Impact of the ambulatory blood pressure monitoring profile on cognitive and imaging findings of cerebral small-vessel disease in older adults with cognitive complaints

Yong S Shim,Hae-Eun Shin

doi:10.1038/s41371-021-00490-y

Abstract

We investigated ambulatory blood pressure (BP) monitoring (ABPM) profiles and magnetic resonance imaging (MRI) findings of cerebral small-vessel disease (cSVD) in older adults with cognitive complaints who were grouped as follows: subjective cognitive decline, mild cognitive impairment, and dementia of Alzheimer’s type. Group comparisons and correlation analyses among demographic characteristics, cognitive and MRI findings, and ABPM profiles were performed. Furthermore, multivariate logistic regression analyses for dependent variables of (1) dementia or not and (2) MRI criteria of subcortical vascular dementia (SVaD) or not were conducted with independent variables of dichotomized ABPM profiles. A total of 174 subjects (55 males and 119 females) were included: mean age 75.36 ± 7.13 years; Mini-Mental State Examination (MMSE) score 20.51 ± 6.23. No MRI and ABPM findings except medial temporal atrophy were different between three groups. Twenty-four-hour systolic BP (sBP) was correlated with MMSE score (r = –0.182; p = 0.022) and the severity of white matter hyperintensity (WMH) (r = 0.157; p = 0.048). A higher daytime sBP was associated with dementia (odds ratio (OR): 3.734; 95% confidence interval (CI): 1.041–13.390; p = 0.043) and MRI finding of SVaD (OR: 10.543; 95% CI: 1.161–95.740; p = 0.036). Although there were no differences in ABPM profiles between three groups, a higher BP—especially a higher sBP—correlated with cognitive dysfunction and severity of WMH in older adults. Only higher daytime sBP was an independent predictor for dementia and MRI findings of SVaD. Among various ABPM profiles in this study, a higher BP, especially a higher sBP, may be considered the most important for clinical and MRI findings of cSVD.

Highlights

Cerebral small-vessel disease is caused by a group of pathological processes involving perforating cerebral arterioles, capillaries, and venules of the brain [1]
This study demonstrated that, there were no differences in ambulatory blood pressure (BP) monitoring (ABPM) profiles among the three groups (SCD, mild cognitive impairment (MCI), and dementia of Alzheimer’s type (DAT)), a higher blood pressure (BP), especially a higher systolic BP (sBP), correlated positively with cognitive dysfunction and severity of white matter hyperintensity (WMH) in older adults
Based on the results of this study, it is suggested that the ABPM is useful for measurements of cognitive and imaging findings related to Cerebral small-vessel disease (cSVD) and that ABPM profile might be predictive of progression of cSVD

Summary

Introduction

Cerebral small-vessel disease (cSVD) is caused by a group of pathological processes involving perforating cerebral arterioles, capillaries, and venules of the brain [1]. On magnetic resonance imaging (MRI), cSVD can be observed as lacunae, white matter hyperintensities (WMHs), cerebral microbleeds, and so on [2, 3] These imaging findings can be seen in cognitively normal older adults as well as patients with dementia, including those with Alzheimer’s disease (AD). The mean nocturnal systolic BP (sBP) is 10–20% lower than the mean daytime sBP, a phenomenon known as dipping [12]. Alteration of this nocturnal dipping is associated with an elevated risk of end-organ injury, to the heart, brain, and kidneys [12,13,14]. High BP variability, defined by a standard deviation (SD) of nighttime sBP of at least 10.8 mmHg, was associated with a significantly greater risk (41%) of cardiovascular events, a greater risk (55%) of cardiovascular death, and an increased risk (59%) of all-cause mortality [16]

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Discussion

Conclusion