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Abstract
Background and Objectives The Boston Puerto Rican Health Study (BPRHS) is a longitudinal study following self-identified Puerto Rican older adults living in the Greater Boston area. Studies have shown higher prevalence of hypertension (HTN) and type 2 diabetes (T2D) within this ethnic group compared to age-matched non-Hispanic White adults. In this study, we investigated the associations of HTN and T2D comorbidity on brain structural integrity and cognitive capacity in community-dwelling Puerto Rican adults and compared these measures with older adult participants (non-Hispanic White and Hispanic) from the Alzheimer's Disease Neuroimaging Initiative (ADNI) and National Alzheimer's Coordinating Center (NACC) databases.
Methods BPRHS participants who underwent brain MRI and cognitive testing were divided into 4 groups based on their HTN and T2D status: HTN−/T2D−, HTN+/T2D−, HTN−/T2D+, and HTN+/T2D+. We assessed microstructural integrity of white matter (WM) pathways using diffusion MRI, brain macrostructural integrity using hippocampal volumes, and brain age using T1-weighted MRI and cognitive test scores. BPRHS results were then compared with results from non-Hispanic White and Hispanic participants from the ADNI and NACC databases.
Results The prevalence of HTN was almost 2 times (66.7% vs 38.7%) and of T2D was 5 times (31.8% vs 6.6.%) higher in BPRHS than in ADNI non-Hispanic White participants. Diffusion MRI showed clear deterioration patterns in major WM tracts in the HTN+/T2D+ group and, to a lesser extent, in the HTN+/T2D− group compared to the HTN−/T2D− group. HTN+/T2D+ participants also had the smallest hippocampal volume and larger brain aging deviations. Trends toward lower executive function and global cognitive scores were observed in HTN+/T2D+ relative to HTN−/T2D− individuals. MRI measures and the Mini-Mental State Examination (MMSE) scores from the HTN+/T2D+ BPRHS group resembled those of ADNI White participants with progressive mild cognitive impairment (MCI), while the BPRHS HTN−/T2D− participants resembled participants with stable MCI. The BPRHS was not significantly different from the ADNI + NACC Hispanic cohort on imaging or MMSE measures.
Discussion The effects of T2D and HTN comorbidity led to greater brain structural disruptions than HTN alone. The high prevalence of HTN and T2D in the Puerto Rican population may be a key factor contributing to health disparities in cognitive impairment in this group compared to non-Hispanic White adults in the same age range.
Trial Registration Information ClinicalTrials.gov identifier: NCT01231958.
Glossary
- AD=
- Alzheimer disease;
- ADNI=
- Alzheimer's Disease Neuroimaging Initiative;
- BMI=
- body mass index;
- BP=
- blood pressure;
- BPRHS=
- Boston Puerto Rican Health Study;
- CN=
- cognitively normal;
- FA=
- flip angle;
- FOV=
- field of view;
- GCS=
- global cognitive score;
- GM=
- gray matter;
- HTN=
- hypertension;
- IFOF=
- inferior fronto-occipital fasciculus;
- ILF=
- inferior longitudinal fasciculus;
- MCI=
- mild cognitive impairment;
- MCIc=
- MCI converter;
- MCInc=
- MCI nonconverter;
- MMSE=
- Mini-Mental State Examination;
- NACC=
- National Alzheimer's Coordinating Center;
- NDI=
- neurite density imaging;
- ST=
- slice thickness;
- TE=
- echo time;
- TI=
- inversion time;
- TL=
- total slices;
- TR=
- repetition time;
- T2D=
- type 2 diabetes;
- WM=
- white matter
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.
↵* These authors contributed equally to this work as first authors.
Data used in preparation of this article were obtained from the Alzheimer's Disease Neuroimaging Initiative (ADNI) database (adni.loni.usc.edu). As such, the investigators within the ADNI contributed to the design and implementation of ADNI and/or provided data but did not participate in analysis or writing of this report. A complete listing of ADNI investigators can be found in Appendix 2 at links.lww.com/WNL/B833.
Editorial, page 609
- Received September 27, 2021.
- Accepted in final form January 11, 2022.
- © 2022 American Academy of Neurology
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