scholarly journals Blood Pressure and Cognitive Decline in Prevalent Hemodialysis Patients

2019 ◽  
Vol 49 (6) ◽  
pp. 460-469 ◽  
Author(s):  
David A. Drew ◽  
Hocine Tighiouart ◽  
Sarah Duncan ◽  
Jasmine Rollins ◽  
Aditi Gupta ◽  
...  
Keyword(s):  
Blood Pressure ◽  
Executive Function ◽  
Cognitive Decline ◽  
Pulse Pressure ◽  
Memory Function ◽  
Cognitive Test ◽  
Maintenance Hemodialysis ◽  
Joint Models ◽  
High Pulse

Background: Hypertension is associated with cognitive decline in the general population. It is unclear what impact blood pressure (BP) has on cognitive decline in patients receiving maintenance hemodialysis (HD). Methods: Using a longitudinal cohort of 314 prevalent HD patients without dementia at baseline, we examined the association of predialysis systolic BP (SBP) and diastolic BP (DBP), pulse pressure, and intradialytic SBP change (pre minus post), averaged for a month, with cognitive decline. Cognitive function was determined by a neurocognitive battery, administered yearly. Individual cognitive test results were reduced into 2 domain scores using principal components analysis (by definition mean of 0 and SD of 1), representing memory and executive function. Joint models, allowing for characterization of cognitive score slopes and including adjustment for potential confounders, were utilized to account for competing risks from death, dropout, or kidney transplantation. Results: Mean age was 62 years; 54% were men, 23% were black, and 90% had at least a high school education. During median follow-up of 2.1 years (25th–75th: 1.0–4.5), 191 had at least one follow-up test, 148 died, and 43 received kidney transplants. Low predialysis DBP and high pulse pressure were both associated with steeper executive function decline (each 10 mm Hg lower DBP = –0.03 SD [–0.01 to –0.05] per year steeper decline) in executive function (each 10 mm Hg higher pulse pressure = –0.03 SD [–0.06 to –0.01] steeper decline) but not for memory function. SBP and intradialytic change were not associated with steeper decline for either memory or executive function. Conclusions: No relationship was seen between SBP or intradialytic change in BP with cognitive decline. In prevalent HD patients, lower predialysis DBP and wider predialysis pulse pressure are associated with steeper cognitive decline in executive function but not memory.

scholarly journals Blood pressure variability is related to faster cognitive decline in ischemic stroke patients: PICASSO subanalysis

2021 ◽  
Vol 11 (1) ◽  
Author(s):  
Yerim Kim ◽  
Jae-Sung Lim ◽  
Mi Sun Oh ◽  
Kyung-Ho Yu ◽  
Ji Sung Lee ◽  
...  
Keyword(s):  
Blood Pressure ◽  
Ischemic Stroke ◽  
Cognitive Function ◽  
Cognitive Decline ◽  
Repeated Measures ◽  
Blood Pressure Variability ◽  
Cognitive Test ◽  
Multiple Variables ◽  
Over Time

AbstractBlood pressure variability (BPV) is associated with higher cardiovascular morbidity risks; however, its association with cognitive decline remains unclear. We investigated whether higher BPV is associated with faster declines in cognitive function in ischemic stroke (IS) patients. Cognitive function was evaluated between April 2010 and August 2015 using the Mini-mental State Examination (MMSE) and Montreal Cognitive Assessment in 1,240 Korean PICASSO participants. Patients for whom baseline and follow-up cognitive test results and at least five valid BP readings were available were included. A restricted maximum likelihood–based Mixed Model for Repeated Measures was used to compare changes in cognitive function over time. Among a total of 746 participants (64.6 ± 10.8 years; 35.9% female). Baseline mean-MMSE score was 24.9 ± 4.7. The median number of BP readings was 11. During a mean follow-up of 2.6 years, mean baseline and last follow-up MMSE scores were 25.4 ± 4.8 vs. 27.8 ± 4.4 (the lowest BPV group) and 23.9 ± 5.2 vs. 23.2 ± 5.9 (the highest BPV group). After adjusting for multiple variables, higher BPV was independently associated with faster cognitive decline over time. However, no significant intergroup difference in cognitive changes associated with mean systolic BP was observed. Further research is needed to elucidate how BPV might affect cognitive function.

scholarly journals Epigenetic Age Acceleration and Cognitive Decline: A Twin Study

2021 ◽  
Author(s):  
Viola Vaccarino ◽  
Minxuan Huang ◽  
Zeyuan Wang ◽  
Qin Hui ◽  
Amit J Shah ◽  
...  
Keyword(s):  
Executive Function ◽  
Cognitive Function ◽  
Cognitive Decline ◽  
Twin Study ◽  
Memory Function ◽  
Function Score ◽  
Epigenetic Age ◽  
Epigenetic Age Acceleration

Abstract Background Little is known about the role of DNA methylation (DNAm) epigenetic age acceleration in cognitive decline. Using a twin study design, we examined whether DNAm age acceleration is related to cognitive decline measured longitudinally in persons without a clinical diagnosis of dementia. Methods We studied 266 paired male twins (133 pairs) with a mean age of 56 years at baseline. Of these, 114 paired twins returned for a follow-up after an average of 11.5 years. We obtained six indices of DNAm age acceleration based on epigenome-wide data from peripheral blood lymphocytes. At both baseline and follow-up, we administered a battery of cognitive measures and constructed two composite scores, one for executive function and one for memory function. We fitted multivariable mixed regression models to examine the association of DNAm age acceleration markers with cognitive function within pairs. Results In cross sectional analyses at baseline, there was no association between DNAm age acceleration and cognitive function scores. In longitudinal analyses, however, comparing twins within pairs, each additional year of age acceleration using the Horvath’s method was associated with a 3% decline (95% CI, 1% to 5%) in the composite executive function score and a 2.5% decline (95% CI, 0.01% to 4.9%) in the memory function score. These results did not attenuate after adjusting for education and other risk factors. Conclusions Middle-aged men who had older DNAm age relative to their brothers of the same demographic age, showed a faster rate of cognitive decline in the subsequent 11.5 years. These results point to the role of epigenetic modifications in cognitive aging.

The Effects of Mean of Visit-to-Visit Blood Pressure on Incident Brain Vascular Lesions and Functional-Cognitive Decline

2021 ◽  
pp. 1-12
Author(s):  
Bibek Gyanwali ◽  
Celestine Xue Ting Cai ◽  
Christopher Chen ◽  
Henri Vrooman ◽  
Chuen Seng Tan ◽  
...  
Keyword(s):  
Blood Pressure ◽  
Cognitive Decline ◽  
Hippocampal Volume ◽  
Intracranial Stenosis ◽  
Vascular Lesions ◽  
Linear Regression Models ◽  
Volume Functional ◽  
Mri Scans ◽  
The Mean

Background: Cerebrovascular disease (CeVD) is an underlying cause of cognitive impairment and dementia. Hypertension is a known risk factor of CeVD, but the effects of mean of visit-to-visit blood pressure (BP) on incident CeVD and functional-cognitive decline remains unclear. Objective: To determine the association between mean of visit-to-visit BP with the incidence and progression of CeVD [white matter hyperintensities (WMH), infarcts (cortical infarcts and lacunes), cerebral microbleeds (CMBs), intracranial stenosis, and hippocampal volume] as well as functional-cognitive decline over 2 years of follow-up. Methods: 373 patients from a memory-clinic underwent BP measurements at baseline, year 1, and year 2. The mean of visit-to-visit systolic BP, diastolic BP, pulse pressure, and mean arterial pressure were calculated. Baseline and year 2 MRI scans were graded for WMH, infarcts, CMBs, intracranial stenosis, and hippocampal volume. Functional-cognitive decline was assessed using locally validated protocol. Logistic and linear regression models with odds ratios, mean difference, and 95%confidence interval were constructed to analyze associations of visit-to-visit BP on CeVD incidence and progression as well as functional-cognitive decline. Results: Higher mean of visit-to-visit diastolic BP was associated with WMH progression. Higher tertiles of diastolic BP was associated with WMH progression and incident CMBs. There was no association between mean of visit-to-visit BP measures with incident cerebral infarcts, intracranial stenosis, change in hippocampal volume, and functional-cognitive decline. Conclusion: These findings suggest the possibility of hypertension-related vascular brain damage. Careful monitoring and management of BP in elderly patients is essential to reduce the incidence and progression of CeVD.

Abstract WP495: Sex Differences in Cognitive Decline: A Pooled Cohort Analysis of ARIC, CARDIA, CHS, FOS, NOMAS

Stroke ◽  
2020 ◽  
Vol 51 (Suppl_1) ◽  
Author(s):  
Deborah A Levine ◽  
Alden L Gross ◽  
Emily M Briceño ◽  
Nicholas Tilton ◽  
Mohammed U Kabeto ◽  
...  
Keyword(s):  
Sex Differences ◽  
Executive Function ◽  
Cognitive Decline ◽  
Cognitive Assessment ◽  
Cohort Analysis ◽  
Cognitive Outcome ◽  
Health Study ◽  
Cardiovascular Health Study ◽  
Global Cognition

Background: Sex differences in dementia risk are unclear but some have found greater risk for women. We hypothesized that women have greater cognitive decline than men, after adjusting for potential confounders. Objective: Determine associations between sex and cognitive decline. Methods: We pooled data from 19,378 participants free of stroke and dementia (mean [SD] age 59.8 [10.4] years at first cognitive assessment), of whom 8,654 (44.7%) were men and 3,852 (19.9%) were black, from 5 longitudinal cohorts between 1971 and 2017: Atherosclerosis Risk in Communities Study, Coronary Artery Risk Development in Young Adults Study, Cardiovascular Health Study, Framingham Offspring Study, and Northern Manhattan Study. The primary outcome was change in global cognition. Secondary outcomes were change in memory and executive function. Linear mixed-effects models measured changes in each continuous cognitive outcome over time by sex, adjusted for demographics, education, vascular risk factors, and age*follow-up time, race*follow-up time, systolic blood pressure*follow-up time, and use of antihypertensive medication*follow-up time interaction terms. Cognitive outcomes were set to a t-score metric (mean 50, standard deviation [SD] 10) at a participant’s first cognitive assessment; a 1-point difference represents a 0.1 SD difference in the distribution of cognition across the 5 cohorts. Median follow-up was 12.4 (IQR: 5.9, 21.0) years. Results: Women had significantly higher baseline performance than men in global cognition, executive function, and memory (adjusted differences in intercepts, 2.09 to 2.15 points; all P<0.001) ( Figure ). Compared with men, women had significantly faster declines in global cognition, executive function, and memory (adjusted differences in slopes, 0.04 to 0.06 points per year faster; P <0.001) ( Figure ). Conclusion: These results are consistent with women having greater cognitive reserve but faster cognitive decline than men.

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

Circulation ◽  
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.

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

2019 ◽  
Vol 3 (Supplement_1) ◽  
pp. S643-S643
Author(s):  
Yukihiro Namihira ◽  
Takashi Tokashiki ◽  
Akio Ishida ◽  
Yusuke Ohya ◽  
Hiroko H Dodge
Keyword(s):  
Blood Pressure ◽  
Cognitive Function ◽  
Arterial Stiffness ◽  
Cognitive Decline ◽  
Pulse Pressure ◽  
Cognitive Aging ◽  
Oldest Old ◽  
Community Dwelling ◽  
Vascular Stiffness ◽  
High Cognitive Function

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 &lt; 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.

scholarly journals Ankle Blood Pressure and Pulse Pressure as Predictors of Cerebrovascular Morbidity and Mortality in a Prospective Follow-Up Study

2010 ◽  
Vol 2010 ◽  
pp. 1-6 ◽  
Author(s):  
Heikki J. Hietanen ◽  
Rauni Pääkkönen ◽  
Veikko Salomaa
Keyword(s):  
Blood Pressure ◽  
Pulse Pressure ◽  
Reference Group ◽  
Morbidity And Mortality ◽  
Abnormal Finding ◽  
Follow Up Study ◽  
Exercise Blood Pressure ◽  
Blood Pressures ◽  
Age And Sex

Background and Objective. We examined the association of elevated ankle blood pressure (ABP), together with exercise blood pressure, with incident cerebrovascular (CV) morbidity and mortality in a prospective follow-up study of 3,808 patients. The results were compared with pulse pressure, another indicator of arterial stiffness.Methods. Patients with normal ankle and exercise brachial blood pressures were taken as the reference group. Pulse pressure was considered as quartiles with the lowest quartile as the reference category.Results. A total of 170 subjects had a CV event during the follow-up. Multivariate adjusted hazard ratio of a CV event was 2.24 (95% CI 1.43–3.52, ) in patients with abnormal ABP. The pulse pressure was significant only in the model adjusted for age and sex.Conclusion. The risk of a future CV event was elevated already in those patients among whom elevated ABP was the only abnormal finding. As a risk marker, ABP is superior to the pulse pressure.

scholarly journals White Matter Hyperintensities and Cognitive Decline in de Novo Parkinson’s Disease Patients

2017 ◽  
Author(s):  
Mahsa Dadar ◽  
Yashar Zeighami ◽  
Yvonne Yau ◽  
Seyed-Mohammad Fereshtehnejad ◽  
Josefina Maranzano ◽  
...  
Keyword(s):  
Parkinson’S Disease ◽  
Parkinson's Disease ◽  
White Matter ◽  
Cognitive Decline ◽  
White Matter Hyperintensities ◽  
De Novo ◽  
Cognitive Test ◽  
Cortical Thinning

AbstractObjectiveWhite Matter Hyperintensities (WMHs) are associated with cognitive decline in normative aging and Alzheimer’s disease. However, the pathogenesis of cognitive decline in Parkinson’s disease (PD) is not directly related to vascular causes, and therefore the role of WMHs in PD remains unclear. If WMH has a higher impact on cognitive decline in PD, vascular pathology should be assessed and treated with a higher priority in this population. Here we investigate whether WMH leads to increased cognitive decline in PD, and if these effects relate to cortical thinningMethodsTo investigate the role of WMHs in PD, it is essential to study recently-diagnosed/non-treated patients.De novoPD patients and age-matched controls (NPD=365,NControl=174) with FLAIR/T2-weighted scans at baseline were selected from Parkinson’s Progression Markers Initiative (PPMI). WMHs and cortical thickness were measured to analyse the relationship between baseline WMHs and future cognitive decline (follow-up:4.09±1.14 years) and cortical thinning (follow-up:1.05±0.10 years).ResultsHigh WMH load (WMHL) at baseline in PD was associated with increased cognitive decline, significantly more than i) PDs with low WMHL and ii) controls with high WMHL. Furthermore, PD patients with higher baseline WMHL showed more cortical thinning in right frontal lobe than subjects with low WMHL. Cortical thinning of this region also predicted decline in performance on a cognitive test.InterpretationPresence of WMHs inde novoPD patients predicts greater future cognitive decline and cortical thinning than in normal aging. Recognizing WMHs as a potential predictor of cognitive deficit in PD provides an opportunity for timely interventions.

scholarly journals Automatic Prediction of Cognitive and Functional Decline Can Significantly Decrease the Number of Subjects Required for Clinical Trials in Early Alzheimer’s Disease

2021 ◽  
pp. 1-8
Author(s):  
Neda Shafiee ◽  
Mahsa Dadar ◽  
Simon Ducharme ◽  
D. Louis Collins ◽  
Keyword(s):  
Alzheimer’S Disease ◽  
Alzheimer's Disease ◽  
Clinical Trials ◽  
Cognitive Decline ◽  
Functional Decline ◽  
Amyloid Β ◽  
Cognitive Test ◽  
Disease Heterogeneity ◽  
Early Alzheimer’S Disease

Background: While both cognitive and magnetic resonance imaging (MRI) data has been used to predict progression in Alzheimer’s disease, heterogeneity between patients makes it challenging to predict the rate of cognitive and functional decline for individual subjects. Objective: To investigate prognostic power of MRI-based biomarkers of medial temporal lobe atrophy and macroscopic tissue change to predict cognitive decline in individual patients in clinical trials of early Alzheimer’s disease. Methods: Data used in this study included 312 patients with mild cognitive impairment from the ADNI dataset with baseline MRI, cerebrospinal fluid amyloid-β, cognitive test scores, and a minimum of two-year follow-up information available. We built a prognostic model using baseline cognitive scores and MRI-based features to determine which subjects remain stable and which functionally decline over 2 and 3-year follow-up periods. Results: Combining both sets of features yields 77%accuracy (81%sensitivity and 75%specificity) to predict cognitive decline at 2 years (74%accuracy at 3 years with 75%sensitivity and 73%specificity). When used to select trial participants, this tool yields a 3.8-fold decrease in the required sample size for a 2-year study (2.8-fold decrease for a 3-year study) for a hypothesized 25%treatment effect to reduce cognitive decline. Conclusion: When used in clinical trials for cohort enrichment, this tool could accelerate development of new treatments by significantly increasing statistical power to detect differences in cognitive decline between arms. In addition, detection of future decline can help clinicians improve patient management strategies that will slow or delay symptom progression.

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