Key result
Higher SBP is linked to worse cognition, ~52% mediated by periventricular white matter hyperintensities.
Why the study?
The interdependence of blood pressure, its treatment, white matter hyperintensities, and cognitive performance has not been systematically studied in population-based studies.
Observational (n=560)
Effect estimate: β -0.10 (95% CI -0.19 to -0.02)
Periventricular white matter hyperintensities strongly mediate the harmful effects of systolic blood pressure on cognitive performance, particularly in nonverbal memory and executive function.
Periventricular WMH may mediate SBP effects on cognition; extends observational data but leaves causal inference open for trials.
OBJECTIVES: White matter hyperintensities (WMH) of presumed vascular origin are frequent in cerebral MRI of older people. They represent a sign of small vessel disease, are promoted by arterial hypertension, and relate to cognitive deficits. The interdependence of blood pressure and its treatment, WMH, and cognitive performance has not systematically been studied in population-based studies. METHODS: Consequently, we analysed the interdependence of SBP, DBP, and antihypertensive medications, as well as BP/treatment category, with WMH and cognitive performance in 560 participants of the population-based 1000BRAINS study. RESULTS: BP, its treatment, and BP/treatment category were moderately associated with cognitive performance (e.g. unadjusted β = -0.10, 95%CI = -0.19 to -0.02 for the association of SBP (per standard deviation of 17.2 mmHg) with global cognition (per standard deviation of 0.5 z score)]. The harmful effect of BP on cognition was strongly mediated by periventricular hyperintensities (PVH), which were significantly associated with both SBP [ β = 0.24, 95% CI = 0.14-0.34 (per 1-point-increase in Fazekas score)] and global cognition ( β = -0.22, 95%CI = -0.32 to -0.13). Thus, PVH mediated as much as 52% of the effects of SBP on cognitive performance. Mediation was less strong for deep white matter hyperintensities (DWMH, 16%), which showed less association with SBP ( β = 0.14, 95% CI = 0.05-0.24) and global cognition ( β = -0.12, 95%CI = -0.21 to -0.03). Regarding different cognitive domains, PVH most strongly mediated effects of SBP on nonverbal memory (94%) and executive function (81%). CONCLUSION: Our results indicate that PVH may predispose to cognitive impairment associated with hypertension, especially in the domains of nonverbal memory and executive function.
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Gronewold et al. (2022) conducted an observational in Cognitive performance and white matter hyperintensities (n=560). Systolic blood pressure (SBP) was evaluated on Global cognition (β -0.10, 95% CI -0.19 to -0.02). Higher systolic blood pressure was associated with worse global cognition (β = -0.10; 95% CI -0.19 to -0.02), an effect that was 52% mediated by periventricular white matter hyperintensities.
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