Alves de Moraes Suzana, Szklo Moyses, Knopman David, Sato Reiko
Department of Epidemiology, School of Hygiene and Public Health, The Johns Hoipkins University, 615 N Wolfe Street, Room W6009, Baltimore, MD 21205, USA.
Prev Med. 2002 Sep;35(3):258-63. doi: 10.1006/pmed.2002.1077.
Although previous epidemiological studies have reported that hypertension is a major risk factor for decline in brain perfusion and atrophy, which are known to be related to cognitive decline, the impact of temporal changes in blood pressure on age-related cognitive declines has not been assessed.
The present study evaluates changes in blood pressure and cognitive decline over a 6-year period in the Atherosclerosis Risk in Communities (ARIC) Study. This report is based on 8,058 men and women aged 48-67 years examined in the second (1990-92), and fourth (1996-98) ARIC cohort visits. Changes between these visits were measured in hypertension status and three cognitive function tests: Delayed Word Recall (DWR), the Digit Symbol Subtest of the Wechsler Adult Intelligence Scale-Revised (DSS/WAIS-R), and the Word Fluency (WF). Adjusted mean differences in cognitive function were compared among five categories of hypertension status by using linear regression modeling.
In the present study, older subjects with uncontrolled hypertension had a significantly larger mean DSS/WAIS-R score decline than normotensive subjects. Although other cognitive declines did not achieve statistical significance, both cross-sectional and change analysis suggested that partially controlled or uncontrolled hypertension is associated with a less favorable cognitive profile, particularly when considering results of the DSS and the WF tests.
The present study results provide some support to the hypothesis that hypertension status changes over 6 years in individuals initially aged 48-67 years are related to cognitive changes.
尽管先前的流行病学研究报告称，高血压是脑灌注下降和脑萎缩的主要危险因素，而这两者已知与认知能力下降有关，但血压的时间变化对与年龄相关的认知能力下降的影响尚未得到评估。
本研究评估了社区动脉粥样硬化风险（ARIC）研究中6年期间血压和认知能力下降的变化。本报告基于在ARIC队列第二次（1990 - 1992年）和第四次（1996 - 1998年）访视中检查的8058名年龄在48 - 67岁之间的男性和女性。在这些访视之间测量了高血压状态的变化以及三项认知功能测试：延迟词语回忆（DWR）、韦氏成人智力量表修订版数字符号分测验（DSS/WAIS - R）和词语流畅性（WF）。通过线性回归模型比较了五类高血压状态下认知功能的调整后平均差异。
在本研究中，高血压未得到控制的老年受试者的平均DSS/WAIS - R分数下降幅度明显大于血压正常的受试者。尽管其他认知能力下降未达到统计学显著性，但横断面分析和变化分析均表明，部分控制或未控制的高血压与较差的认知状况相关，尤其是在考虑DSS和WF测试结果时。
本研究结果为以下假设提供了一些支持，即最初年龄在48 - 67岁的个体在6年期间的高血压状态变化与认知变化有关。
