Abstract
BackgroundHypertension is the strongest modifiable risk factor for subcortical ischemic changes and is also a risk factor for Alzheimer’s dementia. We used neuroimaging to investigate the pathological basis of early cognitive symptoms in patients with hypertension.MethodsIn this cross-sectional cohort study 67 patients age >60 years with hypertension and Clinical Dementia Rating scale score of 0.5 without dementia, and without history of symptomatic stroke, underwent MRI for measurement of subcortical vascular changes and positron emission tomography (PET) scan with Pittsburgh Compound B (PiB-PET) to detect beta-amyloid deposition. These imaging measures were related to neuropsychological tests of memory, executive function and processing speed.ResultsMean age was 75.0 (standard deviation, SD, 7.3). Mean neuropsychological Z scores were: episodic memory -0.63 (SD 1.23), executive function -0.40 (SD 1.10), processing speed -0.24 (SD 0.88); 22 of the 67 subjects met criteria for mild cognitive impairment (MCI) and the remaining 45 subjects had subjective cognitive concerns only. In multivariable models adjusting for age and years of education, each 0.1 unit increase in mean cortical PiB-PET binding was associated with 0.14 lower mean Z score for episodic memory (95% CI -0.28 to -0.01). This means that for every 0.1 unit increase in mean cortical PiB-PET, episodic memory was 0.14 standard deviations lower. White matter hyperintensity volume, silent brain infarcts and microbleeds were not associated with neuropsychological test scores.ConclusionsEpisodic memory was prominently affected in hypertensive participants with MCI or subjective cognitive concerns, and was associated with PiB-PET binding. This suggests a prominent role for Alzheimer pathology in cognitive impairment even in hypertensive participants at elevated risk for vascular cognitive impairment.
Highlights
Hypertension is a risk factor for vascular dementia as well as dementia due to clinically probable Alzheimer’s disease (AD).[1,2,3] Hypertension is a risk factor for mild cognitive impairment (MCI),[4] and may increase the risk of conversion from MCI to dementia.[5]
In multivariable models adjusting for age and years of education, each 0.1 unit increase in mean cortical PiB-positron emission tomography (PET) binding was associated with 0.14 lower mean Z score for episodic memory
Episodic memory was prominently affected in hypertensive participants with MCI or subjective cognitive concerns, and was associated with PiB-PET binding
Summary
Hypertension is the strongest modifiable risk factor for subcortical ischemic changes and is a risk factor for Alzheimer’s dementia. We used neuroimaging to investigate the pathological basis of early cognitive symptoms in patients with hypertension. Data Availability Statement: The study data are owned by Massachusetts General Hospital, and access to the data is regulated by its Institutional Review Board. The Massachusetts General Alzheimer’s Disease Research Center (MGH ADRC) is the custodian of the data for the purpose of data access and sharing. Researchers should contact the MGH ADRC at massadrc@mgh.harvard.edu (telephone: 617-726-3987) to request data access. De-identified individual patient data will be made
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