Related Experiment Video
Updated: Dec 15, 2025
Evaluation of the Cognitive Performance of Hypertensive Patients with Silent Cerebrovascular Lesions
Published on: April 23, 2021
Association of cerebrovascular reactivity and Alzheimer pathologic markers with cognitive performance
Sandeepa Sur1, Zixuan Lin1, Yang Li1
1From the Departments of Radiology (S.S., Z.L., Y.L., X.H., K.H., G.P., C.X., P.v.Z., J.P., P.L., H.L.), Biomedical Engineering (Z.L., X.H., H.L.), Medicine (S.Y., R.K.), Psychiatry and Behavioral Sciences (P.R.), Neurology (A.M., M.A.), and Neurosurgery (J.P.), Johns Hopkins University, School of Medicine; and F.M. Kirby Research Center (P.v.Z., H.L.), Kennedy Krieger Institute, Baltimore, MD.
Objective:
To determine whether MRI-based cerebrovascular reactivity (CVR) can predict cognitive performance independently of Alzheimer pathologic markers, we studied the relationship between cognition, CVR, and CSF-derived β-amyloid42 (Aβ42) and tau in a group of elderly individuals with mixed Alzheimer and vascular cognitive impairment and dementia.
Methods:
This was a cross-sectional study of 72 participants 69 ± 8 years of age consisting of individuals with normal cognition (n = 28) and cognitive impairment (n = 44) (including 36 with mild cognitive impairment [MCI] and 8 with mild dementia). CVR was measured with hypercapnia-MRI. Whole-brain CVR (percent blood oxygen level-dependent per 1 mm Hg Etco2) was used to estimate vasodilatory capacity. Montreal Cognitive Assessment (MoCA) scores, cognitive domains scores, and a global composite cognitive score were obtained. AD biomarkers included CSF assays of Aβ42 and tau.
Results:
Whole-brain CVR was lower in the impaired (mean ± SE, 0.132 ± 0.006%/mm Hg) compared to the normal (0.151 ± 0.007%/mm Hg) group (β = -0.02%/mm Hg; 95% confidence interval [CI] -0.038 to -0.001). After adjustment for CSF Aβ42 and tau, higher whole-brain CVR was associated with better performance on the MoCA (β = 29.64, 95% CI 9.94-49.34) and with a global composite cognitive score (β = 4.32, 95% CI 0.05-8.58). When the CVR marker was compared with the Fazekas score based on white matter hyperintensities and vascular risk-score in a single regression model predicting the MoCA score, only CVR revealed a significant effect (β = 28.09, 95% CI 6.14-50.04), while the other 2 measures were not significant.
Conclusions:
CVR was significantly associated with cognitive performance independently of AD pathology. Whole-brain CVR may be a useful biomarker for evaluating cognitive impairment related to vascular disease in older individuals.
Classification Of Evidence:
This study provides Class II evidence that CVR was significantly associated with cognitive performance independent of AD pathology.
Insights
Cerebrovascular reactivity (CVR) measured by MRI predicts cognitive function in older adults, independent of Alzheimer's disease markers. This finding highlights CVR's potential as a biomarker for vascular cognitive impairment.
Area of Science:
- Neurology
- Radiology
- Gerontology
Background:
- Cognitive impairment in older adults often results from a mix of Alzheimer's disease (AD) pathology and vascular factors.
- Cerebrovascular reactivity (CVR), a measure of the brain's ability to adjust blood flow, is crucial for maintaining cognitive function.
- Assessing CVR may help differentiate causes of cognitive decline and identify individuals at risk.
Purpose of the Study:
- To investigate whether MRI-based CVR can predict cognitive performance independently of Alzheimer's disease biomarkers (Aβ42 and tau).
- To explore the relationship between CVR, cognitive function, and established AD markers in elderly individuals with mixed cognitive impairment.
Main Methods:
- A cross-sectional study involving 72 elderly participants (28 normal cognition, 44 cognitive impairment) was conducted.
- Whole-brain CVR was measured using hypercapnia-MRI to assess vasodilatory capacity.
- Cognitive performance was evaluated using MoCA scores and a global cognitive composite score, alongside CSF assays for Aβ42 and tau.
Main Results:
- Lower whole-brain CVR was observed in participants with cognitive impairment compared to those with normal cognition.
- Higher CVR was significantly associated with better MoCA and global cognitive scores, even after adjusting for Aβ42 and tau levels.
- In predicting MoCA scores, CVR showed a significant effect, outperforming Fazekas scores and vascular risk scores.
Conclusions:
- Cerebrovascular reactivity is significantly associated with cognitive performance, independent of Alzheimer's disease pathology.
- Whole-brain CVR shows promise as a valuable biomarker for assessing cognitive impairment, particularly in cases related to vascular disease in older individuals.
Related Concept Videos
01:26Alzheimer's Disease: Overview
The clinical diagnosis of AD hinges on the presence of memory and other cognitive impairments. Biomarkers, such as changes in Aβ...
01:22Alzheimer's Disease: Treatment