Diastolic dysfunction novel risk factor for cognitive impairment

Increasing diastolic dysfunction is associated with more difficulty with executive functioning and with increasing cerebral small vessel disease, as demonstrated by white matter hyperintensities on brain imaging. These observations strongly suggest diastolic dysfunction to be a novel, modifiable risk factor for cognitive impairment and dementia [1].

Systolic dysfunction has an important effect on cardiovascular outcomes and is associated with cognitive decline [2]. The relationship between diastolic dysfunction and cognition is undefined, however. To this end, Parker et al. analysed echocardiographic, MRI, and neuropsychological data, collected  between 2005-2008 in 1,438 participants >55 years in the Framingham Heart Study Offspring Cohort.

The outcomes demonstrated that an increasing E/E’ ratio (early mitral filling/diastolic mitral annular velocity) was associated with increased incident mild cognitive impairment (HR 1.29; 95% CI 1.01-1.66; P<0.043) and an increase in executive function impairment in the Similarities (P<0.002) and Phonemic Fluency (P<0.001) tasks. Participants with moderate-to-severe diastolic dysfunction were more impaired on both tasks (P<0.046 and P<0.023, respectively). In 1,217 participants, those with mild diastolic dysfunction showed a trend towards increased white matter hyperintensities (portion of total cranial volume=0.11±0.07, P<0.105); those with moderate-to-severe diastolic dysfunction had increased white matter hyperintensities (0.30±0.09, P<0.001). The authors noted that these results align well with clinical findings in cerebral small vessel disease, as this usually presents with executive dysfunction.

 

1. Parker A, et al. Abstract S15.005, AAN 2020.
2. Zuccalà, et al. Am J Med. 2005;118(5):496-502.

Posted on 8 September 202027 March 2024