Document Detail

Rapid buildup of brain white matter hyperintensities over 4 years linked to ambulatory blood pressure, mobility, cognition, and depression in old persons.
MedLine Citation:
PMID:  23766429     Owner:  NLM     Status:  MEDLINE    
BACKGROUND: Brain white matter hyperintensities (WMH) are associated with functional decline in older people. We performed a 4-year cohort study examining progression of WMH, its effects on mobility, cognition, and depression with the role of clinic and 24-hour ambulatory systolic blood pressure as a predisposing factor.
METHODS: Ninety-nine subjects, 75-89 years were stratified by age and mobility, with the 67 completing 4-years comprising the cohort. Mobility, cognition, depressive symptoms, and ambulatory blood pressure were assessed, and WMH volumes were determined by quantitative analysis of magnetic resonance images.
RESULTS: WMH increased from 0.99±0.98% of intracranial cavity volume at baseline to 1.47±1.2% at 2 years and 1.74±1.30% after 4 years. Baseline WMH was associated with 4-year WMH (p < .0001), explaining 83% of variability. Small, but consistent mobility decrements and some evidence of cognitive decline were noted over 4 years. Regression analyses using baseline and 4-year WMHs were associated with three of five mobility measures, two of four cognitive measures and the depression scale, all performed at 4 years. Increases in ambulatory systolic blood pressure but not clinic systolic blood pressure during the initial 2 years were associated with greater WMH accrual during those years, while ambulatory systolic blood pressure was related to WMH at 4 years.
CONCLUSION: Declines in mobility, cognition, and depressive symptoms were related to WMH accrual over 4 years, and WMH was related to out-of-office blood pressure. This suggests that prevention of microvascular disease, even in asymptomatic older persons, is fundamental for preserving function. There may be value in tighter 24-hour blood pressure control in older persons although this requires further investigation.
Leslie Wolfson; Dorothy B Wakefield; Nicola Moscufo; Richard F Kaplan; Charles B Hall; Julia A Schmidt; Charles R G Guttmann; William B White
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Publication Detail:
Type:  Journal Article; Research Support, N.I.H., Extramural     Date:  2013-06-13
Journal Detail:
Title:  The journals of gerontology. Series A, Biological sciences and medical sciences     Volume:  68     ISSN:  1758-535X     ISO Abbreviation:  J. Gerontol. A Biol. Sci. Med. Sci.     Publication Date:  2013 Nov 
Date Detail:
Created Date:  2013-10-18     Completed Date:  2013-12-12     Revised Date:  2014-11-04    
Medline Journal Info:
Nlm Unique ID:  9502837     Medline TA:  J Gerontol A Biol Sci Med Sci     Country:  United States    
Other Details:
Languages:  eng     Pagination:  1387-94     Citation Subset:  AIM; IM    
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MeSH Terms
Aged, 80 and over
Aging / physiology*
Blood Pressure / physiology*
Blood Pressure Monitoring, Ambulatory
Brain / pathology*
Cognition Disorders / etiology*,  physiopathology
Cohort Studies
Depression / etiology*,  physiopathology
Mobility Limitation*
Regression Analysis
Grant Support
MO1 RR06192/RR/NCRR NIH HHS; R01 AG022092/AG/NIA NIH HHS; R01 AG022092-06/AG/NIA NIH HHS

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