Key result
Elevated nightly diastolic BP variability links to higher neuropsychiatric scores across the Alzheimer's continuum.
Why the study?
Blood pressure variability is an emerging modifiable vascular risk factor for Alzheimer disease, but its potential role across the Alzheimer disease continuum required systematic evaluation.
Does short-term blood pressure variability correlate with neuropsychological tests, cerebrospinal fluid biomarkers, and multimodal neuroimaging measures in patients on the Alzheimer's disease continuum?
Observational (n=263)
Does short-term blood pressure variability correlate with neuropsychological tests, cerebrospinal fluid biomarkers, and multimodal neuroimaging measures in patients on the Alzheimer's disease continuum?
Short-term blood pressure variability, particularly nightly variability, is associated with neuropsychiatric symptoms, cognitive scores, and biomarkers in patients on the Alzheimer's disease continuum, suggesting a vascular pathway to AD.
Should not change BP management; leaves open vascular contributions to neuropsychiatric symptoms in AD continuum.
Background Emerging evidence indicates that blood pressure variability (BPV) is a modifiable vascular risk factor for Alzheimer's disease (AD). Herein, we aimed to systematically evaluate the potential role of short‐term BPV across the AD continuum. Methods This study included 263 patients on the AD continuum from the Chinese Imaging, Biomarkers, and Lifestyle study between January 1, 2023, and December 31, 2023. 24‐h ambulatory blood pressure monitoring was performed to obtain blood pressure measurements and evaluate BPV. Partial Spearman's correlation and restricted cubic spline analysis were performed to assess the associations between BPV and neuropsychological tests, cerebrospinal fluid biomarkers, and multimodal neuroimaging measures, respectively. The mediating effects of multimodal neuroimaging measures on the association between BPV and neuropsychiatric symptoms (NPS) were analyzed. Results The elevated standard deviation (SD) and average real variability of nightly diastolic blood pressure (DBP) were correlated with higher Neuropsychiatric Inventory (NPI) scores ( r = 0.19, p = 0.034; r = 0.22, p = 0.013). The increased SD of nightly systolic blood pressure (SBP) was correlated with increased Hamilton Anxiety Scale (HAMA) scores and total tau levels ( r = 0.20, p = 0.026; r = 0.17, p = 0.027), and elevated coefficient of variation (CV) of nightly SBP was correlated with higher HAMA scores and lower Aβ 42/40 levels ( r = 0.20, p = 0.026; r = –0.18, p = 0.021). The nightly variability of SBP showed an inverted U‐shaped relationship with Montreal Cognitive Assessment scores ( P for nonlinear = 0.008; P for nonlinear = 0.015; P for nonlinear = 0.021). The left cuneus volume mediated 29.41% of the association between the CV of nightly SBP and HAMA scores, while the right medial orbitofrontal thickness mediated 35.44% of the association between the CV of nightly DBP and NPI scores. Conclusion This study suggests that short‐term BPV may play a role in the AD continuum. These findings provide evidence of a vascular pathway to AD, as well as a potential and accessible intervention target for patients on the AD continuum.
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Zou et al. (2025) conducted an observational in Alzheimer's disease continuum (n=263). Short-term blood pressure variability was evaluated on Associations between blood pressure variability and neuropsychological tests, cerebrospinal fluid biomarkers, and multimodal neuroimaging measures. Elevated average real variability of nightly diastolic blood pressure correlated with higher Neuropsychiatric Inventory scores in patients on the Alzheimer's disease continuum (r=0.22, p=0.013).
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