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Objective: Arterial stiffness is a measure of cerebrovascular disease. We analyzed the association between arterial stiffness, cognitions and silent brain ischemia. Methods: We performed a cross sectional study in 2055 neurologically normal subjects in brain checkup system. We estimated periventricular hyperintensity (PVH), white matter hyperintensity (WMH) and silent brain infarction (SBI) as silent brain ischemia in MRI with brachial-ankle pulse wave velocity (baPWV) as arterial stiffness. Kohs’ block design test, Okabe’s Intelligence Scale and frontal assessment battery (FAB) were assessed as measures of cognitive function. Results: The baPWV was higher in PVH+(grade 2 and 3) and WMH+(grade 3) groups than in PVHand WMHgroups (p<0.01). The baPWV was also higher in SBI group than in non SBI group (p<0.001). The baPWV was inversely correlated with Kohs test (p<0.01, β=-0.066) and FAB test (p<0.01, β=-0.084) independently after adjusted for age, education level, presence of PVH, WMH and SBI. The middle and high tertiles of baPWV were not correlated with silent brain ischemia after adjusted for age, and vascular risk factors. Conclusions: The baPWV is not only a biomarker of arterial stiffness, but also index of cognitive impairment independent of silent brain ischemia. The checkup system includes MRI scans of the head, neuropsychological testing, blood tests and baPWV. Magnetic resonance imaging and silent brain ischemia Head MRIs were obtained using conventional pulse sequences for T2-weighted image, T1-weighted image, and fluid-attenuated inversion recovery (FLAIR) image in the transverse plane with a slice thickness of 7 mm by a 1.5-Tesla MRI (Symphony, Siemens). Silent brain infarction (SBI) was defined as a focal hyper intensity lesion 3 mm or large in diameter in the T2-weighted image corresponding to a hypointensity lesion in the T1-weighted image. Periventricular hyperintensity (PVH) were evaluated separately based on their distinct subcortical distributions and graded on a scale of 0 to 4 as described [10]. We defined grades 0 to 4 PVH as PVH-, grades 2 to 4 PVH as PVH+. We also defined deep and subcortical white matter hyperintensity (WMH) as grades 0 to 4 with Fazekas grading scale [11]. Measurement of baPWV The brachial-ankle pulse wave velocity (baPWV) was measured by Form PWV/ABI: OMRON COLIN Co Ltd, Tokyo, Japan. This device simultaneously measures bilateral and posterior tibial arterial pulse waveforms and arterial blood pressure by the oscillometric method. The baPWV on each side were automatically calculated and the average values of the baPWV obtained bilaterally were used for the analysis.

Arterial Stiffness is Correlated with Cognitive Decline Independent of Silent Brain Ischemia