Baumgartner Nicholas W, Capuano Ana W, Barnes Lisa L, Bennett David A, Arvanitakis Zoe
Rush Alzheimer's Disease Center, Rush University Medical Center, Chicago, IL, USA.
medRxiv. 2025 Jan 9:2025.01.08.25320209. doi: 10.1101/2025.01.08.25320209.
Both high and declining blood pressure (BP) are associated with cognitive decline risk in older adults. In late-life, women have higher rates of hypertension, experience faster cognitive decline, and represent two-thirds of individuals with Alzheimer's disease dementia. However, sex differences in the association between BP decline and cognitive decline are unknown.
Data were analyzed from 4719 older adults without known baseline dementia (mean age = 76.7 [SD = 7.7] years; 74% women) enrolled in one of five US-based prospective community-based cohort studies, followed annually for up to 31 years (mean = 8.7 [SD = 5.7] years). A 19-test cognitive battery, yielding composite global and five domain-specific scores, and BP were assessed annually. Bivariate mixed-effects models simultaneously estimated change in BP and cognition, for the total group and by sex.
Systolic BP, diastolic BP, and cognition all declined over time (ps <0.01). Bivariate mixed-effect models revealed a sex difference in the correlation of decline in systolic BP and decline in global cognition (women: r = 0.26, 95%CI: 0.17 - 0.37; men: r = 0.01, 95%CI: -0.13 - 0.11), such that women exhibited a stronger correlation than men. Decline in systolic BP was related to decline in global and all five cognitive domains in women but none in men, with another sex difference identified in the working memory domain. An increase of diastolic BP was related to decline in working memory in men, and no other associations with diastolic BP were significant for either sex.
Systolic BP decline in late-life is related to decline in global and domain-specific cognition in women but not men, with sex differences in global cognition and the working memory domain. These findings suggest that in older women, declining systolic BP - a routinely-used clinical measure - may be an important marker of concurrent cognitive decline.
血压升高和血压下降均与老年人认知能力下降风险相关。在晚年，女性高血压发病率更高，认知能力下降更快，且在阿尔茨海默病痴呆患者中占三分之二。然而，血压下降与认知能力下降之间的关联是否存在性别差异尚不清楚。
对4719名无已知基线痴呆的老年人（平均年龄=76.7[标准差=7.7]岁；74%为女性）的数据进行分析，这些老年人参与了美国五项基于社区的前瞻性队列研究之一，每年随访长达31年（平均=8.7[标准差=5.7]年）。每年评估一次包含19项测试的认知量表，得出综合整体得分和五个特定领域得分，同时测量血压。双变量混合效应模型同时估计了整个组以及按性别划分的血压和认知变化。
收缩压、舒张压和认知能力均随时间下降（p值<0.01）。双变量混合效应模型显示，收缩压下降与整体认知能力下降之间的相关性存在性别差异（女性：r=0.26，95%置信区间：0.17 - 0.37；男性：r=0.01，95%置信区间：-0.13 - 0.11），女性的相关性强于男性。收缩压下降与女性的整体认知能力及所有五个认知领域的下降有关，但与男性无关，在工作记忆领域也发现了另一个性别差异。舒张压升高与男性工作记忆能力下降有关，而舒张压与两性的其他关联均不显著。
晚年收缩压下降与女性的整体认知能力及特定领域认知能力下降有关，但与男性无关，在整体认知能力和工作记忆领域存在性别差异。这些发现表明，在老年女性中，收缩压下降（一种常用的临床指标）可能是同时发生的认知能力下降的重要标志。
