Measurement of resistance-area product by transcranial Doppler: An alternative tool for cognitive screening in hypertensive on drug treatment?

Michel Ferreira Machado; Henrique Cotchi Simbo Muela; Valeria Aparecida Costa-Hong; Ronney B Panerai; Monica S Yassuda; Natalia Cristina Moraes; Claudia Maia Memória; Edson Bor-Seng-Shu; Ricardo Nitrini; Luiz Aparecido Bortolotto; Ricardo de Carvalho Nogueira

doi:10.1016/j.cccb.2023.100191

Measurement of resistance-area product by transcranial Doppler: An alternative tool for cognitive screening in hypertensive on drug treatment?

Cereb Circ Cogn Behav. 2023 Nov 10:5:100191. doi: 10.1016/j.cccb.2023.100191. eCollection 2023.

Affiliations

¹ Department of Neurology, Hospital das Clínicas, University of São Paulo Medical School, Brazil.
² Hypertension Unit, Instituto do Coração (INCOR), University of São Paulo Medical School, Brazil.
³ Department of Cardiovascular Sciences, University of Leicester, UK.
⁴ Gerontology, School of Arts, Sciences and Humanities, University of São Paulo Medical School, Brazil.

Abstract

Introduction: Arterial hypertrophy and remodeling are adaptive responses present in systemic arterial hypertension that can result in silent ischemia and neurodegeneration, compromising brain connections and cognitive performance (CP). However, CP is affected differently over time, so traditional screening methods may become less sensitive in assessing certain cognitive domains. The study aimed to evaluate whether cerebrovascular hemodynamic parameters can serve as a tool for cognitive screening in hypertensive without clinically manifest cognitive decline.

Methods: Participants were allocated into groups: non-hypertensive (n = 30) [group 1], hypertensive with systolic blood pressure (SBP) < 140 and diastolic blood pressure (DBP) < 90 mmHg (n = 54) [group 2] and hypertensive with SBP ≥ 140 or DBP ≥ 90 (n = 31) [group 3]. Measurements of blood pressure and middle cerebral artery blood flow velocity were obtained from digital plethysmography and transcranial Doppler. For the cognitive assessment, the Mini Mental State Examination (MMSE), the Montreal Cognitive Assessment (MoCA) and a broad neuropsychological battery were applied.

Results: Patients in groups 2 and 3 show no significant differences in most of the clinical-epidemiological variables or pulsatility index (p = 0.361), however compared to group 1 and 2, patients in group 3 had greater resistance-area product [RAP] (1.7 [±0.7] vs. 1.2 [±0.2], p < 0.001). There was a negative correlation between RAP, episodic memory (r = -0.277, p = 0.004) and cognitive processing speed (r = -0.319, p = 0.001).

Conclusion: RAP reflects the real cerebrovascular resistance, regardless of the direct action of antihypertensive on the microcirculation, and seems to be a potential alternative tool for cognitive screening in hypertensive.

Keywords: Arterial stiffness; Cerebral blood flow; Cognitive decline; Hypertension; Ultrasonography Doppler.