Arterial stiffness and its influence on cerebral morphology and cognitive function

 

So if you have arterial stiffness what the fuck is your doctor's protocol to address the problem? Maybe something in one of these?

• stiff arteries (11 posts to May 2013)

• Arterial stiffness (26 posts to April 2016) 

Or does your doctor incompetently not even know about testing for and correcting this problem?

Do you prefer your  doctor incompetence NOT KNOWING? OR NOT DOING?

Arterial stiffness and its influence on cerebral morphology and cognitive function

Melanie Haidegger https://orcid.org/0000-0003-0180-7917, Simon Lindenbeck, […], and Reinhold Schmidt reinhold.schmidt@medunigraz.at+9View all authors and affiliations

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https://doi.org/10.1177/17562864231180715

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• • Abstract
  • Introduction
  • Methods
  • Results
  • Discussion
  • Conclusion
  • Acknowledgments
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Abstract

Background:

Recently, arterial stiffness has been associated with cerebral small vessel disease (SVD), brain atrophy and vascular dementia. Arterial stiffness is assessed via pulse wave velocity (PWV) measurement and is strongly dependent on arterial blood pressure. While circadian blood pressure fluctuations are important determinants of end-organ damage, the role of 24-h PWV variability is yet unclear.

Objectives:

We here investigated the association between PWV and its circadian changes on brain morphology and cognitive function in community-dwelling individuals.

Design:

Single-centre, prospective, community-based follow-up study.

Methods:

The study cohort comprised elderly community-based participants of the Austrian Stroke Prevention Family Study which was started in 2006. Patients with any history of cerebrovascular disease or dementia were excluded. The study consists of 84 participants who underwent ambulatory 24-h PWV measurement. White matter hyperintensity volume and brain volume were evaluated by 3-Tesla magnetic resonance imaging (MRI). A subgroup of patients was evaluated for cognitive function using an extensive neuropsychological test battery.

Results:

PWV was significantly related to reduced total brain volume (p = 0.013), which was independent of blood pressure and blood pressure variability. We found no association between PWV with markers of cerebral SVD or impaired cognitive functioning. Only night-time PWV values were associated with global brain atrophy (p = 0.005).

Conclusions:

This study shows a relationship of arterial stiffness and reduced total brain volume. Elevations in PWV during night-time are of greater importance than day-time measures.

Introduction

In recent studies, arterial stiffness has been related to cerebral small vessel disease (SVD), brain volume and cognitive function. With increasing age, the elasticity of the aortic wall is reduced, resulting in an increased aortic pulse wave transmitted to the cerebral microvasculature and consecutive brain tissue damage.¹ This process is accelerated by exposure to vascular risk factors such as arterial hypertension, diabetes mellitus and cardiac disease.^2,3

Arterial stiffness has been related to higher burden of white matter hyperintensities (WMHs).^4,5 In addition, recent studies investigated a possible association between arterial stiffness and microstructural changes of the white matter captured by diffusion tensor imaging (DTI) techniques. Arterial stiffness related to lower fractional anisotropy and to higher mean diffusivity, suggesting that increased arterial stiffness exerts widespread detrimental effects on microstructural integrity of the white matter.^6–8

Current literature also indicates an association of arterial stiffness and reduced brain volume as well as impaired cognitive abilities, including executive function and processing speed.^2,9,10

The gold standard of measurement of arterial stiffness is assessment of carotid-femoral pulse wave velocity (PWV).¹¹ New technological approaches of PWV measurements, however, have been developed. These include pulse wave analysis which can easily be combined with a blood pressure measurement device allowing repetitive evaluation in an ambulatory 24-h setting.^12,13 As arterial stiffness is highly depending on arterial blood pressure, a circadian rhythm of PWV is assumed.^14,15 Data on circadian changes of PWV and its associations to cerebral structural damage and impairment of cognitive function, however, are lacking.

Therefore, this study aims to investigate the associations between PWV and its circadian fluctuations and focal SVD-related brain lesions, the peak width of skeletonized mean diffusivity (PSMD), brain volume and cognitive functioning.

 

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