Abstract 3165: Influence Of Hypertension On Cognition Is Mediated By Brain Injury

Stroke ◽  
2012 ◽  
Vol 43 (suppl_1) ◽  
Author(s):  
Julie Kuo ◽  
Anne Lee ◽  
Evan Fletcher ◽  
Baljeet Singh ◽  
Oliver Martinez ◽  
...  
Keyword(s):  
Blood Pressure ◽  
Brain Injury ◽  
Cognitive Performance ◽  
Gray Matter ◽  
Brain Mri ◽  
White Matter Hyperintensity ◽  
Quadratic Term ◽  
Community Based ◽  
The Impact ◽  
Over Time

Background Substantial evidence indicates that hypertension is a major risk factor for cognitive decline and incident dementia. Unfortunately, community based, longitudinal studies examining this association are limited. In addition, while it is assumed that vascular brain injury likely mediates this association, these studies are similarly limited. Methods The Sacramento Area Latino Study of Aging is a community based longitudinal study of life-style factors and cognitive performance among individuals 65 years and older. Comprehensive assessment including blood pressure measures and yearly cognitive testing was performed. In addition, a subgroup of 207 subjects received brain MRI with quantitative analysis of gray matter, hippocampus and white matter hyperintensity (WMH) volumes. We analyzed the relationship between baseline measures of blood pressure (systolic (SBP), diastolic (DBP) and pulse pressure (PP)), MRI measures and longitudinal cognitive performance over an average of six visits as measured by the 3MMSE using random mixed models regression analysis. Results On average, subject performance improved slightly during the first two visits after baseline measurement, but then began to deteriorate in a fashion best estimated by a quadratic term (trial*trial). 3MMSE performance was significantly and inversely associated with increased baseline SBP and PP, as well as linear (BP*trial) and quadratic (BP*trial*trial) declines over time (p<0.03 for all comparisons). Similarly, baseline 3MMSE performance was associated with gray matter and hippocampal volumes (p < 0.01 for all comparisons). Hippocampal and WMH volumes were also associated with change in 3MMSE performance over time (p <0.002 for all comparisons). In a multivariate model that included blood pressure and MRI measures, the MRI associations remained significant predictors of 3MMSE performance at baseline and over time, whereas blood pressure measures were no longer significant. Conclusion The impact of elevated blood pressure on cognition is mediated through measures of brain injury. This has implications for clinical trials of blood pressure modification designed to improve cognitive health in our aging society.

Abstract 39: Acute Blood Pressure Dysregulation Increases the Risk of Border Zone Ischemic Lesions in Hypertensive Intracerebral Hemorrhage

Stroke ◽  
2021 ◽  
Vol 52 (Suppl_1) ◽  
Author(s):  
Szu-Ju Chen ◽  
Hsin-Hsi Tsai ◽  
Li-Kai Tsai ◽  
Ya-Fang Chen ◽  
Sung-Chun Tang ◽  
...  
Keyword(s):  
Blood Pressure ◽  
Intracerebral Hemorrhage ◽  
Small Vessel Disease ◽  
Brain Mri ◽  
Border Zone ◽  
Cerebral Hypoperfusion ◽  
White Matter Hyperintensity ◽  
Roc Curve Analysis ◽  
The Difference ◽  
The Impact

Background: Intensive blood pressure (BP) reduction is regarded as the gold standard therapy for acute intracerebral hemorrhage (ICH), but its associations to cerebral hypoperfusion and ischemic lesions have been suspected. This study aims to investigate the impact of acute BP reduction on the development of acute ischemic lesions (AILs) at border zone (BZ) areas in patients with hypertensive ICH. Methods: We enrolled patients with acute hypertensive ICH (hemorrhagic lesions restricted to deep region [Strictly deep-ICH] or located in mixed lobar and deep areas [Mixed-ICH]) who received brain MRI within 7 days after ICH onset. BZ AILs were defined as lesions locating at BZ areas that were hyperintense on DWI sequence and hypointense on ADC series (figure). Acute SBP change was the difference between the initial SBP and the SBP recorded at 24 hours after ICH onset. Results: Of the 274 enrolled patients (62.5 ± 12.7 years old, 65% male), 11 subjects had BZ AILs. Compared to patients without BZ AILs, patients with lesions had wider amount of acute SBP reduction (71.7 ± 33.6 vs. 43.0 ± 32.2 mmHg, P = 0.023), more lobar and deep microbleeds (MB) and larger white matter hyperintensity volume (all p < 0.05). Using ROC curve analysis, acute SBP drop at more than 54mmHg was linked to the occurrence of AILs (sensitivity 82%, specificity 64%, P = 0.002). In multiple logistic regression model, acute SBP decline at above 54mmHg (OR 11.45, 95%CI 2.06 - 63.49, P = 0.005) and higher deep MB burden ( P = 0.032) raised the risk of AILs after adjustment for age, sex, and image markers of cerebral small vessel disease. In subgroup analysis, larger acute SBP drop remained to be an independent risk factor for development of AILs in patients with Mixed-ICH ( P = 0.008), but not in patients with strictly deep-ICH ( P = 0.715). Conclusion: Acute SBP change in hypertensive ICH, especially in Mixed-ICH, increases the risk of AILs at BZ areas, showing widespread microangiopathy that is vulnerable to rapid BP dysregulation to ischemia.

scholarly journals The Impact of a Yearlong Diabetes Prevention Program-Based Lifestyle Intervention on Cardiovascular Health Metrics

2021 ◽  
Vol 12 ◽  
pp. 215013272110298
Author(s):  
Susan M. Devaraj ◽  
Bonny Rockette-Wagner ◽  
Rachel G. Miller ◽  
Vincent C. Arena ◽  
Jenna M. Napoleone ◽  
...  
Keyword(s):  
Risk Factors ◽  
Blood Pressure ◽  
Lifestyle Intervention ◽  
Prevention Program ◽  
Diabetes Prevention ◽  
Cardiovascular Health ◽  
Diabetes Prevention Program ◽  
Behavioral Risk ◽  
Community Based ◽  
The Impact

Introduction The American Heart Association created “Life’s Simple Seven” metrics to estimate progress toward improving US cardiovascular health in a standardized manner. Given the widespread use of federally funded Diabetes Prevention Program (DPP)-based lifestyle interventions such as the Group Lifestyle Balance (DPP-GLB), evaluation of change in health metrics within such a program is of national interest. This study examined change in cardiovascular health metric scores during the course of a yearlong DPP-GLB intervention. Methods Data were combined from 2 similar randomized trials offering a community based DPP-GLB lifestyle intervention to overweight/obese individuals with prediabetes and/or metabolic syndrome. Pre/post lifestyle intervention participation changes in 5 of the 7 cardiovascular health metrics were examined at 6 and 12 months (BMI, blood pressure, total cholesterol, fasting plasma glucose, physical activity). Smoking was rare and diet was not measured. Results Among 305 participants with complete data (81.8% of 373 eligible adults), significant improvements were demonstrated in all 5 risk factors measured continuously at 6 and 12 months. There were significant positive shifts in the “ideal” and “total” metric scores at both time points. Also noted were beneficial shifts in the proportion of participants across categories for BMI, activity, and blood pressure. Conclusion AHA-metrics could have clinical utility in estimating an individual’s cardiovascular health status and in capturing improvement in cardiometabolic/behavioral risk factors resulting from participation in a community-based translation of the DPP lifestyle intervention.

scholarly journals Publisher Correction to: BRAINSTORMING: A study protocol for a randomised double-blind clinical trial to assess the impact of concurrent brain stimulation (tDCS) and working memory training on cognitive performance in Acquired Brain Injury (ABI)

2021 ◽  
Vol 9 (1) ◽  
Author(s):  
Sara Assecondi ◽  
Rong Hu ◽  
Gail Eskes ◽  
Michelle Read ◽  
Chris Griffiths ◽  
...  
Keyword(s):  
Clinical Trial ◽  
Working Memory ◽  
Brain Injury ◽  
Cognitive Performance ◽  
Acquired Brain Injury ◽  
Working Memory Training ◽  
Memory Training ◽  
Double Blind ◽  
Double Blind Clinical Trial ◽  
The Impact

Following publication of the original article [1], the authors flagged that the article had published with the Acknowledgements erroneously excluded from the declarations at the end of the article.

scholarly journals Office, Central, and Ambulatory Blood Pressure for Predicting First Stroke in Older Adults: A Community-Based Cohort Study

Hypertension ◽  
2021 ◽  
Author(s):  
Kenji Matsumoto ◽  
Zhezhen Jin ◽  
Shunichi Homma ◽  
Mitchell S.V. Elkind ◽  
Joseph E. Schwartz ◽  
...  
Keyword(s):  
Blood Pressure ◽  
Risk Model ◽  
Population Based ◽  
Applanation Tonometry ◽  
Competing Risk ◽  
Community Based ◽  
Older Population ◽  
Competing Risk Model ◽  
The Impact

Hypertension is the most prevalent modifiable risk factor for stroke. Office blood pressure (BP) measurements may have limitations in defining the impact of hypertension on stroke. Our aim was to compare the stroke risk for office, central, and ambulatory BP measurements in a predominantly older population-based prospective cohort. Participants in the CABL study (Cardiovascular Abnormalities and Brain Lesions; n=816; mean age, 70.8±9.0 years; 39.8% men) underwent applanation tonometry of the radial artery for central BP and 24-hour ambulatory BP monitoring. During a follow-up of 9.6±3.1 years, stroke occurred in 76 participants (9.3%). Among office BP variables, only diastolic BP was associated with stroke in multivariable competing risk model ( P =0.016). None of the central BP variables showed a significant association with stroke. Conversely, all ambulatory systolic and diastolic BP variables were significantly associated with stroke after adjustment for clinical confounders (all P <0.005). In an additional multivariable competing risk model including both ambulatory systolic and diastolic BP values obtained at the same time of the day, diastolic BP was more strongly associated with stroke than systolic BP in 24-hour, daytime, and nighttime periods (all P <0.05). Therefore, in a predominantly older population-based cohort, office diastolic BP was weakly associated with incident stroke; no central BP variable was prognostic of stroke. However, all ambulatory systolic and diastolic BP values were significantly associated with stroke in multivariable competing risk analyses. Moreover, ambulatory diastolic BP was a stronger predictor of stroke than ambulatory systolic BP.

Abstract P172: Relationship of Four Blood Pressure Indexes to Subclinical Cerebrovascular Diseases Assessed by Brain MRI in General Japanese Men

Circulation ◽  
2020 ◽  
Vol 141 (Suppl_1) ◽  
Author(s):  
Ebtehal Salman ◽  
Aya Kadota ◽  
Takashi Hisamatsu ◽  
Hiroyoshi Segawa ◽  
Sayuki Torii ◽  
...  
Keyword(s):  
Blood Pressure ◽  
Effect Size ◽  
Brain Mri ◽  
Cerebrovascular Diseases ◽  
Subcortical White Matter ◽  
Arterial Stenosis ◽  
White Matter Hyperintensity ◽  
Japanese Men ◽  
Short Period ◽  
Similar Association

Background: Blood pressure (BP) indexes (systolic blood pressure [SBP], diastolic blood pressure [DBP], pulse pressure [PP], mean arterial pressure [MAP]) shows association with subclinical cerebrovascular diseases (SCVDs). Although various studies reported this association, there are still controversy in the effect size of long period versus short period of these indexes to SCVDs. Aim: Identifying the effect size of four BP indexes measured at two visits on SCVDs assessed by magnetic resonance imaging (MRI) in general Japanese men. Methods: Four office BP indexes were measured at two visits 4.5 years apart in general Japanese men aged 40-79 years. Participants without myocardial infarction or stroke history were analyzed (N=629). MRI obtained at 3 rd visit were investigated for prevalent of five SCVDs diagnosed as follows; lacunar infarction (LI)= any presence, periventricular hyperintensity (PVH)= Fazekas grade ≥2, deep subcortical white matter hyperintensity (DSWMH)= Fazekas grade ≥3, microbleeds= any presence, and intracranial arterial stenosis (ICAS)= ≥1% stenosis. Using multivariable logistic regression, we computed and compared odds ratio OR (95% CI) of each prevalent SCVD for 1 standard deviation higher of each of 4 BP indexes after adjusting for SCVDs’ conventional risk factors. Results: Participants’ mean age at Visit 1 was 63.9 years. Our results show all office BP indexes, except PP, similar association with MRI outcomes at both Visit 1 and Visit 2. SBP, DBP and MAP were associated with LI, PVH, DSWMH, microbleed and ICAS, while PP was associated with LI and ICAS only. Conclusion: In general Japanese men, BP indexes SBP, DBP and MAP measured at two distinct visits show similar association to all future MRI assessed SCVD, while PP shows association to LI and ICAS only.

scholarly journals Blood Pressure and Brain Injury in Older Adults: Findings from a Community-Based Autopsy Study

2009 ◽  
Vol 57 (11) ◽  
pp. 1975-1981 ◽  
Author(s):  
Lucy Y. Wang ◽  
Eric B. Larson ◽  
Joshua A. Sonnen ◽  
Jane B. Shofer ◽  
Wayne McCormick ◽  
...  
Keyword(s):  
Blood Pressure ◽  
Older Adults ◽  
Brain Injury ◽  
Autopsy Study ◽  
Community Based

FC08-04 - Trajectories of depressive episodes and hypertension over 24 years: the whitehall II prospective cohort study

2011 ◽  
Vol 26 (S2) ◽  
pp. 1855-1855
Author(s):  
H. Nabi ◽  
J.-F. Chanstang ◽  
T. Lefèvre ◽  
A. Dugravot ◽  
M. Melchior ◽  
...  
Keyword(s):  
Blood Pressure ◽  
General Health Questionnaire ◽  
Antidepressant Medication ◽  
Estimating Equation ◽  
Depression Subscale ◽  
Medical Examinations ◽  
Depressive Episodes ◽  
The Impact ◽  
Over Time

IntroductionProspective data on depressive symptoms and blood pressure (BP) are scarce, and the impact of age on this association is poorly understood.ObjectivesThe present study examines longitudinal trajectories of depressive episodes and the probability of hypertension associated with these trajectories over time.MethodsParticipants were 6,889 men and 3,413 women London based civil servants followed for 24 years between 1985 and 2009. The age of participants over the follow-up ranged from 35 to 80 years. Depressive episode (defined as scoring 4 or more on the General Health Questionnaire-Depression subscale or using prescribed antidepressant medication) and hypertension (systolic/diastolic blood pressure ≥ 140/90 mm Hg or use of antihypertensive medication) were assessed concurrently at five medical examinations.ResultsIn longitudinal logistic regression analyses based on Generalized-Estimating-Equation using age as the time scale, participants with depression trajectory characterised by increasing depressive episodes overtime had a greater increase in the likelihood for hypertension with advancing age; an adjusted-excess increase of 7% (95% CI 3-12, p < 0.001) for each five-year increase in age compared to those with a low/stable depression trajectory. In a model adjusted for relevant confounders, a higher risk of hypertension in the first group of participants did not become evident before age 55. A similar pattern of association was observed in men and women although the association was stronger in men.ConclusionsThis study suggests that the risk of hypertension increases with repeated experience of depressive episodes over time and materializes in later adulthood.

scholarly journals Serum Brain–Derived Neurotrophic Factor and Vascular Endothelial Growth Factor Levels Are Associated With Risk of Stroke and Vascular Brain Injury

Stroke ◽  
2013 ◽  
Vol 44 (10) ◽  
pp. 2768-2775 ◽  
Author(s):  
Aleksandra Pikula ◽  
Alexa S. Beiser ◽  
Tai C. Chen ◽  
Sarah R. Preis ◽  
Demetrios Vorgias ◽  
...  
Keyword(s):  
Vascular Endothelial Growth Factor ◽  
Brain Injury ◽  
White Matter ◽  
Visual Memory ◽  
Brain Mri ◽  
White Matter Hyperintensity ◽  
Vascular Endothelial ◽  
Increased Risk ◽  
Endothelial Growth Factor ◽  
Serum Bdnf

Background and Purpose— Brain-derived neurotrophic factor (BDNF), a major neurotrophin and vascular endothelial growth factor (VEGF) have a documented role in neurogenesis, angiogenesis, and neuronal survival. In animal experiments, they impact infarct size and functional motor recovery after an ischemic brain lesion. We sought to examine the association of serum BDNF and VEGF with the risk of clinical stroke or subclinical vascular brain injury in a community-based sample. Methods— In 3440 Framingham Study participants (mean age, 65±11 years; 56% women) who were free of stroke/transient ischemic attack (TIA), we related baseline BDNF and logVEGF to risk of incident stroke/TIA. In a subsample with brain MRI and with neuropsychological tests available (n=1863 and 2104, respectively; mean age, 61±9 years, 55% women, in each), we related baseline BDNF and logVEGF to log-white matter hyperintensity volume on brain MRI, and to visuospatial memory and executive function tests. Results— During a median follow-up of 10 years, 193 participants experienced incident stroke/TIA. In multivariable analyses adjusted for age, sex, and traditional stroke risk factors, lower BDNF and higher logVEGF levels were associated with an increased risk of incident stroke/TIA (hazard ratio comparing BDNF Q1 versus Q2–Q4, 1.47; 95% confidence interval, 1.09–2.00; P =0.012 and hazard ratio/SD increase in logVEGF, 1.21; 95% confidence interval, 1.04–1.40; P =0.012). Persons with higher BDNF levels had less log-white matter hyperintensity volume (β±SE=−0.05±0.02; P =0.025), and better visual memory (β±SE=0.18±0.07; P =0.005). Conclusions— Lower serum BDNF and higher VEGF concentrations were associated with increased risk of incident stroke/TIA. Higher levels of BDNF were also associated with less white matter hyperintensity and better visual memory. Our findings suggest that circulating BDNF and VEGF levels modify risk of clinical and subclinical vascular brain injury.

Cognitive functions in multiple sclerosis: impact of gray matter integrity

2013 ◽  
Vol 20 (4) ◽  
pp. 424-432 ◽  
Author(s):  
Sara Llufriu ◽  
Eloy Martinez-Heras ◽  
Juan Fortea ◽  
Yolanda Blanco ◽  
Joan Berenguer ◽  
...  
Keyword(s):  
Multiple Sclerosis ◽  
Cognitive Performance ◽  
Gray Matter ◽  
Cognitive Functions ◽  
Diffusion Tensor ◽  
Lesion Volume ◽  
Memory And Attention ◽  
Diffusion Tensor Images ◽  
Explained Variance ◽  
The Impact

Objectives: Our aim was to investigate the impact of gray matter (GM) integrity on cognitive performance in multiple sclerosis (MS), and its relationship with white matter (WM) integrity and presence of lesions. Methods: Sixty-seven patients with MS and 26 healthy controls underwent voxel-based analysis of diffusion tensor images (DTI) in GM and tract-based spatial statistics (TBSS) from WM to identify the regional correlations between cognitive functions and integrity. Lesion probability mapping (LPM) was generated for correlation analysis with cognition. Multiple linear regression analyses were used to identify the imaging measures associated with cognitive scores. Results: Compared with controls, patients showed abnormal DTI indices in several GM regions and in most WM tracts. Impairment in DTI indices in specific GM regions was associated with worse performance of distinct cognitive functions. Those regions showed anatomical correspondence with cognitively relevant tracts in TBSS and LPM. The combination of regional GM and WM DTI and lesion volume accounted for 36–51% of the variance of memory and attention scores. Regional GM DTI explained less than 5% of that variance. Conclusion: GM and WM integrity of specific networks influences cognitive performance in MS. However, GM damage assessed by DTI only adds a small increment to the explained variance by WM in predicting cognitive functioning.

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