Key result
Higher nonlinear 24-hour BP variability linked to ~118% greater odds of prevalent dementia.
Why the study?
Studies evaluating vascular dysregulation in ADRD have focused on linear variability, limiting the assessment of dynamics and regulation of temporal vascular signals such as blood pressure.
Is nonlinear 24-hour blood pressure variability associated with cognitive impairment and dementia in older adults?
Cross-Sectional (n=3,648)
Yes
Is nonlinear 24-hour blood pressure variability associated with cognitive impairment and dementia in older adults?
Odds Ratio: 2.18 (95% CI 1.39–3.42)
Nonlinear 24-hour blood pressure variability metrics, such as high entropy and Poincaré values, are significantly associated with cognitive impairment and dementia prevalence.
Nonlinear 24-h BP variability linked to prevalent dementia; extends linear metrics research but leaves open prospective prediction and practice change.
Objective: Vascular dysregulation contributes to the pathophysiology of Alzheimer's disease and related disorders (ADRD). When examining dynamic biological functions in ADRD, studies have focused on linear vascular variability, which limits evaluating the dynamics and regulation of temporal vascular signals, including blood pressure (BP). Therefore, we aimed to evaluate nonlinear variability to quantify the degree of vascular dynamics and regulation associated with cognitive impairment and dementia. Design and method: In this cross-sectional study, we evaluated data from 1,772 participants from the Maracaibo Aging Study (Venezuela) and 1,876 participants from the ENRICA study (Spain). We included individuals with 24-hour ambulatory BP monitoring (ABPM) data, cognitive function (assessed with the Mini-Mental State Examination [MMSE]), and adjudication of dementia. ABPM data were structured as a time series, and missing values were imputed. Metrics of nonlinear variability included sample entropy, detrended fluctuation analysis (DFA), and Poincaré analysis of the 24-hour systolic BP. High entropy and Poincaré values with low DFA suggest irregular BP dynamics, whereas the opposite indicates a more rigid and predictable BP system. Statistics included linear and logistic multivariate regression models. Results: In both cohorts, the mean age was 64.5y in the MAS and 71.5y in the ENRICA study; >51.% were women. Higher entropy and Poincaré measures were associated with lower MMSE, with adjusted-mean MMSE estimates ranging from -0.083 (95% CI, -0.148 to -0.018) to -0.027 (95% CI, -0.052 to -0.002) in the Maracaibo Study. In this cohort, we additionally analyzed mild cognitive impairment (212 cases among 1,691 participants), and we found that each unit increase in measures of nonlinear systolic or diastolic BP variability was associated with increased odds of MCI (odds ratios [OR] =>1.41). High entropy, lower DFA, and high Poincaré measures were associated with higher ORs of having dementia at baseline; the ORs ranged from 1.45 (95% CI, 1.19-1.76) to 2.18 (95% CI, 1.39-3.42). Conclusions: Nonlinear 24-hour BP variability was associated with cognitive impairment and dementia prevalence. In addition to examining BP variability with metrics of linear variability, evaluating nonlinear dynamics could provide further characterization of vascular dynamics related to aging and disease.
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Melgarejo et al. (2026) conducted a cross-sectional in Cognitive impairment and dementia (n=3,648). Nonlinear 24-hour blood pressure variability vs. Lower nonlinear blood pressure variability was evaluated on Dementia at baseline (OR 2.18, 95% CI 1.39-3.42). Higher nonlinear 24-hour blood pressure variability was associated with increased odds of prevalent dementia (OR up to 2.18; 95% CI 1.39-3.42).
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