Relationship Of Pulse Pressure And Cognitive Performance In Individuals With Advanced Carotid Atherosclerosis

Introduction: Elevation in pulse pressure (PP), the difference between systolic and diastolic blood pressure, is associated with vascular remodeling, arterial stiffness, and carotid plaque instability (i.e. strain indices and ulceration), which is a risk factor for vascular cognitive decline. We have previously demonstrated that increased carotid plaque strain indices are associated with poorer cognitive performance in individuals with advanced carotid atherosclerosis. We examined the relationship between pre-operative pulse-pressure and cognition in individuals undergoing clinically indicated carotid endarterectomy. We hypothesized that higher PP will be associated with poorer cognitive performance. Methods: Patients with advanced carotid atherosclerosis (>60 % stenosis NASCET, ACAS criteria) underwent neurocognitive testing, blood pressure measurements, and PP calculation (n=128). Cognition was measured using a 60-minute neuropsychological battery recommended by the National Institute of Neurological Disorders and Canadian Stroke Network (NINDS-CSN). Kendell Tau correlations were used to examine the relationship between cognitive tests, ulceration and PP. Results: Participants were a median age of 72 (IQR 13) years of age, 50 females (40%), 78 males (60%), median 70% stenosis (IQR 10.8), median systolic blood pressure of 132 (IQR 26) mmHg, median diastolic blood pressure of 71.5 (IQR 15) mmHg, and median PP of 58.5 mmHg (IQR 23.75). PP ranged from 36 mmHg to 163 mmHg. Results did demonstrate evidence of an association between PP and WAIS-IV Block Design in asymptomatic patients (τ=-0.23, p=0.02). It did not show a significant relationship between PP and other subtests (all p-values>0.05). There was no significant association between PP and operative plaque ulceration scores (p=0.542). Conclusions: PP was not associated with cognitive performance in individuals with advanced carotid atherosclerosis except for the relationship between PP and WAIS-IV Block Design in asymptomatic patients. This finding is consistent with prior work that suggests visuospatial processing presenting as one of the earliest declines in patients with cerebrovascular disease. Though asymptomatic patients did not show classic signs of stroke, they likely had silent strokes due to plaque instability.