Premium
P2‐230: Relationships between 24‐hour blood pressure, subcortical ischemic lesions and vascular cognitive impairment
Author(s) -
Kim Jung Eun
Publication year - 2008
Publication title -
alzheimer's and dementia
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 6.713
H-Index - 118
eISSN - 1552-5279
pISSN - 1552-5260
DOI - 10.1016/j.jalz.2008.05.1305
Subject(s) - medicine , blood pressure , neurology , ambulatory blood pressure , dementia , cardiology , neuropsychology , ambulatory , vascular dementia , cognition , disease , psychiatry
Background: Controlling blood pressure (BP) is the most important treatment for subcortical vascular dementia (SVaD), since high systolic BP (SBP) and pulse pressures (PP) are correlated with the presence and severity of white matter lesions. However, the few studies into the relationship between diurnal BP rhythm and the progression of small vessel disease in the brain have produced inconclusive results. Some studies suggest that small vessel lesions and cognitive performance are affected by the loss of a nocturnal BP dip or SBP variaibility, but others have produced opposing results. These conflicting results are due to differences in subjects, methods and assessment techniques. In this study, I compared and analyzed 24-hour BP values between control, subcortical vascular mild cognitive impairment (SvMCI), and SVaD groups using careful criteria for each patient groups and 24-hour ambulatory BP monitoring. Methods: Among outpatients that visited the Department of Neurology, Konyang University Hospital, Department of Neurology, Seoul National University Bundang Hospital and the Department of Neurology, Ewha Womans University Mokdong Hospital for the evaluation of cognitive impairment and the Department of Cardiology, Konyang University Hospital, for control of hypertension between March 2006 and November 2007. During this period, 42 patients with SVaD, 37 patients with SvMCI, and 20 normal control subjects were selected according to inclusion criteria. All of the subjects received brain MRI and MR angiography, detailed neuropsychological testing, and 24-hour ambulatory BP monitoring. Results: All types of BP except diastolic BP differed significantly between the study groups. Multiple comparisons between these groups revealed significant statistical differences in daytime SBP between controls and SvMCI; in SBP variability, PP and ambulatory arterial stiffness index (AASI) between controls and SVaD;, and also marked differences in the prevalence of nondippers between SvMCI and controls and between SVaD and SvMCI. Loss of nocturnal dipping was significantly associated with periventricular hyperintensity and cognitive impairment. Conclusions: I have found that SVaD is associated with loss of nocturnal BP dipping, increased PP, and SBP variability. Accordingly, the correction of these factors could be important for prevention of SVaD, independent of the reduction in BP.