Cognitive dysfunction and greater visit-to-visit systolic blood pressure variability

To determine whether variability in blood pressure (BP) is negatively associated with performance on cognitive testing.

Multinational, longitudinal, observational cohort study.

The Alzheimer's Disease Neuroimaging Initiative study.

Individuals with a screening diagnosis of mild cognitive impairment or normal cognition (N=626).

Mean, variance, and maximum BP were calculated based on measures collected from screening to 36 months. Analysis of covariance models were used to determine the association between BP measures and cognitive scores at 36 months after adjusting for covariates.

Greater variability in systolic (P<.05) but not diastolic (P>.18) BP was associated with worse global (Modified Alzheimer's Disease Assessment Scale Cognitive Component and Clinical Dementia Rating sum of boxes) and executive (Trail-Making Test Part B, Animal Fluency, and Vegetable Fluency) function and episodic memory (Rey Auditory Verbal Learning Test Total Score).

There is a clinically significant association between greater systolic BP variability and greater cognitive dysfunction. These results should be verified in other well-characterized cohorts, and the neuroanatomical pathophysiology underlying the observed greater cognitive impairment should be further explored.