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An analysis of the Atherosclerosis Risk in Communities (ARIC) cohort study data showed that individuals with stiffer arteries were at a higher risk of developing dementia over time. Arterial stiffness was measured through the speed at which pressure generated by heartbeats travels through arteries. The paper was published in Alzheimer’s & Dementia.
Arterial stiffness refers to the loss of elasticity of the large arteries, which makes them less able to expand and recoil as blood is pumped through them with each heartbeat. In healthy younger people, elastic arteries help cushion the pressure generated by the heart and maintain a relatively smooth flow of blood through the circulation. With increasing age, however, arterial walls gradually become stiffer as elastin fibers deteriorate, collagen becomes more prominent, and structural changes such as calcification accumulate.
In older adults, some increase in arterial stiffness is therefore a normal consequence of vascular aging, although its extent varies substantially between individuals. Excessive arterial stiffness increases the pressure experienced by the heart and by small blood vessels in organs such as the brain and kidneys and is associated with an increased risk of cardiovascular disease. It should be noted that, apart from age, arterial stiffness is also influenced by blood pressure, inflammation, metabolic factors, smoking, diabetes, kidney disease, and various other factors.
One of the most widely used ways of assessing arterial stiffness is measuring pulse wave velocity (PWV), i.e., measuring how quickly the pressure wave created by a heartbeat travels along an artery. Because compliant arteries expand as the wave passes through them, they slow its propagation, whereas stiff arteries transmit the wave more rapidly. Consequently, a higher PWV generally indicates greater arterial stiffness.
Study author Jenna Barbee and her colleagues analyzed data from the Atherosclerosis Risk in Communities (ARIC) Neurocognitive Study (ARIC-NCS) to explore the associations between arterial stiffness and subsequent development of dementia. ARIC is a community-based cohort study of predominantly Black or White adults from four U.S. communities – Washington County, Maryland; Forsyth County, North Carolina; Minneapolis, Minnesota; and Jackson, Mississippi.
The ARIC study initially involved 15,792 participants between 45 and 64 years of age, recruited between 1987 and 1989. This was followed by three initial assessments every three years and several subsequent assessments years later, with the most recent being in 2021 and 2022, when 2,105 participants remained in the study.
This analysis used data collected between 2011 and 2022, with the data collected between 2011 and 2013 serving as baseline measures (measures at the start of the study). The 2011-2013 data collection was the fifth data collection wave of the study and it included 6,538 participants.
After excluding participants who had already developed dementia and a number of participants with missing measurements and various other disqualifying characteristics, the analysis was based on 4,818 participants. Their average age at the start of the analytic period was 75 years. Fifty-nine percent of them were women.
The study primarily assessed participants’ arterial stiffness through carotid-femoral pulse wave velocity (cfPWV), which means that they measured how quickly the arterial pressure wave travels between the carotid artery in the neck and the femoral artery in the groin. Study authors hypothesized that individuals in which this wave travels faster (meaning that their arteries are stiffer) would be more likely to develop dementia later in life.
Participants’ cfPWV in this study was measured using an automated waveform analyzer and a segmometer (a tool similar to a tape measure used to measure body segments) after participants were lying on their backs for 5 to 10 minutes. The study also recorded whether participants developed dementia in each data collection wave.
Results showed that, during the examined period (a median follow-up of nine years), 22% of participants developed dementia. As expected, higher cfPWV was associated with greater dementia risk. Similarly, other pulse wave velocity measures such as total pulse wave velocity, structural pulse wave velocity, and load-dependent pulse wave velocity were also associated with greater dementia risk.
Total pulse wave velocity reflects overall arterial stiffness, structural pulse wave velocity reflects the intrinsic stiffness of the arterial wall independent of current pressure, and load-dependent pulse wave velocity reflects the portion of stiffness caused by the artery being stretched by the prevailing blood pressure.
“Arterial stiffness, measured through PWV [pulse wave velocity], is longitudinally associated with increased incidence and a greater risk of all-cause dementia. Associations between arterial stiffness and dementia risk may be driven by both age-related structural remodeling of the arterial wall and increases in arterial stiffness due to elevated blood pressure levels, especially in older populations with a high burden of cardiometabolic risk factors,” study authors concluded.
The study contributes to the scientific knowledge about links between cardio-vascular changes and cognitive functioning. However, it should be noted that the design of the study does not allow any definitive causal inferences to be derived from the results.
The paper, “Arterial stiffness and risk of dementia in late life: The ARIC neurocognitive study,” was authored by Jenna Barbee, James Russell Pike, Jingkai Wei, Hirofumi Tanaka, David S. Knopman, Anna Kucharska-Newton, A. Richey Sharrett, Timothy M. Hughes, Kunihiro Matsushita, Thomas H. Mosley, Michelle L. Meyer, and Priya Palta.