Academic journal article Cognitive, Affective and Behavioral Neuroscience

Evidence for a Detrimental Relationship between Hypertension History, Prospective Memory, and Prefrontal Cortex White Matter in Cognitively Normal Older Adults

Academic journal article Cognitive, Affective and Behavioral Neuroscience

Evidence for a Detrimental Relationship between Hypertension History, Prospective Memory, and Prefrontal Cortex White Matter in Cognitively Normal Older Adults

Article excerpt

Abstract Hypertension affects many older adults and is associated with impaired neural and cognitive functioning. We investigated whether a history of hypertension was associated with impairments to prospective memory, which refers to the ability to remember to perform delayed intentions, such as remembering to take medication. Thirty-two cognitively normal older adult participants with or without a history of hypertension (self-reported) performed two laboratory prospective memory tasks, one that relied more strongly on executive control (nonfocal prospective memory) and one that relied more strongly on spontaneous memory retrieval processes (focal prospective memory). We observed hypertension-related impairments for nonfocal, but not focal, prospective memory. To complement our behavioral approach, we conducted a retrospective analysis of available structural magnetic resonance imaging data. Lower white matter volume estimates in the anterior prefrontal cortex were associated with lower nonfocal prospective memory and with a history of hypertension. A history of hypertension may be associated with worsened executive control and lower prefrontal white matter volume. The translational implication is that individuals who must remember to take antihypertensive medications and to monitor their blood pressure at home may be impaired in the executive control process that helps to support these prospective memory behaviors.

Keywords Prefrontal cortex . Cognitive control . Episodic memory . Prospective memory . Hypertension

Hypertension, or sustained high blood pressure, is a serious pathological disease that affects more than 50 % of adults over the age of 60 (Kearney et al., 2005). Hypertension may be asymptomatic but still increases risk for stroke and, therefore, is sometimes referred to as the "silent killer" (e.g., Cooper, 1973). Prior to stroke, hypertension impairs the cerebrovascular system's ability to distribute blood to regions of need, such as areas with high neuronal activity (Novak & Hajjar, 2010). In older adults, hypertension is also associated with increases in white matter lesions (de Leeuw et al., 2002; Goldstein, Bartzokis, Hance, & Shapiro, 1998; Raz, Rodrigue, Kennedy, & Acker, 2007), impaired white matter microstructure (Kennedy & Raz, 2009), and decreased gray and white matter volume (Raz, Rodrigue,&Acker, 2003). These negative influences on the brain are often concomitant with behavioral deficits: An array of epidemiological and clinical studies has found that hypertension is associated with worse performance on cognitive tests, as well as increased risk for dementia (e.g., Unverzagt et al., 2011; for reviews, see Elias, Goodell, & Dore, 2012; Igase, Kohara, & Miki, 2012; Novak & Hajjar, 2010; Qiu, Winblad, & Fratiglioni, 2005; for an example of a discrepant finding, see Jacobs et al., 2011). In the present study, we extended this literature by investigating hypertension-related impairments in prospective memory tasks, which we considered might have theoretical and translational implications.

Prospective memory

Prospective memory refers to memory for performing an intended action in the future, such as remembering to take medications, remembering to attend physician appointments, and managing blood pressure with a home monitoring unit (patients are encouraged to remember to monitor blood pressure twice in the morning and evening, although they often fail to remember to do so; Niiranen, Johansson, Reunanen, & Jula, 2011; van der Hoeven, van den Born, Cammenga, & van Montfrans, 2009). Three characteristics distinguish prospective memory from the more traditionally studied retrospective memory (e.g., memory for a list of studied words). First, prospective memory is future focused rather than past focused. Second, prospective memory retrieval must be selfinitiated; individuals must "remember to remember," rather than be prompted to recall information. …

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