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Neurology. 2017 Dec 5;89(23):2327-2334. doi: 10.1212/WNL.0000000000004707. Epub 2017 Nov 8.

Lower cardiac index levels relate to lower cerebral blood flow in older adults.

Author information

1
From the Vanderbilt Memory & Alzheimer's Center (A.L.J., K.R.P., E.A.G., S.P.B., K.A.G., T.J.H., M.J.D.), Department of Neurology, Department of Biostatistics (D.L.), Division of Cardiovascular Medicine (D.K.G., S.P.B., L.A.M., T.J.W.), Department of Medicine, Division of General Internal Medicine, Center for Quality Aging (S.P.B.), Radiology & Radiological Sciences (L.T.D., M.J.D.), and Department of Psychiatry (M.J.D.), Vanderbilt University Medical Center; Vanderbilt University Institute of Imaging Science (J.M.W., M.J.D.), Nashville, TN; and Radiology (S.R.), University of Washington Medical Center, Seattle. angela.jefferson@vanderbilt.edu.
2
From the Vanderbilt Memory & Alzheimer's Center (A.L.J., K.R.P., E.A.G., S.P.B., K.A.G., T.J.H., M.J.D.), Department of Neurology, Department of Biostatistics (D.L.), Division of Cardiovascular Medicine (D.K.G., S.P.B., L.A.M., T.J.W.), Department of Medicine, Division of General Internal Medicine, Center for Quality Aging (S.P.B.), Radiology & Radiological Sciences (L.T.D., M.J.D.), and Department of Psychiatry (M.J.D.), Vanderbilt University Medical Center; Vanderbilt University Institute of Imaging Science (J.M.W., M.J.D.), Nashville, TN; and Radiology (S.R.), University of Washington Medical Center, Seattle.

Abstract

OBJECTIVE:

To assess cross-sectionally whether lower cardiac index relates to lower resting cerebral blood flow (CBF) and cerebrovascular reactivity (CVR) among older adults.

METHODS:

Vanderbilt Memory & Aging Project participants free of stroke, dementia, and heart failure were studied (n = 314, age 73 ± 7 years, 59% male, 39% with mild cognitive impairment). Cardiac index (liters per minute per meter squared) was quantified from echocardiography. Resting CBF (milliliters per 100 grams per minute) and hypercapnia-induced CVR were quantified from pseudo-continuous arterial spin-labeling MRI. Linear regressions with ordinary least-square estimates related cardiac index to regional CBF, with adjustment for age, education, race/ethnicity, Framingham Stroke Risk Profile score (systolic blood pressure, antihypertensive medication use, diabetes mellitus, current cigarette smoking, left ventricular hypertrophy, prevalent cardiovascular disease [CVD], atrial fibrillation), APOE ε4 status, cognitive diagnosis, and regional tissue volume.

RESULTS:

Lower cardiac index corresponded to lower resting CBF in the left (β = 2.4, p = 0.001) and right (β = 2.5, p = 0.001) temporal lobes. Results were similar when participants with prevalent CVD and atrial fibrillation were excluded (left temporal lobe β = 2.3, p = 0.003; right temporal lobe β = 2.5, p = 0.003). Cardiac index was unrelated to CBF in other regions assessed (p > 0.25) and CVR in all regions (p > 0.05). In secondary cardiac index × cognitive diagnosis interaction models, cardiac index and CBF associations were present only in cognitively normal participants and affected a majority of regions assessed with effects strongest in the left (p < 0.0001) and right (p < 0.0001) temporal lobes.

CONCLUSIONS:

Among older adults without stroke, dementia, or heart failure, systemic blood flow correlates with cerebral CBF in the temporal lobe, independently of prevalent CVD, but not CVR.

PMID:
29117962
PMCID:
PMC5719926
[Available on 2018-12-05]
DOI:
10.1212/WNL.0000000000004707
[Indexed for MEDLINE]

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