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January 24, 2005

Association between blood pressure, white matter lesions, and atrophy of the medial temporal lobe

T. den Heijer, MD, PhD, L. J. Launer, PhD, N. D. Prins, MD, PhD, E. J. van Dijk, MD, PhD, S. E. Vermeer, MD, PhD, A. Hofman, MD, PhD, P. J. Koudstaal, MD, PhD, and M. M.B. Breteler, MD, PhDAuthors Info & Affiliations

January 25, 2005 issue

64 (2) 263-267

https://doi.org/10.1212/01.WNL.0000149641.55751.2E

Abstract

Background: Blood pressure level is associated with the risk of clinical Alzheimer disease (AD), yet the underlying mechanisms are unclear. High blood pressure levels may cause cerebral small-vessel pathology, which contributes to cognitive decline in patients with AD. Alternatively, in persons with high blood pressure, increased numbers of neurofibrillary tangles and amyloid plaques at autopsy have also been observed, suggesting direct links between blood pressure and AD.

Objective: To investigate the association of blood pressure and markers of small-vessel disease (white matter lesions [WMLs] on MRI) with hippocampal and amygdalar atrophy on MRI—potential in vivo indicators of Alzheimer pathology.

Methods: In 1995 to 1996, 511 nondemented elderly subjects (age 60 to 90) underwent MRI. The extent of WMLs was assessed, and volumes of the hippocampus and amygdala were measured. Blood pressure levels were assessed at the time of MRI and 5 years before the MRI.

Results: Higher diastolic blood pressure 5 years before MRI predicted more hippocampal atrophy in persons untreated for hypertension (per SD increase −0.10 mL [95% CI −0.19 to −0.02, p = 0.02]). Conversely, in persons treated for hypertension, a low diastolic blood pressure was associated with more severe atrophy. Persons with more WMLs on MRI more often had severe atrophy of the hippocampus and amygdala.

Conclusion: Blood pressure and indicators of small-vessel disease in the brain may be associated with atrophy of structures affected by Alzheimer pathology.

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Information & Authors

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Published In

Neurology^®

Volume 64 • Number 2 • January 25, 2005

Pages: 263-267

PubMed: 15668423

Copyright

© 2005.

Publication History

Published online: January 24, 2005

Published in print: January 25, 2005

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Authors

Affiliations & Disclosures

T. den Heijer, MD, PhD

From the Departments of Epidemiology and Biostatistics (Drs. Den Heijer, Prins, Van Dijk, Vermeer, Hofman, and Breteler) and Neurology (Drs. Den Heijer, Prins, Van Dijk, Vermeer, and Koudstaal), Erasmus Medical Center, Rotterdam, the Netherlands; and Neuroepidemiology Section (Dr. Launer), National Institute on Aging, Bethesda, MD.

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L. J. Launer, PhD

From the Departments of Epidemiology and Biostatistics (Drs. Den Heijer, Prins, Van Dijk, Vermeer, Hofman, and Breteler) and Neurology (Drs. Den Heijer, Prins, Van Dijk, Vermeer, and Koudstaal), Erasmus Medical Center, Rotterdam, the Netherlands; and Neuroepidemiology Section (Dr. Launer), National Institute on Aging, Bethesda, MD.

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N. D. Prins, MD, PhD

From the Departments of Epidemiology and Biostatistics (Drs. Den Heijer, Prins, Van Dijk, Vermeer, Hofman, and Breteler) and Neurology (Drs. Den Heijer, Prins, Van Dijk, Vermeer, and Koudstaal), Erasmus Medical Center, Rotterdam, the Netherlands; and Neuroepidemiology Section (Dr. Launer), National Institute on Aging, Bethesda, MD.

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E. J. van Dijk, MD, PhD

From the Departments of Epidemiology and Biostatistics (Drs. Den Heijer, Prins, Van Dijk, Vermeer, Hofman, and Breteler) and Neurology (Drs. Den Heijer, Prins, Van Dijk, Vermeer, and Koudstaal), Erasmus Medical Center, Rotterdam, the Netherlands; and Neuroepidemiology Section (Dr. Launer), National Institute on Aging, Bethesda, MD.

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S. E. Vermeer, MD, PhD

From the Departments of Epidemiology and Biostatistics (Drs. Den Heijer, Prins, Van Dijk, Vermeer, Hofman, and Breteler) and Neurology (Drs. Den Heijer, Prins, Van Dijk, Vermeer, and Koudstaal), Erasmus Medical Center, Rotterdam, the Netherlands; and Neuroepidemiology Section (Dr. Launer), National Institute on Aging, Bethesda, MD.

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A. Hofman, MD, PhD

From the Departments of Epidemiology and Biostatistics (Drs. Den Heijer, Prins, Van Dijk, Vermeer, Hofman, and Breteler) and Neurology (Drs. Den Heijer, Prins, Van Dijk, Vermeer, and Koudstaal), Erasmus Medical Center, Rotterdam, the Netherlands; and Neuroepidemiology Section (Dr. Launer), National Institute on Aging, Bethesda, MD.

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P. J. Koudstaal, MD, PhD

From the Departments of Epidemiology and Biostatistics (Drs. Den Heijer, Prins, Van Dijk, Vermeer, Hofman, and Breteler) and Neurology (Drs. Den Heijer, Prins, Van Dijk, Vermeer, and Koudstaal), Erasmus Medical Center, Rotterdam, the Netherlands; and Neuroepidemiology Section (Dr. Launer), National Institute on Aging, Bethesda, MD.

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M. M.B. Breteler, MD, PhD

From the Departments of Epidemiology and Biostatistics (Drs. Den Heijer, Prins, Van Dijk, Vermeer, Hofman, and Breteler) and Neurology (Drs. Den Heijer, Prins, Van Dijk, Vermeer, and Koudstaal), Erasmus Medical Center, Rotterdam, the Netherlands; and Neuroepidemiology Section (Dr. Launer), National Institute on Aging, Bethesda, MD.

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Notes

Address correspondence and reprint requests to Dr. M.M.B. Breteler, Department of Epidemiology and Biostatistics, Erasmus MC, 3000 DR Rotterdam, the Netherlands; e-mail: [email protected]

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