Impaired memory is more closely associated with brain beta-amyloid than leukoaraiosis in hypertensive patients with cognitive symptoms

Hypertension 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. In this cross-sectional cohort study 67...

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Bibliographic Details
Published in:PloS one 2018-01, Vol.13 (1), p.e0191345-e0191345
Main Authors: Smith, Eric E, Muzikansky, Alona, McCreary, Cheryl R, Batool, Saima, Viswanathan, Anand, Dickerson, Bradford C, Johnson, Keith, Greenberg, Steven M, Blacker, Deborah
Format: Article
Language:English
Subjects:
Age
Aged
Aging
Alzheimer's disease
Amyloid beta-Peptides - metabolism
Binding
Biology and Life Sciences
Brain
Brain - metabolism
Brain research
Cognition
Cognitive ability
Cortex
Dementia
Dementia disorders
Diagnosis
Executive function
Family medical history
Female
Hospitals
Humans
Hypertension
Hypertension - complications
Hypertension - diagnosis
Hypertension - metabolism
Hypertension - physiopathology
Impairment
Ischemia
Leukoaraiosis
Leukoaraiosis - complications
Magnetic resonance imaging
Male
Medical imaging
Medical schools
Medicine and Health Sciences
Memory
Neurobiology
Neuroimaging
Neurology
Neurosciences
NMR
Nuclear magnetic resonance
Pathology
Patients
Positron emission
Positron emission tomography
Psychiatrists
Psychiatry
Research and Analysis Methods
Risk factors
Stroke
Substantia alba
Systematic review
Tomography
β-Amyloid
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Summary:Hypertension 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. In 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. Mean 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. Episodic 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.
ISSN:1932-6203
1932-6203
DOI:10.1371/journal.pone.0191345