Blood Pressure, Aortic Stiffness, Hemodynamics, and Cognition in Twin Pairs Discordant for Type 2 Diabetes

Article type: Research Article

Authors: Karayiannis, Christopher^{a; b} | Moran, Chris^{a; b; c} | Sharman, James E.^d | Beare, Richard^{a; b} | Quinn, Stephen J.^e | Phan, Thanh G.^b | Wood, Amanda G.^{f; g} | Thrift, Amanda G.^b | Wang, Wei C.^a | Srikanth, Velandai^{a; b; d; *}

Affiliations: [a] Department of Medicine, Peninsula Health and Monash University, Melbourne, Australia | [b] Stroke and Ageing Research Centre, Medicine, School of Clinical Sciences, Monash Medical Centre, Monash University, Melbourne, Australia | [c] Alfred Health, Melbourne, Australia | [d] Menzies Institute for Medical Research, University of Tasmania, Hobart, Australia | [e] Department of Statistics, Data Science and Epidemiology, Swinburne University of Technology, Melbourne, Australia | [f] Clinical Sciences, Murdoch Children’s Research Institute, Melbourne, Australia | [g] Life and Health Sciences, Aston University, Birmingham, United Kingdom

Correspondence: [*] Correspondence to: Professor Velandai Srikanth, Professor of Medicine, Peninsula Health, Academic Unit, Monash University, 2 Hastings Rd, Frankston 3199, VIC, Australia. Tel.: +61 3 97881723; E-mail: [email protected].

Abstract: Background:Type 2 diabetes (T2D) is associated with an increased risk of cognitive impairment and dementia with poorly understood underlying mechanisms. Objective:We examined the role of blood pressure (BP), aortic stiffness, and hemodynamics in this association. Methods:Cross-sectional sample of late middle-aged twins discordant for T2D from the Australian Twin Registry. Measurements included neuropsychological battery and brain MRI including arterial spin labelling (ASL) to measure cerebral perfusion. Mobil-o-Graph devices were used to non-invasively obtain 24-hour BP, aortic stiffness, and hemodynamic measures. Using mixed modelling, we studied associations of T2D with cognition, MRI measures, BP, aortic stiffness, and hemodynamics. Results:There were 23 twin pairs with mean age 63.7 (SD = 6.1) years. T2D (β=–0.45, p < 0.001) and age (β=–0.05, p = 0.022) were independently associated with poorer attention but not with memory or perceptual speed. T2D was associated with reduced nocturnal central systolic BP dipping (β=–3.79, p = 0.027), but not with BP, aortic stiffness, cerebral perfusion, or other hemodynamic measures. There was a statistically significant interaction between T2D and central systolic BP dipping in predicting attention scores (both p < 0.05 for the interaction term) whereby there was a positive association between BP dipping and attention scores in those with T2D, but not in those without T2D. Conclusion:We found an association between T2D and reduced nocturnal central systolic dipping, but not with any other measures of BP, stiffness or hemodynamic measures. Further study of the role of nocturnal central BP dipping in the association between T2D and cognitive impairment may help identify potential mechanisms.

Keywords: Blood pressure, cerebrovascular circulation, cognitive dysfunction, dementia, hemodynamics, type 2 diabetes mellitus, vascular stiffness

DOI: 10.3233/JAD-190319

Journal: Journal of Alzheimer's Disease, vol. 71, no. 3, pp. 763-773, 2019