Subclinical cerebral manifestations and changes of brain associated with newly diagnosed asymptomatic arterial hypertension

Abstract

Background.Progressive aggravation of cerebral affection in patientswith asymptomatic arterial hypertension (AH) suggests importanceof the affection in the development of subclinical cerebralmanifestations. Objective.To evaluate the dependence of subclinical depression,anxiety, and memory impairments on the severity of white matterhyperintensity (WMH) and microstructural changes in a visuallyintact brain matter in patients with asymptomatic AH. Materials and methods.The study involved 82 patients with newlydiagnosed asymptomatic AH, aged 4059 years. All patients wereassessed for delayed memory (Lurias test) as well as depressionand anxiety (Hospital Anxiety and Depression Scale (HADS))and underwent brain MRI (T1 and T2 weighted imaging, FLAIR,diffusion weighted imaging with calculation of apparent diffusioncoefficient (ADC) maps). Results.The earliest structural-functional relationships betweensubdepressive symptoms and ACD-assessed microstructuralchanges were found in the hippocampus, thalamus, and visuallyintact deep white matter of the cerebral hemispheres. AH worseningwas accompanied by a growing number of areas associatedwith subclinical depression, anxiety, and memory impairmentsand characterized by WMH lesions and an increased ACD in avisually intact brain matter. Conclusion.Microstructural changes in the hippocampus, thalamus,and deep structures of the hemispheres are the structural/functional basis of subclinical depression at the early AH stages.The AH worsening-associated involvement of new structures associatedwith subclinical depression, anxiety, and memory impairments,which are characterized by an increased ACD and WMHlesions, demonstrates the importance of progressive diffuse braindamage in the development of both subclinical and subsequentclinical manifestations of depression, anxiety, and memory impairments.The nature of relationships between hypertension anddepression needs to be clarified. In this connection, it seems appropriateto study the role of their common stress-induced processes:inflammation and neurovascular association due to hyperactivationof the suprasegmental autonomic centers.

Keywords

• asymptomatic hypertension
• intact white matter microstructural changes
• white matter hyperintensity
• depression
• anxiety
• memory
• cognitive impairments