Abstract MP56: Association of Arterial Stiffness and Pressure Amplification with Mild Cognitive Impairment and Dementia: The Atherosclerosis Risk in Communities Study - Neurocognitive Study (ARIC-NCS)
Abstract MP56: Association of Arterial Stiffness and Pressure Amplification with Mild Cognitive Impairment and Dementia: The Atherosclerosis Risk in Communities Study - Neurocognitive Study (ARIC-NCS)
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摘要 MP56：动脉僵硬和压力放大与轻度认知障碍和痴呆的关联：社区研究中的动脉粥样硬化风险 - 神经认知研究 (ARIC-NCS)
DOI：
10.1161/circ.133.suppl_1.mp56
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发表时间：
2016
期刊：
影响因子：
37.8
通讯作者：
G. Heiss
中科院分区：
文献类型：
--
作者：
M. Meyer;P. Palta;Hirofumi Tanaka;J. Deal;Jacqueline D Wright;C. Jack;D. Knopman;M. Griswold;T. Mosley;G. Heiss
背景资料：
作为一个高流量、低阻抗的器官，大脑对过高的压力和流量脉动很敏感。脉动性和动脉僵硬度增加被假设为与认知障碍相关的脑微血管损伤的原因。在双种族人群中，动脉僵硬度与轻度认知功能障碍（MCI）和痴呆的相关性尚未得到很好的表征，压力放大与MCI和痴呆的相关性相对未被探索。
目的：
在两族老年人群中，通过主动脉脉搏波速度（PWV）和压力放大测量动脉僵硬度与MCI和痴呆的横截面相关性。
研究方法：
我们纳入了来自基于人群的ARIC-NCS的4，945名成年人（2，903名女性; 1，069名非洲裔美国人;平均年龄75岁）。使用Omron VP-1000 plus系统测量动脉硬度（颈动脉-股动脉PWV（cfPWV））和压力放大测量值（中心收缩压（cSBP）、中心脉压（cPP）和脉压放大（PPA））。神经学家和神经心理学家使用心理测量评估、病史、脑磁共振成像和体格检查对MCI和痴呆进行分类，并由第三位评审员进行裁定。我们使用多项逻辑回归来评估种族特异性PWV和压力放大的第25百分位数切割点与正常认知（参考）、MCI和痴呆的相关性。我们按种族分层，并根据年龄、性别和心率、ApoE 4、教育、吸烟状况和研究中心进行调整。
结果如下：
有760名白人患有MCI，110名患有痴呆症，201名非洲裔美国人患有MCI，47名患有痴呆症。在白种人中，PPA较低者痴呆患病率较高，比值比（OR）=1.84（95%置信区间（CI）：1.15，2.97），将低于第25百分位数的参与者与高于第25百分位数的参与者进行比较，cSBP较高的参与者MCI的患病率较高，OR=1.33（95%CI：1.09，1.63），将高于第75百分位数的参与者与低于第75百分位数的参与者进行比较。同样在白人中，cPP较高的人MCI的患病率较高，OR=1.25（95%CI：1.01，1.55）和痴呆，OR=1.66（95%CI：1.00，2.73），比较高于第75百分位数的参与者和低于第75百分位数的参与者。在非裔美国人中，cfPWV没有统计学显著相关性，也没有证据表明高血压或糖尿病会影响疗效。
结论：
在白种人中，动脉僵硬度和压力放大成分与MCI和痴呆相关，但在非裔美国人中则无关，这可能是由于样本量有限。观察到的协会的纵向特征是必要的，以确定这些措施是否是独立的预测指标MCI和老年痴呆症的白人和非洲裔美国人。
Background:
As a high-flow, low-impedance organ, the brain is sensitive to excessive pressure and flow pulsatility. Increased pulsatility and arterial stiffness are hypothesized to contribute to cerebral microvascular damage linked to cognitive impairment. The association of arterial stiffness with mild cognitive impairment (MCI) and dementia in a biethnic population is not well characterized, and the association of pressure amplification with MCI and dementia is relatively unexplored.
Objectives:
To quantify the cross-sectional association of arterial stiffness, measured by aortic pulse wave velocity (PWV), and pressure amplification with MCI and dementia in a biethnic population of older adults.
Methods:
We included 4,945 adults (2,903 females; 1,069 African Americans; mean age 75 years) from the population-based ARIC-NCS. The Omron VP-1000 plus system was used to measure arterial stiffness (carotid-femoral PWV (cfPWV)) and pressure amplification measures (central systolic blood pressure (cSBP), central pulse pressure (cPP), and pulse pressure amplification (PPA)). A neurologist and neuropsychologist classified MCI and dementia using psychometric assessments, medical history, cerebral magnetic resonance imaging, and physical examinations, with adjudication by a third reviewer. We used multinomial logistic regression to evaluate associations of race-specific 25th percentile cut points of PWV and pressure amplification with normal cognition (reference), MCI and dementia. We stratified by race and adjusted for age, sex, and heart rate, ApoE4, education, smoking status, and study center.
Results:
There were 760 Caucasians with MCI and 110 with dementia, and 201 African Americans with MCI and 47 with dementia. Among Caucasians, those with lower PPA had a higher prevalence of dementia, odds ratio (OR)=1.84 (95% confidence interval (CI): 1.15, 2.97), comparing participants below the 25th percentile to those above it, and those with higher cSBP had a higher prevalence of MCI, OR=1.33 (95% CI: 1.09, 1.63), comparing participants above the 75th percentile to those below it. Also among Caucasians, those with higher cPP had a higher prevalence of MCI, OR=1.25 (95%CI: 1.01, 1.55), and dementia, OR=1.66 (95% CI: 1.00, 2.73), comparing participants above the 75th percentile to those below it. There were no statistically significant associations with cfPWV, among African Americans, and no evidence for effect modification by hypertension or diabetes.
Conclusion:
Arterial stiffness and components of pressure amplification were associated with MCI and dementia in Caucasians but not in African Americans, possibly due to the limited sample size. Longitudinal characterization of the observed associations is warranted to determine whether these measures are independent predictors of MCI and dementia among Caucasian and African American older adults.