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Updated: Jul 8, 2026
Evaluation of the Cognitive Performance of Hypertensive Patients with Silent Cerebrovascular Lesions
Published on: April 23, 2021
Abnormal regional cerebral blood flow in cognitively normal elderly subjects with hypertension
Weiying Dai1, Oscar L Lopez, Owen T Carmichael
1Department of Computer Sciences, University of Pittsburgh School of Medicine, Pittsburgh, PA, USA.
Insights
Hypertension (HTN) is linked to reduced regional cerebral blood flow (rCBF) in cognitively normal individuals, affecting brain regions beyond subcortical areas. This suggests HTN may create vulnerability for neurodegenerative disorders like Alzheimer disease.
Area of Science:
- Neuroimaging
- Cerebrovascular Health
- Cognitive Neurology
Background:
- Hypertension (HTN) is a known risk factor for cerebrovascular disease and potentially Alzheimer disease, linked to mechanisms like ischemia and inflammation.
- Few population-based studies have investigated regional cerebral blood flow (rCBF) in cognitively normal individuals with HTN.
- Continuous arterial spin-labeled MRI offers a noninvasive method to measure absolute rCBF without radiation or injections.
Purpose of the Study:
- To assess regional cerebral blood flow (rCBF) in cognitively normal subjects with hypertension (HTN) using continuous arterial spin-labeled MRI.
- To investigate the impact of HTN on brain perfusion in individuals without cognitive impairment.
Main Methods:
- Continuous arterial spin-labeled MRI was employed to measure rCBF in 41 cognitively normal participants from the Cardiovascular Health Study Cognition Study.
- A deformable atrophy-corrected registration method standardized rCBF maps to a common brain space.
- Statistical analyses, including image and cluster-based approaches, were performed to compare groups.
Main Results:
- Cognitively normal subjects with HTN exhibited significantly decreased rCBF in subcortical regions, including the putamen and globus pallidus (bilaterally).
- Reduced rCBF was also observed in limbic and paralimbic structures, such as the hippocampus, anterior cingulate gyrus, posterior cingulate gyrus, medial precuneus, and various cortical areas.
- These findings indicate widespread effects of HTN on brain perfusion even in the absence of cognitive decline.
Conclusions:
- Hypertension impacts rCBF not only in subcortical areas but also in crucial limbic and paralimbic brain structures.
- The study hypothesizes that HTN establishes a vulnerability state conducive to the development of neurodegenerative disorders, particularly Alzheimer disease.
- These findings underscore the importance of managing HTN to potentially mitigate risks for cognitive decline and neurodegeneration.
Background And Purpose:
The purpose of this study was to examine regional cerebral blood flow (rCBF) in normal cognitive-performing subjects with hypertension (HTN) using continuous arterial spin-labeled MRI. The most common explanation for the effect of blood pressure on cognition is that HTN increases the risk of cerebrovascular disease, and it may increase the risk for Alzheimer disease possibly through small vessel disease, ischemia, oxidative stress, and inflammation. However, few studies to date have examined the rCBF of cognitively normal subjects with HTN in population-based cohorts, and none have used continuous arterial spin-labeled MRI. This is a noninvasive technique that does not require either injections or ionizing radiation and can measure absolute rCBF rates over the entire brain.
Methods:
rCBF was measured at 1.5 T using continuous arterial spin-labeled MRI in 41 cognitively normal subjects who were participating in the Cardiovascular Health Study Cognition Study. A deformable atrophy-corrected registration method was used to warp the rCBF maps to the standard colin27 brain space. Image and cluster-based statistical analyses were performed between subject groups.
Results:
Cognitively normal subjects with HTN (n=19) had decreased rCBF in the putamen, globus pallidus, bilaterally, and in the left hippocampus compared with normotensives (n=22). In addition, decreased rCBF was observed in the right and left anterior cingulate gyrus with extension to the subcallosal region, left posterior cingulate gyrus and medial precuneus, left lateral inferior and superior frontal, and inferior parietal, left orbitofrontal, and left superior temporal cortices.
Conclusions:
rCBF is affected in normal subjects with HTN, not only in the subcortical regions, but also in limbic and paralimbic structures. We hypothesize that the HTN creates a vulnerability state for the development of neurodegenerative disorders, especially Alzheimer disease.
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