Morrison Cassandra, Oliver Michael D, Kamal Farooq, Dadar Mahsa
Department of Psychology, Carleton University, Ottawa, Ontario, Canada.
Department of Psychological Science and Neuroscience, Belmont University, Nashville, Tennessee, USA.
J Gerontol B Psychol Sci Soc Sci. 2024 Sep 1;79(9). doi: 10.1093/geronb/gbae121.
Hypertension or high blood pressure (BP) is one of the 12 modifiable risk factors that contribute to 40% of dementia cases that could be delayed or prevented. Although hypertension is associated with cognitive decline and structural brain changes, less is known about the long-term association between variable BP and cognitive/brain changes. This study examined the relationship between variable BP and longitudinal cognitive, white matter hyperintensity (WMH), gray matter (GM), and white matter (WM) volume change over time and postmortem neuropathology.
A total of 4,606 participants (32,776 follow-ups) from RADC Research Resource Sharing Hub (RUSH) and 2,114 participants (9,827 follow-ups) from the Alzheimer's Disease Neuroimaging Initiative (ADNI) were included. Participants were divided into 1 of 3 groups: normal, high, or variable BP. Linear-mixed models investigated the relationship between BP and cognition, brain structure, and neuropathology.
Older adults with variable BP exhibited the highest rate of cognitive decline followed by high and then normal BP. Increased GM volume loss and WMH burden were also observed in variable compared to high and normal BP. In postmortem neuropathology, both variable and high BP had increased rates compared to normal BP. Results were consistent across the RUSH and ADNI participants, supporting the generalizability of the findings.
Damages potentially associated with variable BP may reduce resilience to future dementia-related pathology and increased the risk of dementia more than that caused by high BP. Improved treatment and management of variable BP may help reduce cognitive decline in the older adult population.
高血压是12种可改变的风险因素之一,40%的痴呆病例可被延迟或预防都与之相关。虽然高血压与认知能力下降和脑结构变化有关,但关于血压波动与认知/脑变化之间的长期关联却知之甚少。本研究探讨了血压波动与纵向认知、白质高信号(WMH)、灰质(GM)和白质(WM)体积随时间的变化以及死后神经病理学之间的关系。
纳入了来自RADC研究资源共享中心(RUSH)的4606名参与者(32776次随访)和来自阿尔茨海默病神经影像学倡议(ADNI)的2114名参与者(9827次随访)。参与者被分为三组中的一组:正常血压、高血压或血压波动组。线性混合模型研究了血压与认知、脑结构和神经病理学之间的关系。
血压波动的老年人认知能力下降率最高,其次是高血压组,然后是正常血压组。与高血压和正常血压组相比,血压波动组的灰质体积损失增加和WMH负担也增加。在死后神经病理学中,血压波动组和高血压组的发生率均高于正常血压组。RUSH和ADNI参与者的结果一致,支持了研究结果的普遍性。
与血压波动潜在相关的损害可能会降低对未来痴呆相关病理的恢复能力,并增加痴呆风险,且超过高血压所致的风险。改善血压波动的治疗和管理可能有助于减少老年人群的认知能力下降。