Key result
Lower systolic (β=-0.35, P=0.01) and diastolic (β=-0.66, P=0.02) blood pressure were associated with more apathy symptoms, especially in those with higher cerebral small-vessel disease burden.
Why the study?
Both high and low blood pressure levels are associated with symptoms of apathy in older persons; whether the burden of cerebral small-vessel disease affects this association was explored.
Is lower blood pressure associated with more symptoms of apathy in older persons with mild cognitive deficits and cerebral small-vessel disease?
Cross-Sectional (n=210)
Is lower blood pressure associated with more symptoms of apathy in older persons with mild cognitive deficits and cerebral small-vessel disease?
Effect estimate: β = -0.35 (systolic) and β = -0.66 (diastolic)
p-value: p=0.01 (systolic), 0.02 (diastolic)
Lower blood pressure is associated with increased apathy symptoms in older adults with mild cognitive deficits, specifically those with a high burden of cerebral small-vessel disease.
May warrant caution in BP management for older adults with CSVD; leaves open causality and requires prospective confirmation.
BACKGROUND: In older persons, both high and low blood pressure (BP) levels are associated with symptoms of apathy. Population characteristics, such as burden of cerebral small-vessel disease (CSVD), may underlie these apparently contradictory findings. We aimed to explore, in older persons, whether the burden of CSVD affects the association between BP and apathy. DESIGN: Cross-sectional study. SETTING: Primary care setting, the Netherlands. PARTICIPANTS: Community-dwelling older persons (mean age = 80.7 years; SD = 4.1 years) with mild cognitive deficits and using antihypertensive treatment, participating in the baseline measurement of the magnetic resonance imaging substudy (n = 210) of the Discontinuation of Antihypertensive Treatment in the Elderly Study Leiden. MEASUREMENTS: During home visits, BP was measured in a standardized way and apathy was assessed with the Apathy Scale (range = 0-42). Stratified linear regression analyses were performed according to the burden of CSVD. A higher burden of CSVD was defined as 2 or more points on a compound CSVD score (range = 0-3 points), defined as presence of white matter hyperintensities (greater than median), any lacunar infarct, and/or two or more microbleeds. RESULTS: In the entire population, those with a lower systolic and those with a lower diastolic BP had more symptoms of apathy (β = -.35 [P = .01] and β = -.66 [P = .02], respectively). In older persons with a higher burden of CSVD (n = 50 [24%]), both lower systolic BP (β = -.64, P = .02) and lower diastolic BP (β = -1.6, P = .01) were associated with more symptoms of apathy, whereas no significant association was found between BP and symptoms of apathy in older persons with a lower burden of CSVD (n = 160). CONCLUSIONS: Particularly in older persons with a higher burden of CSVD, lower BP was associated with more symptoms of apathy. Adequate BP levels for optimal psychological functioning may vary across older populations with a different burden of CSVD. J Am Geriatr Soc 68:1811-1817, 2020.
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Bertens et al. (2020) conducted a cross-sectional in Mild cognitive deficits and apathy (n=210). Lower blood pressure vs. Higher blood pressure was evaluated on Symptoms of apathy assessed with the Apathy Scale (β = -0.35 (systolic) and β = -0.66 (diastolic), p=0.01 (systolic), 0.02 (diastolic)). Lower systolic (β=-0.35, P=0.01) and diastolic (β=-0.66, P=0.02) blood pressure were associated with more apathy symptoms, especially in those with higher cerebral small-vessel disease burden.
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