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Updated: Oct 5, 2025

Evaluation of the Cognitive Performance of Hypertensive Patients with Silent Cerebrovascular Lesions
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Evaluation of the Cognitive Performance of Hypertensive Patients with Silent Cerebrovascular Lesions

Published on: April 23, 2021

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Cerebrospinal Fluid Biomarkers, Brain Structural and Cognitive Performances Between Normotensive and Hypertensive

Atef Badji1,2,3, Joana B Pereira3, Sara Shams4,5,6

  • 1NeuroPoly Lab, Institute of Biomedical Engineering, Polytechnique Montréal, Montréal, QC, Canada.

Frontiers in Aging Neuroscience
|January 31, 2022
PubMed

Insights

Hypertension is linked to increased cerebrovascular damage, not Alzheimer's disease pathology, in older adults. Managing blood pressure may prevent brain vascular issues and subsequent cognitive decline.

Area of Science:

  • Neurology
  • Gerontology
  • Cardiology

Background:

  • Hypertension is a known risk factor for Alzheimer's disease (AD), potentially involving microvascular dysfunction.
  • Previous research has explored hypertension's impact on brain integrity markers.
  • A comprehensive comparison of cerebrospinal fluid (CSF) biomarkers and brain structure differences between normotensive and hypertensive older adults concerning cognitive performance is lacking.

Purpose of the Study:

  • To investigate cognitive performance, CSF biomarkers, and brain structure differences in normotensive, controlled hypertensive, uncontrolled hypertensive, and untreated hypertensive older adults.
  • To compare markers of vascular brain pathology and AD pathology/neurodegeneration across different blood pressure groups.
  • To assess the relationship between these markers and cognitive functions.

Main Methods:

  • Magnetic resonance imaging (MRI) to measure white matter hyperintensities (WMHs), lacunes, cerebral microbleeds, enlarged perivascular spaces (epvs), fractional anisotropy (FA), hippocampal volume, and temporal cortical thickness.
  • Cerebrospinal fluid (CSF) analysis for amyloid-β42, phosphorylated tau, and neurofilament light protein (NfL).
  • Neuropsychological tests to evaluate memory, attention, processing speed, executive function, verbal fluency, and visuospatial abilities.

Main Results:

  • Hypertensive participants exhibited greater white matter pathology (lower FA, more WMHs, epvs) compared to normotensive individuals, with the highest burden in uncontrolled hypertensive groups.
  • No significant differences were observed in MRI or CSF markers of AD pathology/neurodegeneration between normotensive and hypertensive groups, or among hypertensive subgroups.
  • Most cognitive functions did not differ significantly between the groups.

Conclusions:

  • Effective blood pressure control may prevent cerebrovascular pathology.
  • Hypertension might contribute to cognitive decline primarily through its impact on cerebrovascular pathology, rather than AD-related pathology.
  • Hypertension is associated with MRI markers of vascular pathology, even without significant cognitive decline.

Keywords:
CSF (cerebrospinal fluid)MRIagingbrainhypertensionwhite matter

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