Published Online
on February 26, 2009

A more recent version of this article appeared on April 1, 2009

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Submitted on July 31, 2008
Revised on September 19, 2008
Accepted on October 23, 2008

Vascular Structure and Function Is Correlated to Cognitive Performance and White Matter Hyperintensities in Older Hypertensive Patients With Subjective Memory Complaints

Anna Kearney-Schwartz MD; Patrick Rossignol MD, PhD; Serge Bracard MD; Jacques Felblinger PhD; Renaud Fay; Jean-Marc Boivin MD; Thomas Lecompte MD; Patrick Lacolley MD, PhD; Athanase Benetos MD, PhD; and Faiez Zannad MD, PhD^*

From Nancy University Hospital (A.K.-S., P.R., R.F., J.M.B., F.Z.) Clinical Investigation Centre (CIC), J. d'Arc Hospital, Dommartin lès Toul, France; Inserm (A.K.-S., P.R., R.F., J.M.B., F.Z.) CIC9501, J. d'Arc Hospital, Dommartin lès Toul, France; Nancy University (A.K.-S., P.R., S.B, J.F., R.F., J.M.B., T.L., P.L., A.B., F.Z.), Faculty of Medicine, Vandoeuvre lès Nancy, France; Inserm U684/961 (A.K.-S., P.R., T.L., P.L., A.B., F.Z.), Faculty of Medicine, Nancy University, Vandoeuvre lès Nancy, France; Nancy University Hospital (S.B.), Neuroradiology Service, Central Hospital, Nancy, France; Nancy University Hospital (A.B.), Geriatric Service, Nancy University Brabois Hospital, Vandoeuvre lès Nancy, France; Inserm ERI 13 Adaptative, Diagnostic and Interventional Imagery, and CIC-Innovative Technologies (J.F.), Brabois Hospital, Vandoeuvre lès Nancy, France; Inserm U 734 (UNIT-M) (T.L.), Faculty of Medicine, Nancy University, Vandoeuvre lès Nancy, France; Nancy University Hospital, Clinical Research-Clinical Laboratories Department, and Haemostasis Unit (Biological Haematology Department, (T.L.), Nancy University Brabois Hospital, Vandoeuvre lès Nancy, France.

^* To whom correspondence should be addressed. E-mail: f.zannad{at}chu-nancy.fr.

Background and Purpose—Arterial stiffening and thickening and endothelial dysfunction may be associated with cognitive decline or white matter hyperintensities (WMH) independently of blood pressure level. We aimed to investigate, using an integrative approach, the relative contributions of structural and functional vascular factors to the degree of cognitive impairment (primary outcome) and the severity of WMH (secondary outcome) in elderly hypertensive patients with subjective memory complaints, a group prone to dementia.

Methods—A prospective, dedicated, cross-sectional population of 198 elderly hypertensive patients (mean age 69.3±6.2 years) with subjective memory complaints underwent a full set of cognitive function assessments, brain MRI with semiquantification of WMH, carotid ultrasonography, carotid–femoral pulse wave velocity, brachial endothelial function, and plasma von Willebrand Factor measurements.

Results—After adjustment for the usual cardiovascular risk factors, increased arterial stiffness (as assessed by pulse wave velocity) was significantly and independently associated with memory impairment in men. The severity of WMH was independently associated with increased carotid intima media thickness and stiffness (as assessed by augmentation index) as well as with increased age and plasma levels of von Willebrand Factor, a biomarker of endothelial dysfunction.

Conclusions—Our data suggest that vascular abnormalities, independently of blood pressure levels, may play a role in the setting of subjective memory complaints as well as of WMH in elderly hypertensive patients. Arterial thickness and stiffness as well as endothelial function should be assessed simultaneously and may represent additional targets for the prevention of subjective memory complaints and WMH.

Key words: aging • arterial stiffness • cognitive impairment • hypertension • leukoaraiosis

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