Journal of geriatric neurology最新文献

{"title":"Systemic proportional pulse index is associated with incident probable dementia: a <i>post-hoc</i> analysis of the SPRINT-MIND trial in the United States.","authors":"Sula Mazimba, Newton Nyirenda, Olayiwola Bolaji, Nicholas Ashur, Patrick Stafford, Joseph Phiri, Jane Chanda Kabwe, Younghoon Kwon, Laprincess C Brewer, Belinda Chihota, Mwenya Mubanga, Selma F Mohammed, Khadijah Breathett, Allana T Forde, Manjunathan Raju, Agrawal Akanksha, Andrija Vidic, Nishaki Mehta, Emily Lin, Kenneth C Bilchick, Deana Saylor, Amber Johnson, Daniel Addison","doi":"10.53991/jgn.2026.00241","DOIUrl":"https://doi.org/10.53991/jgn.2026.00241","url":null,"abstract":"<p><strong>Background: </strong>Pulse pressure (PP) is associated with cognitive decline but does not account for inter-individual differences in body size that may influence vascular load. We evaluated whether the systemic proportional pulse index (SPI), a body size-indexed pulsatile measure, is associated with incident probable dementia in the Systolic Blood Pressure Intervention Trial Memory and Cognition in Decreased Hypertension (SPRINT-MIND).</p><p><strong>Methods: </strong>We conducted a <i>post-hoc</i> analysis of SPRINT-MIND participants with complete baseline blood pressure and anthropometric data. SPI was calculated as PP indexed to the body surface area. The primary outcome was incident probable dementia adjudicated using standardized SPRINT-MIND protocols. Cox proportional hazards models evaluated associations between SPI and dementia after adjustment for demographic and clinical covariates. Incremental prognostic value was assessed using Harrell's C-index and Akaike Information Criterion.</p><p><strong>Results: </strong>Among 6,070 participants (mean age, 63.2±6.0 years; 65.7% male), 110 (1.8%) developed probable dementia during follow-up. Higher SPI was independently associated with increased dementia risk in models adjusting for PP and body surface area (p=0.031). Participants in the highest SPI quartile had greater risk compared with the lowest quartile (hazard ratio, 2.36; 95% confidence interval, 1.27-4.39). Addition of SPI modestly improved model discrimination and fit beyond PP alone.</p><p><strong>Conclusions: </strong>SPI is independently associated with incident probable dementia and provides modest incremental prognostic information beyond standard clinical factors and PP, suggesting that incorporating body size into assessment of pulsatile load may refine vascular risk stratification for cognitive outcomes, pending external validation.</p>","PeriodicalId":524166,"journal":{"name":"Journal of geriatric neurology","volume":" ","pages":""},"PeriodicalIF":0.0,"publicationDate":"2026-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13488910/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148805594","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Estimated pulse wave velocity, dementia risk, and vascular aging phenotypes: a <i>post-hoc</i> analysis of the SPRINT-MIND trial in the United States.","authors":"Newton Nyirenda, Belinda Chihota, Olayiwola Bolaji, Allana T Forde, Patrick Stafford, Nicholas Ashur, Kenneth C Bilchick, Joseph Phiri, Jane Chanda Kabwe, Laprincess C Brewer, Mwenya Mubanga, Selma F Mohammed, Khadijah Breathett, Manjunathan Raju, Andrija Vidic, Nishaki Mehta, Emily Lin, Deana Saylor, Daniel Addison, Younghoon Kwon, Sula Mazimba","doi":"10.53991/jgn.2026.00227","DOIUrl":"https://doi.org/10.53991/jgn.2026.00227","url":null,"abstract":"<p><strong>Background: </strong>Vascular aging contributes to dementia risk, yet clinically interpretable markers for risk stratification remain limited. Estimated pulse wave velocity (ePWV), derived from age and mean arterial pressure, provides an accessible surrogate of arterial stiffness. We evaluated whether baseline ePWV identifies an interpretable threshold for probable dementia and distinct vascular aging phenotypes.</p><p><strong>Methods: </strong>We conducted a <i>post-hoc</i> analysis of SPRINT-MIND including 8,536 participants free of dementia at baseline. Baseline ePWV was calculated using age and mean arterial pressure. The primary outcome was incident probable dementia adjudicated during follow-up. Associations between ePWV and dementia risk were assessed using spline-based and quartile-based Cox proportional hazards models. Model discrimination was evaluated using Harrell's C-index.</p><p><strong>Results: </strong>During follow-up, 323 participants developed probable dementia. Dementia risk was lowest at lower ePWV values and increased beyond approximately 10.7 m/s, identifying an interpretable risk threshold. Risk was concentrated in the highest ePWV quartile, consistent with a threshold-like pattern rather than a uniform linear gradient. In exploratory analyses, longitudinal clustering identified distinct ePWV trajectory phenotypes over 24 months.</p><p><strong>Conclusions: </strong>Baseline ePWV identified an interpretable dementia risk threshold and distinct vascular aging phenotypes in SPRINT-MIND. These findings support ePWV as a clinically interpretable marker of vascular aging that may aid dementia risk stratification.</p>","PeriodicalId":524166,"journal":{"name":"Journal of geriatric neurology","volume":"5 1","pages":"16-23"},"PeriodicalIF":0.0,"publicationDate":"2026-06-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13488911/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148805598","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}