Middle Cerebral Artery Pulsatility Index as Predictor of Cognitive Impairment in Hypertensive Patients

Salim Harris, Teuku Reyhan, Yetty Ramli, Joedo Prihartono, Mohammad Kurniawan, Salim Harris, Teuku Reyhan, Yetty Ramli, Joedo Prihartono, Mohammad Kurniawan

Abstract

Background: Cognitive impairment is a manifestation of cerebrovascular disease regarding hypertension and other degenerative diseases which has become a global health issue due to increased life expectancy. Recently, the gold standard used for diagnosing vascular cognitive impairment (VCI) has required a combination of the neurophysiological approach and magnetic resonance imaging (MRI). The Neurosonological approach, involving measuring the pulsatility index (PI) of the middle cerebral artery (MCA) using Trans Cranial Doppler (TCD), can hopefully be used as an affordable alternative predictor of VCI in patients with hypertension. Methods: A cross-sectional study was conducted at the Outpatient Clinic of the Department of Neurology in Ciptomangunkusumo Hospital, Jakarta. Sixty-six hypertensive subjects with no macrovascular complication were selected and screened using the Montreal Cognitive Assesment-Indonesia version (MoCA-Ina) to determine their cognitive status. Subjects were categorized into two groups; subjects with scores ≥26 were classified as the normal cognitive group, while subjects with scores <26 were classified as the cognitive impairment group. Both groups then underwent TCD examination to determine bilateral MCA PI. Results: There was a significant difference between MCA PI in both groups; it was higher in the cognitive impairment group than normal group (p < 0.001). Subjects with an increased left MCA PI were more likely to suffer cognitive impairment than those with an increased right MCA PI. Conclusion: MCA PI can be used as a predictor for cognitive impairment in hypertensive subjects.

Keywords: cognitive impairment; hypertension; middle cerebral artery; pulsatility index; trans cranial doppler.

Figures

Figure 1
Figure 1
Correlation between duration of hypertension and right MCA PI.
Figure 2
Figure 2
Correlation between duration of hypertension and left MCA PI.

References

    1. Burgess P. Assesment of executive function. In: Halligan PW, Kischka U, Marshall JC, editors. Handbook of Clinical Neuropsychology. Oxford: Oxford University Press; (2003). p. 302–19.
    1. Melzer D, Ely M, Brayne C. Cognitive impairment in elderly people: population based estimate of the future in England, Scotland, and Wales. BMJ (1997) 315:462. 10.1136/bmj.315.7106.462
    1. Kilander L, Nyman H, Boberg M, Hansson L, Lithell H. Hypertension is related to cognitive impairment : a 20-Year follow-up of 999 Men. Hypertension (1998) 31:780–6.
    1. Catindig JA, Venketasubramanian N, Ikram MK, Chen C. Epidemiology of dementia in Asia: Insights on prevalence, trends and novel risk factors. J Neurol Sci. (2012) 321:11–6. 10.1016/j.jns.2012.07.023
    1. Erkinjuntti T, Gauthier S. Vascular Cognitive Impairment. London: Martin Duntz; (2004).
    1. Pandav R, Dodge HH, DeKosky ST, Ganguli M. Blood pressure and cognitive impairment in India and the United States: a cross-national epidemiological study. Arch Neurol. (2003) 60:1123–8. 10.1001/archneur.60.8.1123
    1. Birkenhäger WH, Forette F, Seux ML, Wang JG, Staessen JA. Blood pressure, cognitive functions, and prevention of dementias in older patients with hypertension. Arch Intern Med. (2001) 161:152–6. 10.1001/archinte.161.2.152
    1. Husein N, Lumempouw S, Ramli Y, Herquatanto Montreal cognitive assessment versi indonesia (moca-ina) untuk skrining gangguan fungsi kognitif. Maj Neurona. (2010) 27:4–15. Available online at:
    1. Elias MF, Elias PK, Sullivan LM, Wolf PA, D'Agostino RB. Lower cognitive function in the presence of obesity and hypertension: the Framingham heart study. Int J Obes. (2003) 27:260–8. 10.1038/sj.ijo.802225
    1. Bilello M, Doshi J, Nabavizadeh SA, Toledo JB, Erus G, Xie SX. Correlating cognitive decline with white matter lesion and brain atrophy magnetic resonance imaging measurements in Alzheimer's disease. J Alzheimer's Dis. (2015) 48:987–94. 10.3233/JAD-150400
    1. Lindemer ER, Salat DH, Smith EE, Nguyen K, Fischl B, Greve DN. White matter signal abnormality quality differentiates mild cognitive impairment that converts to Alzheimer's disease from nonconverters. Neurobiol Aging (2015) 36:2447–57. 10.1016/j.neurobiolaging.2015.05.011
    1. Kassab MY, Majid A, Farooq MU, Azhary H, Hershey LA, Bednarczyk EM, et al. . Transcranial Doppler: an introduction for primary care physicians. J Am Board Fam Med. (2007) 20:65–71. 10.3122/jabfm.2007.01.060128
    1. Aleksic M, Heckenkamp J, Gawenda M, Brunkwall J. Pulsatility index determination by flowmeter measurement: a new indicator for vascular resistance? Eur Surg Res. (2004) 36:345–9. 10.1159/000081642
    1. Naqvi J, Yap KH, Ahmad G, Ghosh J. Transcranial Doppler ultrasound: a review of the physical principles and major applications in critical care. Int J Vasc Med. (2013) 2013:629378. 10.1155/2013/629378
    1. Chavhan GB, Parra DA, Mann A, Navarro OM. Normal Doppler spectral waveforms of major pediatric vessels: specific patterns. Radiographics (2008) 28:691–706. 10.1148/rg.283075095
    1. D 'andrea A, Conte M, Cavallaro M, Scarafile R, Riegler L, Cocchia R, et al. . Transcranial Doppler ultrasonography: from methodology to major clinical applications. World J Cardiol. (2016) 8:383–400. 10.4330/wjc.v8.i7.383
    1. Kalbi M, Catindig J, Marasigan S, Navarro J. Transcranial doppler ultrasonography: a method of evaluating cognitively impaired and non-cognitively impaired elderly. Cerebrovasc Dis. (2014) 38:70 10.4172/2155-9562.S1.023
    1. Kurniawan M, Mayza A, Laksono D, Prihartono J. Hubungan Hendaya Kognitif non Demensia Dengan Kendali Glikemik Pada Penyandang DM Tipe 2. (Unpublished: ) (2009).
    1. Indrasari U, Harris S, Saksono D. Rerata Nilai Pulsatility Index Arteri Serebri Media Kanan Pada Penyandang Diabetes Mellitus Tipe 2 Dengan Atau Tanpa Retinopati. (Unpublished) (2014).
    1. Hassing LB, Johansson B, Nilsson SE, Berg S, Pedersen NL, Gatz M, et al. Diabetes mellitus is a risk factor for vascular dementia, but not for Alzheimer's disease: a population-based study of the oldest old. Int Psychogeriatr. (2002) 14:239–48. 10.1017/S104161020200844X
    1. Akbaraly TN, Kivimaki M, Shipley MJ, Tabak AG, Jokela M, Virtanen M, et al. . Metabolic syndrome over 10 years and cognitive functioning in late midlife: the Whitehall II study. Diabetes Care (2010) 33:84–9. 10.2337/dc09-1218
    1. Huadong Z, Juan D, Jingcheng L, Yanjiang W, Meng Z, Hongbo H. Study of the relationship between cigarette smoking, alcohol drinking and cognitive impairment among elderly people in China. Age Ageing (2003) 32:205–10. 10.1093/ageing/32.2.205
    1. Richards M, Jarvis MJ, Thompson N, Wadsworth ME. Cigarette smoking and cognitive decline in midlife: evidence from a prospective birth cohort study. Am J Public Health (2003) 93:994–8. 10.2105/AJPH.93.6.994
    1. Fuller JH, McCartney P, Jarrett RJ, Keen H, Rose G, Shipley MJ, et al. . Hyperglycaemia and coronary heart disease: the Whitehall Study. J Chronic Dis. (1979) 32:721–8.
    1. Forette F, Seux ML, Staessen JA, Thijs L, Babarskiene MR, Babeanu S, et al. . The prevention of dementia with antihypertensive treatment: new evidence from the Systolic Hypertension in Europe (Syst-Eur) study. Arch Intern Med. (2002) 162:2046–52. 10.1001/archinte.162.18.2046
    1. Park KC, Yoon SS, Rhee HY. Executive dysfunction associated with stroke in the posterior cerebral artery territory. J Clin Neurosci. (2011) 18:203–8. 10.1016/j.jocn.2010.05.026
    1. Koçer A. Cognitive problems related to vertebrobasilar circulation. Turkish J Med Sci. (2015) 45:993–7. 10.3906/sag-1403-100
    1. Vicenzini E, Ricciardi MC, Altieri M, Puccinelli F, Bonaffini N, Di Piero V, et al. . Cerebrovascular reactivity in degenerative and vascular dementia: a transcranial doppler study. Eur Neurol. (2007) 58:84–9. 10.1159/000103642
    1. Lee KO, Lee KY, Lee SY, Ahn CW, Park JS. Lacunar infarction in type 2 diabetes is associated with an elevated intracranial arterial pulsatility index. Yonsei Med J. (2007) 48:802–6. 10.3349/ymj.2007.48.5.802
    1. Viola S, Viola P, Buongarzone MP, Fiorelli L, Litterio P. Tissue oxygen saturation and pulsatility index as markers for amnestic mild cognitive impairment: NIRS and TCD study. Clin Neurophysiol. (2013) 124:851–6. 10.1016/j.clinph.2012.11.013

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