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Lower Blood Pressure, Small-Vessel Disease, and Apathy in Older Persons With Mild Cognitive Deficits
Anne Suzanne Bertens1,2, Jessica C Foster-Dingley1, Jeroen van der Grond2
1Department of Psychiatry, Leiden University Medical Center, Leiden, The Netherlands.
Insights
In older adults, lower blood pressure (BP) is linked to apathy, especially in those with high cerebral small-vessel disease (CSVD) burden. This suggests BP needs vary based on CSVD severity for optimal psychological health.
Area of Science:
- Gerontology
- Neurology
- Cardiology
Background:
- Both high and low blood pressure (BP) are linked to apathy in older adults.
- Cerebral small-vessel disease (CSVD) burden may explain these contradictory findings.
- This study investigates the impact of CSVD burden on the BP-apathy association in the elderly.
Purpose of the Study:
- To explore how CSVD burden influences the relationship between BP and apathy in older individuals.
- To determine if BP thresholds for apathy symptoms differ based on CSVD severity.
Main Methods:
- Cross-sectional study in a primary care setting in the Netherlands.
- 210 community-dwelling older adults (mean age 80.7 years) with mild cognitive deficits on antihypertensive treatment.
- BP measured via home visits; apathy assessed using the Apathy Scale. CSVD burden categorized using a compound score.
Main Results:
- In the general population, lower systolic and diastolic BP correlated with more apathy symptoms.
- In older adults with a high CSVD burden (n=50), lower systolic and diastolic BP were significantly associated with increased apathy.
- No significant BP-apathy association was found in older adults with a low CSVD burden (n=160).
Conclusions:
- Lower BP is particularly associated with apathy in older individuals with a high CSVD burden.
- Optimal BP levels for psychological well-being may differ based on an individual's CSVD burden.
- Findings highlight the complex interplay between BP, CSVD, and apathy in aging populations.
Background:
In older persons, both high and low blood pressure (BP) levels are associated with symptoms of apathy. Population characteristics, such as burden of cerebral small-vessel disease (CSVD), may underlie these apparently contradictory findings. We aimed to explore, in older persons, whether the burden of CSVD affects the association between BP and apathy.
Design:
Cross-sectional study.
Setting:
Primary care setting, the Netherlands.
Participants:
Community-dwelling older persons (mean age = 80.7 years; SD = 4.1 years) with mild cognitive deficits and using antihypertensive treatment, participating in the baseline measurement of the magnetic resonance imaging substudy (n = 210) of the Discontinuation of Antihypertensive Treatment in the Elderly Study Leiden.
Measurements:
During home visits, BP was measured in a standardized way and apathy was assessed with the Apathy Scale (range = 0-42). Stratified linear regression analyses were performed according to the burden of CSVD. A higher burden of CSVD was defined as 2 or more points on a compound CSVD score (range = 0-3 points), defined as presence of white matter hyperintensities (greater than median), any lacunar infarct, and/or two or more microbleeds.
Results:
In the entire population, those with a lower systolic and those with a lower diastolic BP had more symptoms of apathy (β = -.35 [P = .01] and β = -.66 [P = .02], respectively). In older persons with a higher burden of CSVD (n = 50 [24%]), both lower systolic BP (β = -.64, P = .02) and lower diastolic BP (β = -1.6, P = .01) were associated with more symptoms of apathy, whereas no significant association was found between BP and symptoms of apathy in older persons with a lower burden of CSVD (n = 160).
Conclusions:
Particularly in older persons with a higher burden of CSVD, lower BP was associated with more symptoms of apathy. Adequate BP levels for optimal psychological functioning may vary across older populations with a different burden of CSVD. J Am Geriatr Soc 68:1811-1817, 2020.
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