Peter van Vliet1, Behnam Sabayan2, Liselotte W Wijsman2, Rosalinde K E Poortvliet2, Simon P Mooijaart2, Wouter de Ruijter2, Jacobijn Gussekloo2, Anton J M de Craen2, R G J Westendorp2. 1. From the Departments of Gerontology and Geriatrics (P.v.V., B.S., L.W.W., S.P.M., A.J.M.d.C., R.G.J.W.), Neurology (P.v.V.), Radiology (B.S.), and Public Health and Primary Care (R.K.E.P., W.d.R., J.G.), Leiden University Medical Center; and Netherlands Consortium of Healthy Ageing (L.W.W., A.J.M.d.C., R.G.J.W.), Leiden, the Netherlands. P.van_Vliet@lumc.nl. 2. From the Departments of Gerontology and Geriatrics (P.v.V., B.S., L.W.W., S.P.M., A.J.M.d.C., R.G.J.W.), Neurology (P.v.V.), Radiology (B.S.), and Public Health and Primary Care (R.K.E.P., W.d.R., J.G.), Leiden University Medical Center; and Netherlands Consortium of Healthy Ageing (L.W.W., A.J.M.d.C., R.G.J.W.), Leiden, the Netherlands.
Abstract
OBJECTIVE: To study the relation between N-terminal pro-brain natriuretic peptide (NT-proBNP) levels, used as a marker of heart failure in clinical practice, blood pressure (BP), and cognitive decline in the oldest old. METHODS: In 560 participants of the Leiden 85-plus Study, we measured NT-proBNP levels and BP at age 85 years, at baseline, and global cognitive function (Mini-Mental State Examination [MMSE]) annually during the follow-up of 5 years. RESULTS: Subjects in the highest tertile of NT-proBNP levels scored 1.7 points lower on the MMSE at age 85 years than subjects in the lowest tertile (p = 0.004), and had a 0.24-point-steeper decline in MMSE score per year (p = 0.021). The longitudinal association disappeared after full adjustment for possible confounders (0.14-point-steeper decline, p = 0.187). Subjects in the category "highest tertile of NT-proBNP and the lowest tertile of systolic BP" had a 3.7-point-lower MMSE score at baseline (p < 0.001) and a 0.49-point-steeper decline in MMSE score per year (p < 0.001) compared with subjects in the other categories. CONCLUSIONS: In the oldest old, high NT-proBNP levels are associated with lower MMSE scores. The combination of high NT-proBNP levels and low systolic BP is associated with worst global cognitive function and the steepest cognitive decline. Possibly, a failing pump function of the heart results in lower BP and lower brain perfusion with resultant brain dysfunction.
OBJECTIVE: To study the relation between N-terminal pro-brain natriuretic peptide (NT-proBNP) levels, used as a marker of heart failure in clinical practice, blood pressure (BP), and cognitive decline in the oldest old. METHODS: In 560 participants of the Leiden 85-plus Study, we measured NT-proBNP levels and BP at age 85 years, at baseline, and global cognitive function (Mini-Mental State Examination [MMSE]) annually during the follow-up of 5 years. RESULTS: Subjects in the highest tertile of NT-proBNP levels scored 1.7 points lower on the MMSE at age 85 years than subjects in the lowest tertile (p = 0.004), and had a 0.24-point-steeper decline in MMSE score per year (p = 0.021). The longitudinal association disappeared after full adjustment for possible confounders (0.14-point-steeper decline, p = 0.187). Subjects in the category "highest tertile of NT-proBNP and the lowest tertile of systolic BP" had a 3.7-point-lower MMSE score at baseline (p < 0.001) and a 0.49-point-steeper decline in MMSE score per year (p < 0.001) compared with subjects in the other categories. CONCLUSIONS: In the oldest old, high NT-proBNP levels are associated with lower MMSE scores. The combination of high NT-proBNP levels and low systolic BP is associated with worst global cognitive function and the steepest cognitive decline. Possibly, a failing pump function of the heart results in lower BP and lower brain perfusion with resultant brain dysfunction.
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