Carmona-Abellan Mar, Trzeciak Malwina, Fernández Miriam Recio, Echeveste Beatriz, Imaz Laura, Luquin Maria-Rosario, Riverol Mario
Department of Neurology, University Clinic of Navarra, 31008 Pamplona, Spain.
Neurodegenerative Diseases Division, Health Research Institute Biocruces, 48903 Bizkaia, Spain.
Brain Sci. 2021 Mar 18;11(3):385. doi: 10.3390/brainsci11030385.
(1) Background: Both cerebral vascular disorders and cognitive decline increase in incidence with age. The role of cerebral vascular disease and hemodynamic changes in the development of cognitive deficits is controversial. The objective of this study was to assess the cardiovascular response during cardiac stress testing in neurologically asymptomatic individuals who developed cognitive impairment several years after previous cardiac stress testing. (2) Methods: This was a retrospective cohort study of patients who underwent cardiac stress testing between January 2001 and December 2010. Patients were followed up until May 2015, and we selected those who developed cognitive dysfunction including dementia, mild cognitive impairment, and subjective cognitive decline, after the stress test. Heart rate and blood pressure both at rest and at peak exercise, and the mean R-R interval at rest were recorded. For each patient who developed cognitive impairment, we selected one matched control who did not show cognitive decline by the end of the follow-up period. (3) Results: From the cohort of 7224 patients, 371 developed cognitive impairment; of these, 186 (124 men) met the inclusion criteria, and 186 of the other patients were selected as matched controls. During follow-up, cognitive impairment appeared 6.2 ± 4.7 years after the cardiac stress test. These patients who had subsequently developed cognitive impairment had significantly lower at-rest systolic, diastolic, and mean blood pressure than controls ( < 0.05). Further, compared with controls, their maximum heart rate was significantly higher at peak exercise. (4) Conclusion: The results from this study suggest that differences in cardiovascular response to stress might be present in individuals who develop cognitive decline. These findings challenge the possibility of assessing blood pressure and heart rate variability at rest and during cardiac stress as potential risk factors associated with cognitive impairment.
（1）背景：脑血管疾病和认知功能衰退的发病率均随年龄增长而增加。脑血管疾病和血流动力学变化在认知缺陷发展中的作用存在争议。本研究的目的是评估在先前心脏应激测试几年后出现认知障碍的神经无症状个体在心脏应激测试期间的心血管反应。（2）方法：这是一项对2001年1月至2010年12月期间接受心脏应激测试的患者进行的回顾性队列研究。对患者进行随访直至2015年5月，我们选择了那些在应激测试后出现认知功能障碍（包括痴呆、轻度认知障碍和主观认知衰退）的患者。记录静息和运动峰值时的心率、血压以及静息时的平均R-R间期。对于每一位出现认知障碍的患者，我们选择一名在随访期结束时未出现认知衰退的匹配对照。（3）结果：在7224名患者的队列中，371人出现认知障碍；其中，186人（124名男性）符合纳入标准，另外186名患者被选为匹配对照。在随访期间，认知障碍在心脏应激测试后6.2±4.7年出现。这些随后出现认知障碍的患者静息时的收缩压、舒张压和平均血压显著低于对照组（P<0.05）。此外，与对照组相比，他们在运动峰值时的最大心率显著更高。（4）结论：本研究结果表明，出现认知衰退的个体在心血管应激反应方面可能存在差异。这些发现对将静息和心脏应激期间的血压和心率变异性评估为与认知障碍相关的潜在风险因素的可能性提出了挑战。
