title: Cardiac output, blood pressure variability, and cognitive decline in geriatric cardiac patients.
abstract: OBJECTIVE
  To prospectively investigate whether baseline findings on specific cardiovascular indices are predictive of subsequent rate of decline in Attention-Executive-Psychomotor function in a cohort of ambulatory older adults with cardiovascular diseases (CVDs).
  
  
  METHODS
  One hundred seventy-two older adults with CVD were administered a neuropsychological battery of executive functions tests at study entry, and at 12 and 36 months thereafter. At study entry, they also underwent vascular assessments including cardiac output, ejection fraction, blood pressure (BP), brachial artery reactivity, and carotid intima media thickness. Random coefficient regressions were used to investigate the effect of these cardiac indices on rate of decline in Attention-Executive-Psychomotor function.
  
  
  RESULTS
  Cardiac output, systolic BP variability, and diastolic BP variability predicted decline in Attention-Executive-Psychomotor function. Specifically, lower cardiac output, reduced variability in systolic BP, and increased variability in diastolic BP were associated with a faster rate of decline in Attention-Executive-Psychomotor function. Mean resting systolic and diastolic blood pressure did not predict decline in Attention-Executive-Psychomotor function.
  
  
  CONCLUSIONS
  Decline in frontal-subcortical cognitive functions among patients with CVDs appears to be mediated by systemic hypoperfusion and variability in blood pressure. The precise nature of these relationships, especially with regard to blood pressure variability, is complex and demands continued investigation.
authors.affiliation: Department of Neurology, School of Medicine, Johns Hopkins University, Baltimore, Maryland 21205, USA. ozioma@jhmi.edu
authors.forename: Ozioma C
authors.initials: OC
authors.lastname: Okonkwo
authors.forename: Ronald A
authors.initials: RA
authors.lastname: Cohen
authors.forename: John
authors.initials: J
authors.lastname: Gunstad
authors.forename: Athena
authors.initials: A
authors.lastname: Poppas
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D001288:Attention / Q000502:physiology*; D001794:Blood Pressure / Q000502:physiology*; D001916:Brachial Artery / Q000503:physiopathology; D002302:Cardiac Output / Q000502:physiology*; D002318:Cardiovascular Diseases / Q000503:physiopathology*; D056344:Executive Function / Q000502:physiology*; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D011446:Prospective Studies; D011597:Psychomotor Performance / Q000502:physiology; D012039:Regional Blood Flow; D017539:Tunica Intima / Q000000981:diagnostic imaging; D018608:Ultrasonography, Doppler