Unfluctuating diastolic pressure, stiff arteries - the unseen culprits behind the curtain of cognitive decline: An observational study.

Cerebral small-vessel disease (CSVD) is an important risk factor for cognitive impairment, which is a pressing health issue for the aging population worldwide. The complex relationship between vascular factors, such as blood pressure variability (BPV) and arteriosclerosis index (AI), and cognitive dysfunction in patients with CSVD is a hot research topic, and research in this area will help prevent and treat cognitive dysfunction in CSVD. This study aims to investigate the effects of diastolic BPV (DBPV) and AI on cognitive function in patients with CSVD. A total of 383 CSVD patients admitted to the Second People's Hospital of Lianyungang City from May 2018 to June 2022 were included in this study. Patients with CSVD were divided into 4 groups based on the Mini-Mental State Examination (MMSE) to compare the differences between these groups. AI = (blood total cholesterol - high-density lipoprotein cholesterol [HDL-C]) ÷ HDL-C; DBPV = standard deviation of 24-hour DBP (SD of 24h-DBP). A logistic regression model was constructed to screen out the risk factors for cognitive dysfunction in patients with CSVD, and the model was evaluated using the receiver operating characteristic curve. Patients with different degrees of cognitive dysfunction revealed differences in 24h mean diastolic blood pressure (DBP), DBPV, daytime DBP, nocturnal systolic blood pressure and nocturnal drop in systolic blood pressure and DBP between the groups, and the mean DBP standard deviation of the groups with mild to moderate cognitive dysfunction was lower than that of the group with normal cognitive function (P < .05).The mean DBP of the groups with moderate cognitive dysfunction was lower than that of the group with normal cognitive function (P < .05). DBPV had a negative correlation with the AI (r = -0.56, P < .001), and a positive correlation with the MMSE score (R = 0.18, P = .024). AI was negatively correlated with MMSE score (r = -0.26, P < .001). Multivariate logistic regression analysis revealed that when DBPV was 10.58 to 13.60 mm Hg as a protective factor for vascular cognitive dysfunction, the AI was a risk factor for vascular cognitive dysfunction. DBPV and AI are strongly associated with CSVD-based cognitive dysfunction.