Cardiac Output, Blood Pressure Variability, and Cognitive Decline in Geriatric Cardiac Patients

Department of Neurology, School of Medicine, Johns Hopkins University, Baltimore, Maryland 21205, USA.
Journal of cardiopulmonary rehabilitation and prevention (Impact Factor: 1.58). 06/2011; 31(5):290-7. DOI: 10.1097/HCR.0b013e318220a817
Source: PubMed


To prospectively investigate whether baseline findings on specific cardiovascular indices are predictive of subsequent rate of decline in Attention-Executive-Psychomotor function in a cohort of ambulatory older adults with cardiovascular diseases (CVDs).
One hundred seventy-two older adults with CVD were administered a neuropsychological battery of executive functions tests at study entry, and at 12 and 36 months thereafter. At study entry, they also underwent vascular assessments including cardiac output, ejection fraction, blood pressure (BP), brachial artery reactivity, and carotid intima media thickness. Random coefficient regressions were used to investigate the effect of these cardiac indices on rate of decline in Attention-Executive-Psychomotor function.
Cardiac output, systolic BP variability, and diastolic BP variability predicted decline in Attention-Executive-Psychomotor function. Specifically, lower cardiac output, reduced variability in systolic BP, and increased variability in diastolic BP were associated with a faster rate of decline in Attention-Executive-Psychomotor function. Mean resting systolic and diastolic blood pressure did not predict decline in Attention-Executive-Psychomotor function.
Decline in frontal-subcortical cognitive functions among patients with CVDs appears to be mediated by systemic hypoperfusion and variability in blood pressure. The precise nature of these relationships, especially with regard to blood pressure variability, is complex and demands continued investigation.

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    • "Similarly, CVD is associated with development of white matter disease [14], pathological changes to blood vessels [15], and inflammatory processes [16], each of which are known to adversely impact cognitive function. Recent work implicates disrupted autonomic nervous system (ANS) signaling as another potential mechanism for the cognitive impairment, as both blood pressure variability (e.g., standard deviation of systolic blood pressure) and heart rate variability have been linked to neurocognitive outcome in persons with CVD [17] [18] [19]. Such findings suggest that other, more easily obtained ANS indices may also be associated with reduced cognitive function and provide insight into potential mechanisms. "
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    ABSTRACT: Cardiovascular disease (CVD) in older adults has been associated with varying degrees of cognitive dysfunction. Several mechanisms may explain this association, including impaired cardiovascular reactivity to autonomic nervous system (ANS) signaling. Reduced heart rate recovery following a stress test may be considered an indication of impaired ANS function (i.e., reduced parasympathetic activity). Participants were 47 older adults (53-83 years) who underwent a treadmill stress test and were administered a comprehensive neuropsychological battery upon entry to phase II cardiac rehabilitation. Reduced parasympathetic activity was associated with impaired cognitive performance on a measure of global cognitive function and on tasks of speeded executive function and confrontation naming. These relationships suggest that changes in autonomic function may be mechanistically related to the impaired cognitive function prevalent in CVD patients.
    Cardiovascular Psychiatry and Neurology 09/2012; 2012:392490. DOI:10.1155/2012/392490
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    ABSTRACT: Older subjects living in nursing homes (NHs) show a high prevalence of multimorbidity, disability, and cognitive impairment. The clinical meaning of arterial hypertension (AH) in this population is unclear, and few studies have adopted ambulatory blood pressure monitoring (ABPM) with this purpose. The aims of the study were to evaluate the concordance between office and monitored blood pressure in a sample of NH residents and to assess the prognostic meaning of ABPM parameters after 1 year. NH residents underwent a comprehensive geriatric assessment and 24-hour ABPM (Spacelabs 90207). White-coat hypertension (WCH) was defined as office blood pressure of 140/90 or higher and ABPM lower than 135/85 mm Hg. Vital status was assessed after 1 year. A total of 100 residents (mean age 83, 51% affected by AH) showed WCH in 33% of cases and in 70% of cases elevated office blood pressure. Correlation between monitored and office blood pressure was limited for systolic (R = 0.30) and nonsignificant for diastolic blood pressure (R = 0.11). Disability and behavioral disorders were independently associated with 1-year mortality. No ABPM parameter, except low nighttime systolic blood pressure variability, was associated with 1-year mortality. Concordance between office and ABPM values is limited, and WCH prevalence is high among NH residents. Survival at 1-year follow-up is predicted by disability and behavioral disorders, but is not associated with blood pressure values.
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