Document Detail


Antemortem pulse pressure elevation predicts cerebrovascular disease in autopsy-confirmed Alzheimer's disease.
MedLine Citation:
PMID:  22451309     Owner:  NLM     Status:  MEDLINE    
Abstract/OtherAbstract:
Elevated pulse pressure (PP) is associated with cognitive decline and increased risk of Alzheimer's disease (AD) in older adults, although the mechanisms behind these associations remain unclear. To address this question, we examined whether antemortem late-life PP elevation predicted vascular or AD pathology in autopsy-confirmed AD patients. Sixty-five elderly patients (mean age 74.2 years) clinically diagnosed with possible or probable AD underwent neuropsychological testing and blood pressure examinations. Postmortem histopathological measures of cerebrovascular disease (CVD) and AD neuropathology were later obtained on these same patients. We expected that antemortem PP elevation, but not standard blood pressure measures such as systolic or diastolic blood pressure, would predict the autopsy-based presence of CVD, and possibly AD pathology, in elderly AD patients. Results demonstrated that antemortem PP elevation was associated with the presence and severity of CVD at autopsy. For every 5 mmHg increase in antemortem PP there was an estimated 36% increase in the odds of having CVD at autopsy. Additionally, PP accounted for 12% of variance in CVD severity. No significant associations were present for cerebral amyloid angiopathy or Braak and Braak staging of the severity of AD pathology. Other standard blood pressure measures also did not significantly predict neuropathology. The association between antemortem PP and CVD at autopsy suggests that in older adults with AD, PP elevation may increase the risk of CVD. These findings may have treatment implications since some antihypertensive medications specifically address the pulsatile component of blood pressure (e.g., renin-angiotensin system inhibitors, calcium channel blockers).
Authors:
Daniel A Nation; Lisa Delano-Wood; Katherine J Bangen; Christina E Wierenga; Amy J Jak; Lawrence A Hansen; Douglas R Galasko; David P Salmon; Mark W Bondi
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Publication Detail:
Type:  Journal Article; Research Support, N.I.H., Extramural; Research Support, Non-U.S. Gov't    
Journal Detail:
Title:  Journal of Alzheimer's disease : JAD     Volume:  30     ISSN:  1875-8908     ISO Abbreviation:  J. Alzheimers Dis.     Publication Date:  2012  
Date Detail:
Created Date:  2012-06-07     Completed Date:  2012-10-16     Revised Date:  2014-07-04    
Medline Journal Info:
Nlm Unique ID:  9814863     Medline TA:  J Alzheimers Dis     Country:  Netherlands    
Other Details:
Languages:  eng     Pagination:  595-603     Citation Subset:  IM    
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MeSH Terms
Descriptor/Qualifier:
Aged
Aged, 80 and over
Alzheimer Disease / complications*,  pathology*,  physiopathology
Autopsy
Blood Pressure / physiology*
Brain / pathology*
Cerebrovascular Disorders / complications*,  pathology,  physiopathology
Female
Humans
Male
Middle Aged
Neuropsychological Tests
Predictive Value of Tests
Grant Support
ID/Acronym/Agency:
K24 AG026431/AG/NIA NIH HHS; K24 AG026431/AG/NIA NIH HHS; K24 AG026431-02/AG/NIA NIH HHS; P50 AG05131/AG/NIA NIH HHS; R01 AG012674/AG/NIA NIH HHS; R01 AG012674-08/AG/NIA NIH HHS; R01 AG012674-15/AG/NIA NIH HHS
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