Hypertension and cognition are minimally associated in late life

Sex differences in the association between hypertension, cerebral small vessel disease and cognitive decline: a narrative review

The objective of this study was to review how cerebral small vessel disease (CSVD) is associated with hypertension and cognitive decline, specifically regarding sex differences in this association. Strong evidence supports the associations between hypertension and cognitive decline, hypertension and CSVD, as well as CSVD and cognitive decline in both women and men. Sex-stratified analyses show that compared to men, hypertension leads to worse cognitive decline in women likely due to its stronger association with CSVD in women. Indeed, compared to men, prevalence of CSVD and CSVD lesion progression is also higher in women and later in life, the incidence of hypertension is higher in women. Moreover, the association between hypertension and CSVD was found to be stronger in women, as was the association between hypertension and cognitive decline. Therefore, focus on hypertension and CSVD as an important pathophysiological mechanism for cognitive decline may uncover novel sex-specific therapeutic avenues.

Characteristics of hypertension and its impact on cognitive functions in older adults: a cross-sectional study

Background

Hypertension is a potentially modifiable risk factor for cognitive decline. Understanding the variables of hypertension related to cognitive functions will help in mitigating the risk.

Objective

The study aims to assess the characteristics of hypertension and its effect on cognitive functions in the older adults.

Methods

The study involved 95 hypertensive participants aged 60 years and above from cardiology and medicine outpatient services of a tertiary care hospital from August to October 2022. The characteristics of hypertension and cognitive functions were assessed using semi-structured proforma and Adenbrooke's Cognitive Examination (ACE-III) Hindi version respectively. Further, individual cognitive functions were compared with duration of the hypertension and hypertensive status of the participants. The chi-square test and independent t-tests were used and p value < 0.05 was considered to be significant.

Result

The mean age of the study population was 68.2 years, the cognitive functions was comparable in terms of age, sex, locality, co-morbidity, and treatment characteristic. Although a significant difference in cognitive functions was present in relation to duration and status of hypertension. Among the individual cognitive domains, a significant difference was observed in attention and fluency domains of cognitive function based on HTN status (p > 0.05) but differential effect on cognitive domains was not seen with the duration of HTN. However, there was overall decline in cognitive domains with both hypertension status and the duration of hypertension.

Conclusion

The study highlights association of status of hypertension and its characteristics with cognitive decline.

Gut microbiome predicts cognitive function and depressive symptoms in late life

Depression in older adults with cognitive impairment increases progression to dementia. Microbiota is associated with current mood and cognition, but the extent to which it predicts future symptoms is unknown. In this work, we identified microbial features that reflect current and predict future cognitive and depressive symptoms. Clinical assessments and stool samples were collected from 268 participants with varying cognitive and depressive symptoms. Seventy participants underwent 2-year follow-up. Microbial community diversity, structure, and composition were assessed using high-resolution 16 S rRNA marker gene sequencing. We implemented linear regression to characterize the relationship between microbiome composition, current cognitive impairment, and depressive symptoms. We leveraged elastic net regression to discover features that reflect current or future cognitive function and depressive symptoms. Greater microbial community diversity associated with lower current cognition in the whole sample, and greater depression in participants not on antidepressants. Poor current cognitive function associated with lower relative abundance of Bifidobacterium, while greater GABA degradation associated with greater current depression severity. Future cognitive decline associated with lower cognitive function, lower relative abundance of Intestinibacter, lower glutamate degradation, and higher baseline histamine synthesis. Future increase in depressive symptoms associated with higher baseline depression and anxiety, lower cognitive function, diabetes, lower relative abundance of Bacteroidota, and lower glutamate degradation. Our results suggest cognitive dysfunction and depression are unique states with an overall biological effect detectable through gut microbiota. The microbiome may present a noninvasive readout and prognostic tool for cognitive and psychiatric states.

Association between the incident hypertension duration and cognitive performance in older adults: data from the NHANES 2011-2014

BACKGROUND

Established evidences have demonstrated that hypertension was associated with the cognitive impairment. But the associations between the duration of hypertension exposure and cognitive performance are still inconclusive.

OBJECTIVES

The objective of this study was to assess the association between the duration of hypertension diagnosis and cognitive performance in older adults by the National Health and Nutrition Examination Survey (2011-2014).

METHODS

To evaluate the relationship between the hypertension duration and cognitive performance, we conducted the logistic regression analysis. Furthermore, we also performed the Restricted cubic spline (RCS) analysis to assess the nonlinear relationship between the duration of exposure to hypertension and cognitive performance.

RESULTS

Initially, total 19,931 participants were included in this study, and 2928 individuals were enrolled. With the increase of hypertension duration, more risk of cognitive impairment was observed in the Digit Symbol Substitution test (DSST) (OR = 1.012, 1.006-1.019), and a similar trend was observed in Animal Fluency test (AFT) (OR = 1.009,1.003-1.016). The RCS results showed that the hypertension duration pattern was linear associated with the risk of cognitive impairment in DDST (P for non-linearity = 0.758). Meanwhile, subgroups analysis of midlife hypertension, we revealed that linear association with the risk of cognitive impairment in DSST (P for non-linearity = 0.391) and CERAD (P for non-linearity = 0.849) among hypertension diagnose < 55 years populations.

CONCLUSION

Collectively, our finding indicates that longer duration of exposure to hypertension worsens the cognition performance, especially for middle-aged hypertension.

Obstructive sleep apnea and non-dipper: epiphenomena or risks of Alzheimer's disease?: a review from the HOPE Asia Network

Obstructive sleep apnea (OSA) and associated nocturnal blood pressure (BP) surges is associated with non-dipper. On the other hand, the relationship between neurodegenerative diseases and non-dipper hypertension has been reported. To date, few studies have evaluated the relationships of nocturnal BP dipping patterns and OSA in relation to neurodegenerative diseases, particularly Alzheimer's disease (AD). This review examines the etiology of the association between OSA and the non-dipper pattern of hypertension and how both are involved in the development of AD. To set the stage for this review, we first focus on the pathophysiology of AD, which is interrelated with sleep apnea and non-dipper through dysregulation of central autonomic network.

2023 update and perspectives

Total 276 manuscripts were published in Hypertension Research in 2022. Here our editorial members picked up the excellent papers, summarized the current topics from the published papers and discussed future perspectives in the sixteen fields. We hope you enjoy our special feature, 2023 update and perspectives in Hypertension Research.