Association between low values of mean arterial pressure and impaired cognitive performance in older patients with mild cognitive impairment: cross-sectional preliminary findings from the STRENGTH Project

Abstract

Background: Uncontrolled blood pressure (BP) is a risk factor for Mild Cognitive Impairment (MCI) and dementia.

Aims: This study examined the relationship between BP and clinical/cognitive/neuropsychological aspects in MCI individuals.

Methods: MCI patients underwent clinical, functional, cognitive and metacognitive, as well as psychological assessments. Social network, lifestyle characteristics, and medication prescriptions were also evaluated. Each patient underwent BP measurements.

Results: Lower values of systolic BP (SBP), diastolic BP (DBP), and mean arterial pressure (MAP) were associated with poorer cognitive performance. Notably, MAP showed greater capability in detecting impairments in attention and visuospatial abilities compared to SBP and DBP.

Discussion: These findings support the notion that in older individuals with MCI excessively low BP values, particularly MAP, might represent a risk and suggest that cerebral hypoperfusion may play a key role.

Conclusions: Routine assessment of MAP could aid clinicians in adjusting antihypertensive treatment and closely monitoring cognitive function in MCI patients.

Keywords: Cognitive performance; Mean arterial pressure; Mild cognitive impairment; Neuropsychological assessment; Older adults.

Fig. 1

Mean arterial pressure (MAP) exhibits significant correlations with a greater number of cognitive/neuropsychological domains compared to systolic and diastolic blood pressures (SBP and DBP). MAP shows positive correlations with scores on the Montreal Cognitive Assessment (MoCA) (A) and Corsi Supra-Span test (B) and negative correlations with scores on the trail making test A (TMT A) (C) and Memory Complaint Questionnaire (MAC-Q) (D). These correlations indicate that patients with lower MAP tend to have poorer cognitive/neuropsychological performances. SBP correlates positively with scores on the Corsi Supra-Span test (E) and negatively with scores on TMT A (F), while DBP correlates positively with scores on TMT A (G). Therefore, SBP and DBP also indicate that lower values are associated with poorer performances, albeit in a smaller number of functional domains. *p < 0.05; **p < 0.01

Fig. 2

Mean arterial pressure (MAP) better reflects performance in the TMT A test than systolic and diastolic blood pressures (SBP and DBP). MAP values are significantly higher in non-impaired (Z score < 1) and borderline (Z score ≥ 1/ < 2) subjects compared to impaired (Z score ≥ 2) patients (A). On the other hand, SBP (B) and DBP (C) are significantly higher only in non-impaired than impaired subjects. These findings suggest that MAP may be a more robust indicator of performance in the TMT A test, while SBP and DBP may have a more limited association with cognitive impairment in this context. *p < 0.05; **p < 0.01; ***p < 0.001