Vascular aging and cognitive decline The Rotterdam study Francesco - PowerPoint PPT Presentation

Vascular aging and cognitive decline The Rotterdam study Francesco Mattace Raso, MD PhD Geriatric Medicine, Department of Internal Medicine

The Ugly The good The Bad

The good The Bad The Ugly

Rotterdam, Ommoord

The Rotterdam Study is a prospective cohort study ongoing since 1990 in the city of Rotterdam in The Netherlands. The study targets cardiovascular , endocrine, hepatic, neurological , ophthalmic, psychiatric, dermatological, otolaryngological, locomotor, and respiratory diseases.

The Rotterdam Study  Invitation to participate  Data collection  Data storage  Analyses  Writing manuscripts  Publications  Thesis

Possible causes of dementia

Causes of cognitive decline  Diabetes  Diabetes  Metabolic disorders  Metabolic disorders  Vascular disorders  Vascular disorders  Atherosclerosis  Atherosclerosis  Arteriosclerosis  Arteriosclerosis  Vascular aging  Vascular aging

What do we know about vascular aging?

Aging and increase of IMT Age 8 Age 52 Age 85

Age and carotid IMT Nagai, Circulation, 1998

Progression of Carotid IMT

Vascular Structure and Function

European Network for Non-Invasive Investigation of Large Arteries

Aging and aPWV Reference Values for Arterial Stiffness' Collaboration Eur Heart J. 2010

aPWV according to BP and age categories Reference Values for Arterial Stiffness' Collaboration Eur Heart J. 2010

aPWV according to BP and age categories Reference Values for Arterial Stiffness' Collaboration Eur Heart J. 2010

Atherosclerosis and dementia

Selwaness M et al Hypertension 2013

Apnea e valori pressori

Association Between PWV (per Increase in SD) and Various Plaque Components (n=1979 Carotid Plaques)

Fazekas scale for WM lesions 0: None or a single punctate WMH lesion 1: Multiple punctate lesions 2: Beginning confluency of lesions (bridging) 3: Large confluent lesions

Strategic Infarctions

Aortic stiffness and cerebral small vessel disease

Arterial stiffness and blood pressure regulation the short-term effects

Blood Pressure regulation

Baroreflex sensitivity (BRS) and age  BRS: the slope of the regression line between changes of SBP and the related lengthening or shortening  in the R-R interval, occurring over spontaneous sequences of three or more consecutive beats

Carotid IMT, Aortic Stiffness and BRS Gianaros PJ et al Am J Hypertens 2002 Mattace-Raso F et al, J Hypertension 2007

Arterial stiffness and orthostatic hypotension  Mattace-Raso F et al, J Hypertension 2006

Conclusions  Vascular aging should no longer be considered an innocent expression  Vascular aging is associated with the risk of CVD  Vascular aging is associated with cognitive decline

f.mattaceraso@erasmusmc.nl