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Effect of Blood Pressure on Cognitive Functions in Elderly Persons

¹ Hebrew Rehabilitation Center for Aged, Boston, Massachusetts.
² Beth Israel Deaconess Medical Center, Boston, Massachusetts.
³ Brigham and Women's Hospital, Boston, Massachusetts.
⁴ New England GRECC, VA Boston Healthcare Division, Massachusetts.
⁵ Department of Psychiatry, Harvard Medical School, Boston, Massachusetts.
⁶ Division of Aging, Harvard Medical School, Boston, Massachusetts.
⁷ Department of Internal Medicine, National Taiwan University Hospital, Taipei.

Address correspondence to Dr. Lewis A. Lipsitz, Hebrew Rehabilitation Center for Aged, 1200 Centre St., Boston, MA 02131. E-mail: lipsitz{at}mail.hrca.harvard.edu

Background. Little is known about what specific cognitive functions are affected by elevated blood pressure (BP) and how orthostatic BP change is related to cognitive impairment. The aim of this study was to determine the effect of BP and its postural change on cognitive functions in otherwise healthy elders.

Methods. In 70 healthy persons (mean age, 72 ± 4 years), supine systolic BP (SBP) was assessed 3 times using a sphygmomanometer, and the average values were obtained for the analysis. After 1, 3, and 5 minutes of standing, 3 BP measurements were obtained and the orthostatic SBP changes were determined by subtracting these values from the supine average. Neuropsychological tests were administered to assess short-term and long-term verbal and visual memory, visuospatial skills, and frontal-executive functions. Participants were considered impaired in the specific cognitive performance if their scores fell below the 25th percentile of the study population. Multiple logistic regression models were used to evaluate the relation of SBP and the magnitude of orthostatic SBP decline to risk for impairment in each of the cognitive tests.

Results. Controlling for potential confounders, each 10 mmHg increase in supine SBP was associated with a 2.31-fold increase (95% confidence interval, 1.14 to 4.66) in risk for impairment in psychomotor speed and set shifting as measured using the Trailmaking Part-B test. There was no significant association between cognitive functions and orthostatic SBP decline at 1, 3, and 5 minutes of standing.

Conclusion. Elevation of BP is associated with a selective impairment in executive function in otherwise healthy community-dwelling elders.

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