Top

BMC Neurology

Published in:

Open Access 01-12-2022 | Research

Pulse pressure is associated with cognitive performance in Japanese non-demented population: a cross-sectional study

Authors: Ryo Mizuhara, Shingo Mitaki, Masahiro Takamura, Satoshi Abe, Keiichi Onoda, Shuhei Yamaguchi, Atsushi Nagai

Published in: BMC Neurology | Issue 1/2022

Abstract

Background

Growing evidence suggests that vascular risk factors, especially hypertension, relate not only to cardiovascular disease but also to cognitive impairment. However, the impact of pulse pressure on cognitive function remains controversial. In this study, we evaluated the associations between pulse pressure and cognitive function in a Japanese health examination cohort using propensity matching analysis.

Methods

We examined 2,546 individuals with a mean age of 60.8 ± 10.3 years who voluntarily participated in health examination. Clinical variables included pulse pressure, and brain magnetic resonance imaging (MRI). We divided the participants into the high and low pulse pressure groups with a pre-defined cut-off value of 65 mmHg and evaluated their physical examination data, cognitive functions including Okabe’s test, Kohs’ test, and silent brain lesions using propensity matching. To clarify whether pulse pressure and blood pressure have different implications for cognitive function, a mediating analysis was also conducted.

Results

From the 2,546 subjects, 439 (17.2%) were in the high PP group. The propensity matching algorithm produced 433 pairs of patients with similar propensities. Higher pulse pressure corresponded to lower Okabe and Kohs’ scores (44.3 ± 7.1 vs 42.7 ± 7.5; p = 0.002, 97.9 ± 18.0 vs 95.0 ± 18.1 p = 0.019, respectively). The relationship between pulse pressure and cognitive impairment was not significantly mediated by systolic blood pressure. We observed no significant associations between silent brain lesions and pulse pressure.

Conclusion

High pulse pressure was associated with lower cognitive performance without systolic blood pressure mediation in Japanese subjects without dementia.

Available only for authorised users

de Simone G, Roman MJ, Alderman MH, Galderisi M, de Divitiis O, Devereux RB. Is high pulse pressure a marker of preclinical cardiovascular disease? Hypertension. 2005;45:575–9. https://doi.org/10.1161/01.HYP.0000158268.95012.08.CrossRefPubMed

Madhavan S, Ooi WL, Cohen H, Alderman MH. Relation of pulse pressure and blood pressure reduction to the incidence of myocardial infarction. Hypertension. 1994;23:395–401. https://doi.org/10.1161/01.hyp.23.3.395.CrossRefPubMed

Livingston G, Huntley J, Sommerlad A, Ames D, Ballard C, Banerjee S, et al. Dementia prevention, intervention, and care: 2020 report of the lancet commission. Lancet. 2020;396:413–46. https://doi.org/10.1016/S0140-6736(20)30367-6.CrossRefPubMedPubMedCentral

de la Torre JC. Is Alzheimer’s disease a neurodegenerative or a vascular disorder? Data, dogma, and dialectics. Lancet Neurol. 2004;3:184–90. https://doi.org/10.1016/S1474-4422(04)00683-0.CrossRefPubMed

Qiu C, Winblad B, Fratiglioni L. The age-dependent relation of blood pressure to cognitive function and dementia. Lancet Neurol. 2005;4:487–99. https://doi.org/10.1016/S1474-4422(05)70141-1.CrossRefPubMed

Zang J, Shi J, Liang J, Zhang X, Wei W, Yao C, et al. Pulse pressure, cognition, and white matter lesions: a mediation analysis. Front Cardiovasc Med. 2021;8:654522. https://doi.org/10.3389/fcvm.2021.654522.CrossRefPubMedPubMedCentral

Obisesan TO, Obisesan OA, Martins S, Alamgir L, Bond V, Maxwell C, et al. High blood pressure, hypertension, and high pulse pressure are associated with poorer cognitive function in persons aged 60 and older: the third national health and nutrition examination survey. J Am Geriatr Soc. 2008;56:501–9. https://doi.org/10.1111/j.1532-5415.2007.01592.x.CrossRefPubMedPubMedCentral

Peters R, Beckett N, Fagard R, Thijs L, Wang JG, Forette F, et al. Increased pulse pressure linked to dementia: further results from the hypertension in the Very Elderly Trial - HYVET. J Hypertens. 2013;31:1868–75. https://doi.org/10.1097/HJH.0b013e3283622cc6.CrossRefPubMed

Ogunniyi A, Lane KA, Baiyewu O, Gao S, Gureje O, Unverzagt FW, et al. Hypertension and incident dementia in community-dwelling elderly Yoruba Nigerians. Acta Neurol Scand. 2011;124:396–402. https://doi.org/10.1111/j.1600-0404.2011.01491.x.CrossRefPubMedPubMedCentral

10.

Molander L, Gustafson Y, Lövheim H. Longitudinal associations between blood pressure and dementia in the very old. Dement Geriatr Cogn Disord. 2010;30:269–76. https://doi.org/10.1159/000320252.CrossRefPubMed

11.

Sabayan B, Oleksik AM, Maier AB, van Buchem MA, Poortvliet RK, de Ruijter W, et al. High blood pressure and resilience to physical and cognitive decline in the oldest old: the Leiden 85-plus Study. J Am Geriatr Soc. 2012;60:2014–9. https://doi.org/10.1111/j.1532-5415.2012.04203.x.CrossRefPubMed

12.

Umemura S, Arima H, Arima S, Asayama K, Dohi Y, Hirooka Y, et al. The Japanese Society of Hypertension guidelines for the management of hypertension (JSH 2019). Hypertens Res. 2019;42:1235–481. https://doi.org/10.1038/s41440-019-0284-9.CrossRefPubMed

13.

Kobayashi S, Okada K, Koide H, Bokura H, Yamaguchi S. Subcortical silent brain infarction as a risk factor for clinical stroke. Stroke. 1997;28:1932–9. https://doi.org/10.1161/01.str.28.10.1932.CrossRefPubMed

14.

Fazekas F, Niederkorn K, Schmidt R, Offenbacher H, Horner S, Bertha G, et al. White matter signal abnormalities in normal individuals: correlation with carotid ultrasonography, cerebral blood flow measurements, and cerebrovascular risk factors. Stroke. 1988;19:1285–8. https://doi.org/10.1161/01.str.19.10.1285.CrossRefPubMed

15.

Okabe S. Simple intelligence assessment scale. Jpn J Clin Psychiat. 1988;17:55–61.

16.

Fukunishi I, Okabe S, Nakagawa T, Hosokawa K. The assessment of intelligence function of aged chronic schizophrenia. Jpn J Psychiatry Neurol. 1990;44:503–9. https://doi.org/10.1111/j.1440-1819.1990.tb01623.x.CrossRefPubMed

17.

Wigg CM, Duro LA. The Kohs’ blocks test as an important instrument to investigate the visuo-spatial impairments in myotonic dystrophy Part I. Quantitative and qualitative analysis. Arq Neuropsiquiatr. 1999;57:547–55. https://doi.org/10.1590/s0004-282x1999000400002.CrossRefPubMed

18.

Dubois B, Slachevsky A, Litvan I, Pillon B. The FAB: a Frontal Assessment Battery at bedside. Neurology. 2000;55:1621–6. https://doi.org/10.1212/wnl.55.11.1621.CrossRefPubMed

19.

Zung WW. A Self-Rating Depression Scale. Arch Gen Psychiatry. 1965;12:63–70. https://doi.org/10.1001/archpsyc.1965.01720310065008.CrossRefPubMed

20.

Okada KK, Suyama S, Yamagata S. ssessment of motivational loss in poststroke patients using the Japanese version of Starkstein’s Apathy Scale (in Japanese). Jpn J Stroke. 1998;20:318–27 KS: Aoki Shoten.CrossRef

21.

Nation DA, Edmonds EC, Bangen KJ, Delano-Wood L, Scanlon BK, Han SD, et al. Pulse pressure in relation to tau-mediated neurodegeneration, cerebral amyloidosis, and progression to dementia in very old adults. JAMA Neurol. 2015;72:546–53. https://doi.org/10.1001/jamaneurol.2014.4477.CrossRefPubMedPubMedCentral

22.

Austin PC. An introduction to propensity score methods for reducing the effects of confounding in observational studies. Multivariate Behav Res. 2011;46:399–424. https://doi.org/10.1080/00273171.2011.568786.CrossRefPubMedPubMedCentral

23.

Naggara O, Raymond J, Guilbert F, Roy D, Weill A, Altman DG. Analysis by categorizing or dichotomizing continuous variables is inadvisable: an example from the natural history of unruptured aneurysms. AJNR Am J Neuroradiol. 2011;32:437–40. https://doi.org/10.3174/ajnr.A2425.CrossRefPubMedPubMedCentral

24.

Waldstein SR, Rice SC, Thayer JF, Najjar SS, Scuteri A, Zonderman AB. Pulse pressure and pulse wave velocity are related to cognitive decline in the Baltimore longitudinal study of aging. Hypertension. 2008;51:99–104. https://doi.org/10.1161/HYPERTENSIONAHA.107.093674.CrossRefPubMed

25.

Guo Z, Fratiglioni L, Winblad B, Viitanen M. Blood pressure and performance on the mini-mental state examination in the very old. Cross-sectional and longitudinal data from the Kungsholmen project. Am J Epidemiol. 1997;145:1106–13. https://doi.org/10.1093/oxfordjournals.aje.a009073.CrossRefPubMed

26.

Tzourio C, Dufouil C, Ducimetière P, Alpérovitch A. Cognitive decline in individuals with high blood pressure: a longitudinal study in the elderly. EVA study group epidemiology of vascular aging. Neurology. 1999;53:1948–52. https://doi.org/10.1212/wnl.53.9.1948.CrossRefPubMed

27.

Mattace-Raso FU, van der Cammen TJ, Hofman A, van Popele NM, Bos ML, Schalekamp MA, et al. Arterial stiffness and risk of coronary heart disease and stroke: the Rotterdam study. Circulation. 2006;113:657–63. https://doi.org/10.1161/CIRCULATIONAHA.105.555235.CrossRefPubMed

28.

Raz N, Dahle CL, Rodrigue KM, Kennedy KM, Land S. Effects of age, genes, and pulse pressure on executive functions in healthy adults. Neurobiol Aging. 2011;32:1124–37. https://doi.org/10.1016/j.neurobiolaging.2009.05.015.CrossRefPubMed

29.

Sha T, Cheng W, Yan Y. Prospective associations between pulse pressure and cognitive performance in Chinese middle-aged and older population across a 5-year study period. Alzheimers Res Ther. 2018;10:29. https://doi.org/10.1186/s13195-018-0355-1.CrossRefPubMedPubMedCentral

30.

Hughes TM, Kuller LH, Barinas-Mitchell EJ, McDade EM, Klunk WE, Cohen AD, et al. Arterial stiffness and beta-amyloid progression in nondemented elderly adults. JAMA Neurol. 2014;71:562–8. https://doi.org/10.1001/jamaneurol.2014.186.CrossRefPubMedPubMedCentral

31.

Hughes TM, Wagenknecht LE, Craft S, Mintz A, Heiss G, Palta P, et al. Arterial stiffness and dementia pathology: Atherosclerosis Risk in Communities (ARIC)-PET Study. Neurology. 2018;90:e1248–56. https://doi.org/10.1212/WNL.0000000000005259.CrossRefPubMedPubMedCentral

32.

Hawkes CA, Sullivan PM, Hands S, Weller RO, Nicoll JA, Carare RO. Disruption of arterial perivascular drainage of amyloid-beta from the brains of mice expressing the human APOE epsilon4 allele. PLoS ONE. 2012;7:e41636. https://doi.org/10.1371/journal.pone.0041636.CrossRefPubMedPubMedCentral

33.

Cirrito JR, May PC, O’Dell MA, Taylor JW, Parsadanian M, Cramer JW, et al. In vivo assessment of brain interstitial fluid with microdialysis reveals plaque-associated changes in amyloid-beta metabolism and half-life. J Neurosci. 2003;23:8844–53. https://doi.org/10.1523/JNEUROSCI.23-26-08844.2003.CrossRefPubMedPubMedCentral

Title: Pulse pressure is associated with cognitive performance in Japanese non-demented population: a cross-sectional study
Authors: Ryo Mizuhara
Shingo Mitaki
Masahiro Takamura
Satoshi Abe
Keiichi Onoda
Shuhei Yamaguchi
Atsushi Nagai
Publication date: 01-12-2022
Publisher: BioMed Central
Published in: BMC Neurology / Issue 1/2022
Electronic ISSN: 1471-2377
DOI: https://doi.org/10.1186/s12883-022-02666-6

Keynote webinar | Spotlight on medication adherence

Springer Medicine

Pulse pressure is associated with cognitive performance in Japanese non-demented population: a cross-sectional study

Abstract

Background

Methods

Results

Conclusion

Keynote webinar | Spotlight on medication adherence

Springer Medicine

Abstract

Background

Methods

Results

Conclusion

Please log in to get access to this content

Other articles of this Issue 1/2022

Neurocognitive patterns across genetic levels in behavioral variant frontotemporal dementia: a multiple single cases study

Hyperperfusion in the cerebellum lobule VIIb in patients with epileptic seizures

MORe PREcISE: a multicentre prospective study of patient reported outcome measures in stroke morbidity: a cross sectional study

Muscle magnetic resonance imaging abnormality in neuroleptic malignant syndrome: a case report

Neuropsychiatric lupus erythematosus with neurogenic pulmonary edema and anti-α-amino-3-hydroxy-5-methyl-4-isoxazolepropionic acid receptor limbic encephalitis: a case report

Sinus pericranii associated with syntelencephaly: a case report