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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