- 作者：Angelo Scuteri ; Manfredi Tesauro ; Letizia Guglini ; Davide Lauro ; Massimo Fini ; Nicola Di Daniele
- 关键词：Aortic stiffness ; Pulse wave velocity ; Hypotension ; White matter lesion ; Cognitive function ; Older subjects
- 刊名：International Journal of Cardiology
- 出版年：20 November, 2013
- 年：2013
- 卷：169
- 期：5
- 页码：371-377
- 全文大小：324 K
Objective
Though CV risk factors and markers of arterial aging are recognized risky for cognition, no study has simultaneously investigated the impact of multiple cardiac, arterial (large and small vessels), and hemodynamic parameters on cognitive function in older subjects.Methods
Two hundred eighty older subjects with subjective complaints of memory loss and no previous stroke (mean age 78.3 卤 6.3 years) were studied. Global cognitive function was evaluated with the Mini-Mental State Examination (MMSE). Cognitive impairment was defined as a MMSE < 21. We measured: traditional CV risk factors; aorta stiffness (Pulse Wave Velocity, PWV); LV mass; presence of WML at neuroimaging; episodes of hypotension (SBP < 100 mm Hg during 24 h Ambulatory Blood Pressure Monitoring).
Results
In both cross-sectional and longitudinal analyses PWV, WML, and episodes of hypotension were significantly associated with poorer cognitive function鈥攃ontrolling for age, sex, education, depression, traditional CV risk factors, and medications. LV mass was no longer associated with cognition in multiple regression. Older subjects with stiffer arteries or episodes of hypotension presented a 4-fold and an 11-fold, respectively, greater odds for progression from normal cognitive function to cognitive impairment. A synergistic effect between PWV, WML, and hypotension was observed: the occurrence of any two of PWV, WML, or hypotension was accompanied by lower MMSE; in the presence of all three factors, a further significant decline in cognitive function was observed.
Interpretation
Systemic hemodynamic parameters (higher PWV and hypotension) together with cerebral microvascular damage (WML) are significantly associated with poorer cognitive function and may identify older subjects with subjective complaints of memory loss at higher risk of cognitive decline.