title: Higher BMI is associated with reduced brain volume in heart failure.
abstract: BACKGROUND
  Heart failure (HF) patients are at risk for structural brain changes due to cerebral hypoperfusion. Past work shows obesity is linked with reduced cerebral blood flow and associated with brain atrophy in healthy individuals, although its effects on the brain in HF are unclear. This study examined the association among body mass index (BMI), cerebral perfusion, and brain volume in HF patients.
  
  
  RESULTS
  Eighty HF patients underwent transcranial Doppler sonography to quantify cerebral blood flow velocity of the middle cerebral artery (CBF-V of the MCA) and brain magnetic resonance imaging (MRI) to quantify total brain, total and subcortical gray matter, white matter volume, and white matter hyperintensities. Body mass index (BMI) operationalized weight status. Nearly 45% of HF patients exhibited a BMI consistent with obesity. Regression analyses adjusting for medical variables, demographic characteristics, and CBF-V of the MCA, showed increased BMI was associated with reduced white matter volume (p<.05). BMI also interacted with cerebral perfusion to impact total gray matter volume, but this pattern did not emerge for any other MRI indices (p< 0.05).
  
  
  CONCLUSIONS
  Our findings suggest increased BMI negatively affects brain volume in HF, and higher BMI interacts with cerebral perfusion to impact gray matter volume. The mechanisms for these findings remain unclear and likely involve multiple physiological processes. Prospective studies are needed to elucidate the exact pattern and rates of brain changes in obese HF persons.
authors.affiliation: Department of Psychology, Kent State University, Kent, OH, USA.
authors.forename: Michael L
authors.initials: ML
authors.lastname: Alosco
authors.affiliation: Taub Institute for Research on Alzheimer's Disease and the Aging Brain, Department of Neurology, College of Physicians and Surgeons, Columbia University, New York, NY, USA.
authors.forename: Adam M
authors.initials: AM
authors.lastname: Brickman
authors.affiliation: Department of Psychology, Kent State University, Kent, OH, USA ; Department of Psychiatry, Summa Health System, Akron City Hospital, Akron, OH, USA.
authors.forename: Mary Beth
authors.initials: MB
authors.lastname: Spitznagel
authors.affiliation: Taub Institute for Research on Alzheimer's Disease and the Aging Brain, Department of Neurology, College of Physicians and Surgeons, Columbia University, New York, NY, USA.
authors.forename: Atul
authors.initials: A
authors.lastname: Narkhede
authors.affiliation: Taub Institute for Research on Alzheimer's Disease and the Aging Brain, Department of Neurology, College of Physicians and Surgeons, Columbia University, New York, NY, USA.
authors.forename: Erica Y
authors.initials: EY
authors.lastname: Griffith
authors.affiliation: Institute of Gerontology, Wayne State University, Detroit, MI, USA.
authors.forename: Naftali
authors.initials: N
authors.lastname: Raz
authors.affiliation: Departments of Neurology Psychiatry and the Institute on Aging, Center for Cognitive Aging and Memory, University of Florida, Gainesville, FL 32611, USA.
authors.forename: Ronald
authors.initials: R
authors.lastname: Cohen
authors.affiliation: Department of Psychology, University of Georgia, Athens, GA, USA.
authors.forename: Lawrence H
authors.initials: LH
authors.lastname: Sweet
authors.affiliation: Department of Kinesiology, University of Wisconsin, Madison, WI, USA.
authors.forename: Lisa H
authors.initials: LH
authors.lastname: Colbert
authors.affiliation: Department of Medicine, University Hospitals Case Medical Center, Cleveland, OH, USA ; Harrington Heart & Vascular Institute, Cleveland, OH, USA ; Case Western Reserve University School of Medicine, Cleveland, OH, USA.
authors.forename: Richard
authors.initials: R
authors.lastname: Josephson
authors.affiliation: Department of Psychology, Kent State University, Kent, OH, USA ; Department of Psychiatry, Summa Health System, Akron City Hospital, Akron, OH, USA.
authors.forename: Joel
authors.initials: J
authors.lastname: Hughes
authors.affiliation: Department of Psychiatry, Summa Health System, Akron City Hospital, Akron, OH, USA.
authors.forename: Jim
authors.initials: J
authors.lastname: Rosneck
authors.affiliation: Department of Psychology, Kent State University, Kent, OH, USA ; Department of Psychiatry, Summa Health System, Akron City Hospital, Akron, OH, USA.
authors.forename: John
authors.initials: J
authors.lastname: Gunstad
keywords: Brain volume; Cerebral blood flow; Heart failure; Neuroimaging; Obesity