Clinical Interventions in Aging (Oct 2018)
Aortic stiffness and brain integrity in elderly patients with cognitive and functional complaints
Abstract
Lisanne Tap,1 Annegreet van Opbroek,2 Wiro J Niessen,2,3 Marion Smits,4 Francesco US Mattace-Raso1 1Department of Internal Medicine, Section of Geriatric Medicine, Erasmus MC, University Medical Center Rotterdam, Rotterdam, the Netherlands; 2Department of Medical Informatics and Radiology, Biomedical Imaging Group Rotterdam, Erasmus MC, University Medical Center Rotterdam, Rotterdam, the Netherlands; 3Imaging Physics, Faculty of Applied Sciences, Delft University of Technology, Delft, the Netherlands; 4Department of Radiology and Nuclear Medicine, Erasmus MC, University Medical Center Rotterdam, Rotterdam, the Netherlands Purpose: Cerebral white matter lesions (WML) and brain atrophy are frequent in older persons and are associated with adverse outcomes. It has been suggested that aortic stiffness plays a role in the pathogenesis of WML and gray matter (GM) loss. There is, however, little evidence on the association between aortic stiffness and brain integrity in older patients. In this study, we investigated whether aortic stiffness is associated with WML and GM volume in older patients with cognitive and functional complaints. Patients and methods: Fazekas score was used to analyze WML on brain imaging data of 84 persons; in a subanalysis on 42 MRI scans, the exact volume of white matter hyperintensities (WMH) and GM was determined using a brain-tissue and WMH tool. Aortic stiffness, measured as aortic pulse wave velocity (aPWV) and central pulse pressure (cPP), and blood pressure levels were non-invasively measured by the Mobil-O-Graph. Results: Mean age was 76.6 (±6.8) years. Age was correlated with cPP (Spearman’s ρ =0.296, P=0.008), aPWV (r²=0.785, P<0.001) and WMH volume (r²=0.297, P<0.001). cPP did not differ between categories of Fazekas, whereas aPWV increased with increasing Fazekas score (P for trend <0.001). After additional adjustment for age, levels of aPWV did not differ between categories. Both cPP and aPWV were associated with WMH volumes (lnB 0.025, P=0.055 and lnB 0.405, P<0.001, respectively); after additional adjustment for age, estimates were less consistent. Both cPP and aPWV were negatively associated with GM volumes in multivariate analysis (B=2.805, P=0.094 and B=111.052, P=0.032). Conclusion: Higher aortic stiffness was partly associated with increased volume of WMH and decreased volume of GM and slightly influenced by blood pressure. Age also plays a role in this association in older patients. Keywords: vascular aging, white matter hyperintensities, gray matter, older persons, cognitive complaints, functional decline
