Department of Neurology, National Neuroscience Institute, Singapore.
Health Services and Systems Research, Duke-NUS Medical School, Singapore.
J Alzheimers Dis. 2020;75(4):1351-1360. doi: 10.3233/JAD-191260.
Hypertension and white matter hyperintensities (WMH) are mutually associated risk factors for cognitive impairment. However, age may modify the associations between hypertension and WMH, and their links to cognitive impairment.
We evaluated the interaction between age and hypertension on WMH, and the age-stratified associations of hypertension and WMH with cognition.
Key measures include systolic blood pressure (SBP), WMH (modified Fazekas visual ratings of cranial MRI), and the Montreal Cognitive Assessment (MoCA). Participants (N = 488) with prodromal and mild dementia were age-stratified (≤49, 50-59, 60-69,≥70), and considered hypertensive if their SBP≥140 mmHg. The interaction between age strata and hypertension on WMH, and age-stratified associations of hypertension and WMH with cognition, were evaluated using multiple linear regression analyses. Analyses controlled for other risk factors for WMH and cognitive impairment.
Age moderated the association between SBP and WMH. Hypertension was associated with higher WMH only in those aged 60-69, and WMH trends across age bands differed between those with and without hypertension. Finally, WMH and SBP≥140 were independently associated with lower MoCA scores within the 50-59 age band, while WMH alone was associated with poorer MoCA scores in the≥70 age band.
In adults with prodromal or mild dementia, hypertension was associated with WMH specifically in the 60-69 age strata. Associations between hypertension and WMH with poorer cognition also differed across age bands. Future studies will be needed to investigate whether blood pressure management to slow cognitive decline by targeting WMH may be age dependent.
高血压和脑白质高信号（WMH）是相互关联的认知障碍危险因素。然而，年龄可能会改变高血压和 WMH 之间的关联，以及它们与认知障碍的关系。
我们评估了年龄和高血压对 WMH 的交互作用，以及高血压和 WMH 与认知的年龄分层关联。
关键测量指标包括收缩压（SBP）、WMH（颅脑 MRI 的改良 Fazekas 视觉评分）和蒙特利尔认知评估（MoCA）。根据年龄分层（≤49、50-59、60-69、≥70），将有前驱期和轻度痴呆的参与者（N=488）分为不同年龄组，并将 SBP≥140mmHg 的参与者视为高血压患者。使用多线性回归分析评估年龄分层和高血压对 WMH 的交互作用，以及高血压和 WMH 与认知的年龄分层关联。分析控制了 WMH 和认知障碍的其他危险因素。
年龄调节了 SBP 和 WMH 之间的关联。只有在 60-69 岁年龄组中，高血压与较高的 WMH 相关，而在高血压和非高血压患者中，WMH 随年龄的变化趋势不同。最后，在 50-59 岁年龄组中，WMH 和 SBP≥140 与 MoCA 评分较低独立相关，而在≥70 岁年龄组中，仅 WMH 与 MoCA 评分较差相关。
在有前驱期或轻度痴呆的成年人中，高血压与 60-69 岁年龄组的 WMH 相关。高血压和 WMH 与认知障碍的关联也因年龄组而异。未来的研究将需要调查针对 WMH 来管理血压以减缓认知衰退的方法是否可能依赖于年龄。
