Preeclampsia and cognitive impairment later in life.
Hypertension is a risk factor for cerebrovascular disease and cognitive impairment. Women with hypertensive episodes during pregnancy report variable neurocognitive changes within the first decade following the affected pregnancy. However, long-term follow-up of these women into their postmenopausal years has not been conducted.



The aim of this study was to examine whether women with a history of preeclampsia were at increased risk of cognitive decline 35-40 years after the affected pregnancy.



Women were identified and recruited through the medical linkage, population-based Rochester Epidemiologic Project. Forty women with a history of preeclampsia were age- and parity-matched to 40 women with a history of normotensive pregnancy. All women underwent comprehensive neuropsychological assessment and completed self-report inventories measuring mood, ie, depression, anxiety, and other symptoms related to emotional state. Scores were compared between groups. In addition, individual cognitive scores were examined by neuropsychologists and a neurologist blinded to pregnancy status, and a clinical consensus diagnosis of normal, mild cognitive impairment, or dementia for each participant was conferred.



Age at time of consent did not differ between preeclampsia (59.2 [range 50.9-71.5] years) and normotensive (59.6 [range 52.1-72.2] years) groups, nor did time from index pregnancy (34.9 [range 32.0-47.2] vs 34.5 [range 32.0-46.4] years, respectively). There were no statistically significant differences in raw scores on tests of cognition and mood between women with histories of preeclampsia compared to women with histories of normotensive pregnancy. However, a consensus diagnosis of mild cognitive impairment or dementia trended toward greater frequency in women with histories of preeclampsia compared to those with normotensive pregnancies (20% vs 8%, P = .10) and affected more domains among the preeclampsia group (P = .03), most strongly related to executive dysfunction (d = 1.96) and verbal list learning impairment (d = 1.93).



These findings suggest a trend for women with a history of preeclampsia to exhibit more cognitive impairment later in life than those with a history of normotensive pregnancy. Furthermore, the pattern of cognitive changes is consistent with that observed with vascular disease/white matter pathology.
Division of Neurocognitive Disorders, Department of Psychiatry and Psychology, Mayo Clinic, Rochester, MN. Electronic address: fields.julie@mayo.edu.
Julie A
JA
Fields
Division of Nephrology and Hypertension, Department of Internal Medicine, Mayo Clinic, Rochester, MN; Division of Maternal Fetal Medicine, Department of Obstetrics and Gynecology, Mayo Clinic, Rochester, MN.
Vesna D
VD
Garovic
Department of Health Sciences Research, Mayo Clinic, Rochester, MN; Department of Neurology, Mayo Clinic, Rochester, MN.
Michelle M
MM
Mielke
Department of Radiology, Mayo Clinic, Rochester, MN.
Kejal
K
Kantarci
Department of Physiology and Biomedical Engineering, Mayo Clinic, Rochester, MN.
Muthuvel
M
Jayachandran
Division of Maternal Fetal Medicine, Department of Obstetrics and Gynecology, Mayo Clinic, Rochester, MN.
Wendy M
WM
White
Division of Neurocognitive Disorders, Department of Psychiatry and Psychology, Mayo Clinic, Rochester, MN.
Alissa M
AM
Butts
Department of Neurology, Mayo Clinic, Rochester, MN.
Jonathan
J
Graff-Radford
Department of Health Sciences Research, Mayo Clinic, Rochester, MN.
Brian D
BD
Lahr
Department of Health Sciences Research, Mayo Clinic, Rochester, MN.
Kent R
KR
Bailey
Department of Physiology and Biomedical Engineering, Mayo Clinic, Rochester, MN; Department of Surgery, Mayo Clinic, Rochester, MN.
Virginia M
VM
Miller
D000339:Affect; D000368:Aged; D001007:Anxiety; D060825:Cognitive Dysfunction / Q000453:epidemiology / Q000209:etiology*; D003863:Depression; D005260:Female; D006801:Humans; D006973:Hypertension / Q000503:physiopathology; D008875:Middle Aged; D009483:Neuropsychological Tests; D011225:Pre-Eclampsia / Q000503:physiopathology*; D011247:Pregnancy; D057566:Self Report
cardiovascular disease; cerebrovascular disease; cognition; dementia; hypertensive pregnancy; mild cognitive impairment; preeclampsia