Progression in cerebral small vessel disease signals cognitive decline

Hypertensive patients who had periventricular white matter abnormalities progress from one brain scan to the next showed a six-fold increased risk of mild cognitive impairment, researchers reported Jan. 4 in Hypertension.

High blood pressure has been linked to cognitive decline and evidence of cerebral small vessel disease—including periventricular white matter hyperintensities (PVH) and cerebral microbleeds—may signal a slide in mental function as well. However, no previous studies had assessed whether markers of cerebral small vessel disease were associated with the development of cognitive impairment in a cohort of patients with hypertension.

To address this knowledge gap, lead author Joan Jimenez-Balado and colleagues followed 345 hypertensive patients for about four years, conducting brain MRIs both on an initial visit and during a follow-up visit. Patients were a median of 65 years old at baseline without a previous history of stroke or dementia.

During follow-up, 9 percent of patients developed mild cognitive impairment based on a screening tool which measures cognitive function based on subscales including memory, conceptualization, attention and construction. Patients who showed a marked progression in PVH were 6.2 times more likely to demonstrate that early stage of cognitive decline versus individuals who didn’t have the same advancement in white matter abnormalities.

Also, the 5.5 percent of patients who were found to have small vessel bleeding in the brain were more likely to demonstrate drops in their attention capacity.

“The brain is an organ exposed to a high volume of blood flow and it is very vulnerable to sustained high blood pressure levels, and this might be happening silently or with mild symptoms, but that doesn’t mean there aren’t consequences,” Jimenez-Balado, a PhD student in psychology at the Vall Hebron Research Institute in Barcelona, Spain, said in a press release. “High blood pressure and its consequences are really ‘covert’ diseases that tend to progress if it is not well managed.”