Han ◽

Fei-Fei Zhai ◽

Ming-Li Li ◽

Li-Xin Zhou ◽

Jun Ni ◽

...

Keyword(s):

Cognitive Function ◽

White Matter ◽

Arterial Stiffness ◽

Cognitive Decline ◽

Sex Education ◽

Diffusion Tensor ◽

Mean Diffusivity ◽

White Matter Injury ◽

White Matter Integrity ◽

Cross Sectional

Background: Mechanisms through which arterial stiffness impacts cognitive function are crucial for devising better strategies to prevent cognitive decline. Objective: To examine the associations of arterial stiffness with white matter integrity and cognition in community dwellings, and to investigate whether white matter injury was the intermediate of the associations between arterial stiffness and cognition. Methods: This study was a cross-sectional analysis on 952 subjects (aged 55.5±9.1 years) who underwent diffusion tensor imaging and measurement of brachial-ankle pulse wave velocity (baPWV). Both linear regression and tract-based spatial statistics were used to investigate the association between baPWV and white matter integrity. The association between baPWV and global cognitive function, measured as the mini-mental state examination (MMSE) was evaluated. Mediation analysis was performed to assess the influence of white matter integrity on the association of baPWV with MMSE. Results: Increased baPWV was significantly associated with lower mean global fractional anisotropy (β= –0.118, p < 0.001), higher mean diffusivity (β= 0.161, p < 0.001), axial diffusivity (β= 0.160, p < 0.001), and radial diffusivity (β= 0.147, p < 0.001) after adjustment of age, sex, and hypertension, which were measures having a direct effect on arterial stiffness and white matter integrity. After adjustment of age, sex, education, apolipoprotein E ɛ4, cardiovascular risk factors, and brain atrophy, we found an association of increased baPWV with worse performance on MMSE (β= –0.093, p = 0.011). White matter disruption partially mediated the effect of baPWV on MMSE. Conclusion: Arterial stiffness is associated with white matter disruption and cognitive decline. Reduced white matter integrity partially explained the effect of arterial stiffness on cognition.

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Accelerated Epigenetic Age in Normal Cognitive Aging of Korean Community-Dwelling Older Adults

Biological Research For Nursing ◽

10.1177/1099800420983896 ◽

2021 ◽

pp. 109980042098389

Author(s):

Jongmin Park ◽

Chang Won Won ◽

Leorey N. Saligan ◽

Youn-Jung Kim ◽

Yoonju Kim ◽

...

Keyword(s):

Older Adults ◽

Dna Methylation ◽

Cognitive Function ◽

Cognitive Aging ◽

Community Dwelling ◽

Test Results ◽

Cohen’S D ◽

Epigenetic Age ◽

Epigenetic Age Acceleration ◽

Community Dwelling Older Adults

Background: Epigenetic age acceleration has been studied as a promising biomarker of age-related conditions, including cognitive aging. This pilot study aims to explore potential cognitive aging-related biomarkers by investigating the relationship of epigenetic age acceleration and cognitive function and by examining the epigenetic age acceleration differences between successful cognitive aging (SCA) and normal cognitive aging (NCA) among Korean community-dwelling older adults (CDOAs). Methods: We used data and blood samples of Korean CDOAs from the Korean Frailty and Aging Cohort Study. The participants were classified into two groups, SCA (above the 50th percentile in all domains of cognitive function) and NCA. The genome-wide DNA methylation profiling array using Illumina Infinium MethylationEPIC BeadChip was used to calculate the following: the DNA methylation age, universal epigenetic age acceleration, intrinsic epigenetic age acceleration (IEAA), and extrinsic epigenetic age acceleration (EEAA). We also used Pearson correlation analysis and independent t-tests to analyze the data. Results: Universal age acceleration correlated with the Frontal Assessment Battery test results ( r = −0.42, p = 0.025); the EEAA correlated with the Word List Recognition test results ( r = −0.41, p = 0.027). There was a significant difference between SCA and NCA groups in IEAA ( p = 0.041, Cohen’s d = 0.82) and EEAA ( p = 0.042, Cohen’s d = 0.78). Conclusions: Epigenetic age acceleration can be used as a biomarker for early detection of cognitive decline in Korean community-dwelling older adults. Large longitudinal studies are warranted.

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MO570PULSE PRESSURE: A PREDICTOR OF CARDIOVASCULAR CALCIFICATION AND CARDIOVASCULAR MORTALITY IN HEMODIALYSIS PATIENTS

Nephrology Dialysis Transplantation ◽

10.1093/ndt/gfab086.008 ◽

2021 ◽

Vol 36 (Supplement_1) ◽

Author(s):

Merita Rroji (Molla) ◽

Saimir Seferi ◽

Majlinda Cafka ◽

Erjola Likaj ◽

Vilma Cadri ◽

...

Keyword(s):

Blood Pressure ◽

Arterial Stiffness ◽

Abdominal Aorta ◽

Cardiovascular Mortality ◽

Pulse Pressure ◽

Univariate Analysis ◽

Hemodialysis Patients ◽

Case Series Study ◽

Increased Risk ◽

Elevated Systolic Blood Pressure

Abstract Background and Aims The mortality rate is extremely high in chronic kidney disease (CKD), primarily due to the high prevalence of cardiovascular disease (CVD). Increased pulse pressure (PP), defined as the difference between inappropriately elevated systolic blood pressure (SBP) and reduced diastolic blood pressure (DBP) at any value of mean arterial pressure (MAP), is a surrogate measure of increased arterial stiffness of central elastic arteries (aorta and its major branches). CKD-MBD anomalies leading to calcification contribute to increased arterial stiffness and pulse pressure. This study aimed to evaluate the relationship of pulse pressure parameter with valve calcification and abdominal aortic calcification in hemodialysis patients and its impact on cardiovascular mortality. Method We performed a prospective case series study with 3 years follow- up. Plain X-ray images of the lateral lumbar spine from all subjects were studied to obtain images of the lower abdominal aorta using semiquantitative scores as described by Kauppila et al. Cardiac valve calcifications were evaluated by two-dimensional echocardiography with an HDI 5000 Sono CT echocardiographic machine with a 3.3-MHz multiphase array probe in subjects lying in the left decubitus position an according to the recommendations of the European Association of Echocardiography. The patient was evaluated as having vascular calcification if he had the presence of calcification in at least one of the site examined: a mitral valve, aortic valve or abdominal aorta. Results We studied 85 chronic stable hemodialysis patients. Mean age and meantime is therapy was 49.9±12.4 years and 51.5±28.7 months, respectively. Mean pulse pressure was 55.72±14.2 mmHg. Fifty-nine patients (69.4%) were identified with aortic abdominal calcification, and the mean Kauppila score was 4.91 ± 4.05. Sixty patients (70.5%) had at least one valve calcified, while thirty-three patients (38.8%) had both valves calcified. Univariate analysis revealed that every 1 mmHg increase in pulse pressure was associated with increased cardiovascular calcification risk p=0.020. In multivariate analysis, after adjustment for age, gender, diabetes mellitus, cholesterol, and triglyceride serum levels, the association also remained strong, where every increase of 1 mm Hg in pulse pressure was associated with increased risk for cardiovascular calcification (HR 1.02, 95% CI (1.00-1.03), p= 0.038). Besides, pulse pressure was an independent predictor for cardiovascular mortality (HR 1.03, 95% CI (1.02-1.05), p=0.002). Conclusion Pulse pressure may identify hemodialysis patients with subclinical cardiovascular calcification who need further evaluation. Wide pulse pressure is associated with increased cardiovascular mortality.

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