Ishikawa Joji, Seino Satoshi, Kitamura Akihiko, Toba Ayumi, Toyoshima Kenji, Tamura Yoshiaki, Watanabe Yutaka, Fujiwara Yoshinori, Inagaki Hiroki, Awata Shuichi, Shinkai Shoji, Araki Atsushi, Harada Kazumasa
Department of Cardiology, Tokyo Metropolitan Geriatric Hospital and Institute of Gerontology, Tokyo, Japan.
Research Team for Social Participation and Community Health, Tokyo Metropolitan Geriatric Hospital and Institute of Gerontology, Tokyo, Japan.
Int J Cardiol Cardiovasc Risk Prev. 2021 Aug 8;10:200104. doi: 10.1016/j.ijcrp.2021.200104. eCollection 2021 Sep.
Although an elevated systolic blood pressure (SBP) is associated with cognitive dysfunction, BP may decrease with advanced cognitive dysfunction; therefore, we attempted to identify the turning point in the relationship between cognitive function and SBP in elderly subjects.
In pooled datasets of general populations and outpatient clinics (age>65 years), in which the risk of frailty or cognitive dysfunction was assessed (N = 4076), the relationship between SBP and the Mini Mental State Examination (MMSE) score was examined.
Mean age was 72.5 ± 6.2 years (male 45.1%), and SBP was 133.0 ± 19.5 mmHg. In an analysis of locally weighted scatter plot smoothing, the relationship between SBP and MMSE scores changed at an MMSE score of 24 points. In subjects with preserved cognitive function (MMSE ≥24 points), MMSE scores decreased with increases in SBP (B = -0.047 per 10 mmHg increase, P = 0.002) after adjustments for age, sex, body mass index, alcohol habit, smoking status, diabetes, a history of stroke, and the geriatric nutritional index; however, in subjects with reduced cognitive function (MMSE<24 points), decreases in the MMSE score were associated with reductions in SBP (B = 1.178 per 1 point decrease in the MMSE score, P = 0.002).
The relationship between SBP and cognitive function changed at a MMSE score of approximately 24 points (mild to moderate cognitive dysfunction). In patients with preserved MMSE, higher BP values were associated with a reduction of cognitive function, but this was not a case for those with impaired MMSE.
尽管收缩压（SBP）升高与认知功能障碍相关，但随着认知功能障碍的进展，血压可能会降低；因此，我们试图确定老年受试者认知功能与SBP之间关系的转折点。
在评估了衰弱或认知功能障碍风险的普通人群和门诊数据集（年龄>65岁）中（N = 4076），研究了SBP与简易精神状态检查表（MMSE）评分之间的关系。
平均年龄为72.5±6.2岁（男性占45.1%），SBP为133.0±19.5 mmHg。在局部加权散点图平滑分析中，SBP与MMSE评分之间的关系在MMSE评分为24分时发生变化。在认知功能保留的受试者（MMSE≥24分）中，在对年龄、性别、体重指数、饮酒习惯、吸烟状况、糖尿病、中风病史和老年营养指数进行调整后，MMSE评分随SBP升高而降低（每升高10 mmHg，B = -0.047，P = 0.002）；然而，在认知功能减退的受试者（MMSE<24分）中，MMSE评分降低与SBP降低相关（MMSE评分每降低1分，B = 1.178，P = 0.002）。
SBP与认知功能之间的关系在MMSE评分为约24分（轻度至中度认知功能障碍）时发生变化。在MMSE保留的患者中，较高的血压值与认知功能降低相关，但MMSE受损的患者并非如此。
