Vascular and microstructural markers of cognitive pathology

Introduction Arterial stiffness may play a role in the development of dementia through poorly understood effects on brain microstructural integrity and perfusion. Methods We examined markers of arterial stiffness (carotid‐femoral pulse wave velocity [cfPWV]) and elevated systolic blood pressure (SBP) in relation to cognitive function and brain magnetic resonance imaging macrostructure (gray matter [GM] and white matter [WM] volumes), microstructure (diffusion based free water [FW] and fractional anisotropy [FA]), and cerebral blood flow (CBF) in WM and GM in models adjusted for age, race, sex, education, and apolipoprotein E ε4 status. Results Among 460 participants (70 ± 8 years; 44 dementia, 158 mild cognitive impairment, 258 normal cognition), higher cfPWV and SBP were independently associated with higher FW, higher WM hyperintensity volume, and worse cognition (global and executive function). Higher SBP alone was significantly associated with lower WM and GM CBF. Discussion Arterial stiffness is associated with impaired WM microstructure and global and executive cognitive function.