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April 28, 2020; 94 (17) Article

White matter hyperintensities mediate the association of nocturnal blood pressure with cognition

Anthony G. Chesebro, Jesus D. Melgarejo, Reinier Leendertz, Kay C. Igwe, Patrick J. Lao, Krystal K. Laing, Batool Rizvi, Mariana Budge, Irene B. Meier, Gustavo Calmon, Joseph H. Lee, Gladys E. Maestre, View ORCID ProfileAdam M. Brickman
First published April 15, 2020, DOI: https://doi.org/10.1212/WNL.0000000000009316
Anthony G. Chesebro
From the Taub Institute for Research on Alzheimer's Disease and the Aging Brain (A.G.C., K.C.I., P.J.L., K.K.L., B.R., M.B., I.B.M., J.H.L., A.M.B.), Gertrude H. Sergievsky Center (J.H.L., A.M.B.), and Department of Neurology (J.H.L., A.M.B.), College of Physicians and Surgeons, and Department of Epidemiology (J.H.L.), Joseph P. Mailman School of Public Health, Columbia University, New York, NY; Laboratory of Neurosciences (J.D.M., R.L., G.E.M.) and Laboratory of Cardiovascular Registry (G.C.), Cardiovascular Institute, University of Zulia, Maracaibo, Venezuela; and Departments of Neuroscience and Human Genetics (G.M.), School of Medicine, University of Texas Rio Grande Valley, Brownsville.
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Jesus D. Melgarejo
From the Taub Institute for Research on Alzheimer's Disease and the Aging Brain (A.G.C., K.C.I., P.J.L., K.K.L., B.R., M.B., I.B.M., J.H.L., A.M.B.), Gertrude H. Sergievsky Center (J.H.L., A.M.B.), and Department of Neurology (J.H.L., A.M.B.), College of Physicians and Surgeons, and Department of Epidemiology (J.H.L.), Joseph P. Mailman School of Public Health, Columbia University, New York, NY; Laboratory of Neurosciences (J.D.M., R.L., G.E.M.) and Laboratory of Cardiovascular Registry (G.C.), Cardiovascular Institute, University of Zulia, Maracaibo, Venezuela; and Departments of Neuroscience and Human Genetics (G.M.), School of Medicine, University of Texas Rio Grande Valley, Brownsville.
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Reinier Leendertz
From the Taub Institute for Research on Alzheimer's Disease and the Aging Brain (A.G.C., K.C.I., P.J.L., K.K.L., B.R., M.B., I.B.M., J.H.L., A.M.B.), Gertrude H. Sergievsky Center (J.H.L., A.M.B.), and Department of Neurology (J.H.L., A.M.B.), College of Physicians and Surgeons, and Department of Epidemiology (J.H.L.), Joseph P. Mailman School of Public Health, Columbia University, New York, NY; Laboratory of Neurosciences (J.D.M., R.L., G.E.M.) and Laboratory of Cardiovascular Registry (G.C.), Cardiovascular Institute, University of Zulia, Maracaibo, Venezuela; and Departments of Neuroscience and Human Genetics (G.M.), School of Medicine, University of Texas Rio Grande Valley, Brownsville.
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Kay C. Igwe
From the Taub Institute for Research on Alzheimer's Disease and the Aging Brain (A.G.C., K.C.I., P.J.L., K.K.L., B.R., M.B., I.B.M., J.H.L., A.M.B.), Gertrude H. Sergievsky Center (J.H.L., A.M.B.), and Department of Neurology (J.H.L., A.M.B.), College of Physicians and Surgeons, and Department of Epidemiology (J.H.L.), Joseph P. Mailman School of Public Health, Columbia University, New York, NY; Laboratory of Neurosciences (J.D.M., R.L., G.E.M.) and Laboratory of Cardiovascular Registry (G.C.), Cardiovascular Institute, University of Zulia, Maracaibo, Venezuela; and Departments of Neuroscience and Human Genetics (G.M.), School of Medicine, University of Texas Rio Grande Valley, Brownsville.
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Patrick J. Lao
From the Taub Institute for Research on Alzheimer's Disease and the Aging Brain (A.G.C., K.C.I., P.J.L., K.K.L., B.R., M.B., I.B.M., J.H.L., A.M.B.), Gertrude H. Sergievsky Center (J.H.L., A.M.B.), and Department of Neurology (J.H.L., A.M.B.), College of Physicians and Surgeons, and Department of Epidemiology (J.H.L.), Joseph P. Mailman School of Public Health, Columbia University, New York, NY; Laboratory of Neurosciences (J.D.M., R.L., G.E.M.) and Laboratory of Cardiovascular Registry (G.C.), Cardiovascular Institute, University of Zulia, Maracaibo, Venezuela; and Departments of Neuroscience and Human Genetics (G.M.), School of Medicine, University of Texas Rio Grande Valley, Brownsville.
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Krystal K. Laing
From the Taub Institute for Research on Alzheimer's Disease and the Aging Brain (A.G.C., K.C.I., P.J.L., K.K.L., B.R., M.B., I.B.M., J.H.L., A.M.B.), Gertrude H. Sergievsky Center (J.H.L., A.M.B.), and Department of Neurology (J.H.L., A.M.B.), College of Physicians and Surgeons, and Department of Epidemiology (J.H.L.), Joseph P. Mailman School of Public Health, Columbia University, New York, NY; Laboratory of Neurosciences (J.D.M., R.L., G.E.M.) and Laboratory of Cardiovascular Registry (G.C.), Cardiovascular Institute, University of Zulia, Maracaibo, Venezuela; and Departments of Neuroscience and Human Genetics (G.M.), School of Medicine, University of Texas Rio Grande Valley, Brownsville.
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Batool Rizvi
From the Taub Institute for Research on Alzheimer's Disease and the Aging Brain (A.G.C., K.C.I., P.J.L., K.K.L., B.R., M.B., I.B.M., J.H.L., A.M.B.), Gertrude H. Sergievsky Center (J.H.L., A.M.B.), and Department of Neurology (J.H.L., A.M.B.), College of Physicians and Surgeons, and Department of Epidemiology (J.H.L.), Joseph P. Mailman School of Public Health, Columbia University, New York, NY; Laboratory of Neurosciences (J.D.M., R.L., G.E.M.) and Laboratory of Cardiovascular Registry (G.C.), Cardiovascular Institute, University of Zulia, Maracaibo, Venezuela; and Departments of Neuroscience and Human Genetics (G.M.), School of Medicine, University of Texas Rio Grande Valley, Brownsville.
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Mariana Budge
From the Taub Institute for Research on Alzheimer's Disease and the Aging Brain (A.G.C., K.C.I., P.J.L., K.K.L., B.R., M.B., I.B.M., J.H.L., A.M.B.), Gertrude H. Sergievsky Center (J.H.L., A.M.B.), and Department of Neurology (J.H.L., A.M.B.), College of Physicians and Surgeons, and Department of Epidemiology (J.H.L.), Joseph P. Mailman School of Public Health, Columbia University, New York, NY; Laboratory of Neurosciences (J.D.M., R.L., G.E.M.) and Laboratory of Cardiovascular Registry (G.C.), Cardiovascular Institute, University of Zulia, Maracaibo, Venezuela; and Departments of Neuroscience and Human Genetics (G.M.), School of Medicine, University of Texas Rio Grande Valley, Brownsville.
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Irene B. Meier
From the Taub Institute for Research on Alzheimer's Disease and the Aging Brain (A.G.C., K.C.I., P.J.L., K.K.L., B.R., M.B., I.B.M., J.H.L., A.M.B.), Gertrude H. Sergievsky Center (J.H.L., A.M.B.), and Department of Neurology (J.H.L., A.M.B.), College of Physicians and Surgeons, and Department of Epidemiology (J.H.L.), Joseph P. Mailman School of Public Health, Columbia University, New York, NY; Laboratory of Neurosciences (J.D.M., R.L., G.E.M.) and Laboratory of Cardiovascular Registry (G.C.), Cardiovascular Institute, University of Zulia, Maracaibo, Venezuela; and Departments of Neuroscience and Human Genetics (G.M.), School of Medicine, University of Texas Rio Grande Valley, Brownsville.
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Gustavo Calmon
From the Taub Institute for Research on Alzheimer's Disease and the Aging Brain (A.G.C., K.C.I., P.J.L., K.K.L., B.R., M.B., I.B.M., J.H.L., A.M.B.), Gertrude H. Sergievsky Center (J.H.L., A.M.B.), and Department of Neurology (J.H.L., A.M.B.), College of Physicians and Surgeons, and Department of Epidemiology (J.H.L.), Joseph P. Mailman School of Public Health, Columbia University, New York, NY; Laboratory of Neurosciences (J.D.M., R.L., G.E.M.) and Laboratory of Cardiovascular Registry (G.C.), Cardiovascular Institute, University of Zulia, Maracaibo, Venezuela; and Departments of Neuroscience and Human Genetics (G.M.), School of Medicine, University of Texas Rio Grande Valley, Brownsville.
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Joseph H. Lee
From the Taub Institute for Research on Alzheimer's Disease and the Aging Brain (A.G.C., K.C.I., P.J.L., K.K.L., B.R., M.B., I.B.M., J.H.L., A.M.B.), Gertrude H. Sergievsky Center (J.H.L., A.M.B.), and Department of Neurology (J.H.L., A.M.B.), College of Physicians and Surgeons, and Department of Epidemiology (J.H.L.), Joseph P. Mailman School of Public Health, Columbia University, New York, NY; Laboratory of Neurosciences (J.D.M., R.L., G.E.M.) and Laboratory of Cardiovascular Registry (G.C.), Cardiovascular Institute, University of Zulia, Maracaibo, Venezuela; and Departments of Neuroscience and Human Genetics (G.M.), School of Medicine, University of Texas Rio Grande Valley, Brownsville.
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Gladys E. Maestre
From the Taub Institute for Research on Alzheimer's Disease and the Aging Brain (A.G.C., K.C.I., P.J.L., K.K.L., B.R., M.B., I.B.M., J.H.L., A.M.B.), Gertrude H. Sergievsky Center (J.H.L., A.M.B.), and Department of Neurology (J.H.L., A.M.B.), College of Physicians and Surgeons, and Department of Epidemiology (J.H.L.), Joseph P. Mailman School of Public Health, Columbia University, New York, NY; Laboratory of Neurosciences (J.D.M., R.L., G.E.M.) and Laboratory of Cardiovascular Registry (G.C.), Cardiovascular Institute, University of Zulia, Maracaibo, Venezuela; and Departments of Neuroscience and Human Genetics (G.M.), School of Medicine, University of Texas Rio Grande Valley, Brownsville.
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Adam M. Brickman
From the Taub Institute for Research on Alzheimer's Disease and the Aging Brain (A.G.C., K.C.I., P.J.L., K.K.L., B.R., M.B., I.B.M., J.H.L., A.M.B.), Gertrude H. Sergievsky Center (J.H.L., A.M.B.), and Department of Neurology (J.H.L., A.M.B.), College of Physicians and Surgeons, and Department of Epidemiology (J.H.L.), Joseph P. Mailman School of Public Health, Columbia University, New York, NY; Laboratory of Neurosciences (J.D.M., R.L., G.E.M.) and Laboratory of Cardiovascular Registry (G.C.), Cardiovascular Institute, University of Zulia, Maracaibo, Venezuela; and Departments of Neuroscience and Human Genetics (G.M.), School of Medicine, University of Texas Rio Grande Valley, Brownsville.
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  • ORCID record for Adam M. Brickman
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White matter hyperintensities mediate the association of nocturnal blood pressure with cognition
Anthony G. Chesebro, Jesus D. Melgarejo, Reinier Leendertz, Kay C. Igwe, Patrick J. Lao, Krystal K. Laing, Batool Rizvi, Mariana Budge, Irene B. Meier, Gustavo Calmon, Joseph H. Lee, Gladys E. Maestre, Adam M. Brickman
Neurology Apr 2020, 94 (17) e1803-e1810; DOI: 10.1212/WNL.0000000000009316

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Abstract

Objective To test the hypotheses that hypertension and nocturnal blood pressure are related to white matter hyperintensity (WMH) volume, an MRI marker of small vessel cerebrovascular disease, and that WMH burden statistically mediates the association of hypertension and dipping status with memory functioning, we examined the relationship of hypertension and dipping status on WMH volume and neuropsychological test scores in middle-aged and older adults.

Methods Participants from the community-based Maracaibo Aging Study received ambulatory 24-hour blood pressure monitoring, structural MRI, and neuropsychological assessment. Four hundred thirty-five participants (mean ± SD age 59 ± 13 years, 71% women) with available ambulatory blood pressure, MRI, and neuropsychological data were included in the analyses. Ambulatory blood pressure was used to define hypertension and dipping status (i.e., dipper, nondipper, and reverse dipper based on night/day blood pressure ratio <0.9, 0.9–1, and >1, respectively). Outcome measures included regional WMH and memory functioning derived from a neuropsychological test battery.

Results The majority of the participants (59%) were hypertensive. Ten percent were reverse dippers, and 40% were nondippers. Reverse dipping in the presence of hypertension was associated with particularly elevated periventricular WMH volume (F2,423 = 3.78, p = 0.024) and with lowered memory scores (F2,423 = 3.911, p = 0.021). Periventricular WMH volume mediated the effect of dipping status and hypertension on memory (β = −4.1, 95% confidence interval −8.7 to −0.2, p < 0.05).

Conclusion Reverse dipping in the presence of hypertension is associated with small vessel cerebrovascular disease, which, in turn, mediates memory functioning. These results point toward reverse dipping as a marker of poor nocturnal blood pressure control, particularly among hypertensive individuals, with potentially pernicious effects on cerebrovascular health and associated cognitive function.

Glossary

CDR=
Clinical Dementia Rating;
CI=
confidence interval;
IED=
Intra-Extra Dimensional Set Shift;
MAS=
Maracaibo Aging Study;
PAL=
Paired Associated Learning;
RTI=
Reaction Time;
WMH=
white matter hyperintensities

Footnotes

  • Go to Neurology.org/N for full disclosures. Funding information and disclosures deemed relevant by the authors, if any, are provided at the end of the article.

  • Podcast: NPub.org/89xwc1

  • Received September 13, 2019.
  • Accepted in final form November 12, 2019.
  • © 2020 American Academy of Neurology
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Disputes & Debates: Rapid online correspondence

  • Author response: White matter hyperintensities mediate the association of nocturnal blood pressure with cognition
    • Anthony G. Chesebro, scientist, Columbia University
    • Jesus D. Melgarejo, scientist, University of Zulia
    • Reinier Leendertz, scientist, University of Zulia
    • Kay C. Igwe, scientist, Columbia University
    • Patrick J. Lao, scientist, Columbia University
    • Krystal K. Laing, scientist, Columbia University
    • Batool Rizvi, scientist, Columbia University
    • Mariana Budge, scientist, Columbia University
    • Irene B. Meier, scientist, Columbia University
    • Gustavo Calmon, scientist, Columbia University
    • Joseph H. Lee, scientist, Columbia University
    • Gladys Maestre, scientist, University of Texas Rio Grande Valley
    • Adam M. Brickman, scientist, Columbia University
    Submitted June 05, 2020
  • Reader response: White matter hyperintensities mediate the association of nocturnal blood pressure with cognition
    • Nevio Cimolai, Physician, Faculty of Medicine, The University of British Columbia
    Submitted May 25, 2020
  • Reader response: White matter hyperintensities mediate the association of nocturnal blood pressure with cognition
    • Mark J. Fisher, Professor of Neurology, UC Irvine
    • Annlia Paganini-Hill, Faculty, UC Irvine
    • Claudia H. Kawas, Professor of Neurology, UC Irvine
    • Maria M. Corrada, Professor of Neurology, UC Irvine
    • Evan Fletcher, Faculty, UC Davis
    Submitted May 20, 2020
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