Hypertension, white matter hyperintensities confer cognitive risk
Patients with hypertension and progression of periventricular white matter abnormalities were at elevated risk for cognitive impairment, according to new findings.
Joan Jiménez-Balado, MSc, a PhD student at Neurovascular Research Lab, Vall d’Hebron Research Institute, Universitat Autònoma de Barcelona, Spain, and colleagues analyzed 345 patients with hypertension (median age, 65 years; 55% men) from the Investigating Silent Strokes in Hypertensives: a magnetic resonance imaging study (ISSYS) cohort without stroke or dementia at baseline.
At baseline and follow-up (mean, 3.95 years), all patients underwent a brain MRI, a cognitive screening test and a cognitive diagnosis to determine changes in cerebral small vessel disease lesions related to cognitive decline and incident mild cognitive impairment.
The researchers observed mild cognitive impairment in 9.1% of the cohort and determined the following prevalence rates: incident infarcts, 6.1%; incident cerebral microbleeds, 5.5%; progression of periventricular white matter hyperintensities, 22%; and progression of deep white matter hyperintensities, 48%.
Compared with patients without progression of periventricular white matter hyperintensities, those with it had elevated risks for reduced global cognition (patients with progression: adjusted mean, –0.519; standard error, 0.176; patients without progression: adjusted mean, 0.057; standard error, 0.044; P = .004) and mild cognitive impairment (OR = 6.184; 95% CI, 1.506-25.37), according to the researchers.
“In this sample of patients with hypertension, we observed associations of marked [periventricular white matter hyperintensities] progression with cognitive decline and incident [mild cognitive impairment]. As [mild cognitive impairment] is one of the most important risk factors in the development of dementia, future research should investigate the mechanisms by which [periventricular white matter hyperintensities] trigger cognitive impairment and the clinical utility of its assessment,” Jiménez-Balado and colleagues wrote. – by Erik Swain
Disclosures: The authors report no relevant financial disclosures.