Visit-to-Visit Blood Pressure Variability and CSF Alzheimer Disease Biomarkers in Cognitively Unimpaired and Mildly Impaired Older Adults
Bibliographic record
Abstract
Background and Objectives Blood pressure variability is an emerging risk factor for cognitive decline and dementia, but mechanisms remain unclear. The current study examined whether visit-to-visit blood pressure variability is related to CSF Alzheimer disease biomarker levels over time and whether associations differed by APOE ε4 carrier status. Methods In this retrospective analysis of a prospective cohort study, cognitively unimpaired or mildly impaired older adults from the Alzheimer9s Disease Neuroimaging Initiative underwent 3 to 4 blood pressure measurements over a 12-month period and ≥1 lumbar puncture for evaluation of CSF phosphorylated tau, total tau, and β-amyloid levels at follow-up (6–108 months later). APOE ε4 carriers were defined as having ≥1 ε4 allele. Visit-to-visit blood pressure variability was determined over 12 months as variability independent of mean. Only CSF samples collected after the final blood pressure measurement were analyzed. Bayesian linear growth modeling investigated the role of blood pressure variability, APOE ε4, and the passage of time on CSF biomarker levels after controlling for several variables, including average blood pressure and baseline hypertension. Results Four hundred sixty-six participants (mean 76.7 [SD 7.1] years of age) were included in the study. Elevated blood pressure variability was associated with increased CSF phosphorylated tau (β = 0.81 [95% CI 0.74, 0.97]), increased total tau (β = 0.98 [95% CI 0.71, 1.31]), and decreased β-amyloid levels (β = −1.52 [95% CI −3.55, −0.34]) at follow-up. APOE ε4 carriers with elevated blood pressure variability had the fastest increase in phosphorylated tau levels (β = 9.03 [95% CI 1.67, 16.36]). Blood pressure variability was not significantly related to total tau or β-amyloid levels over time according to APOE ε4 carrier status. Discussion Older adults with elevated blood pressure variability exhibit increased CSF phosphorylated tau, increased total tau, and decreased β-amyloid over time, suggesting that blood pressure variability may correlate with alterations in Alzheimer disease biomarkers. Findings warrant further study of the relationship between blood pressure variability and the development of Alzheimer disease. APOE ε4 carrier status moderated relationships between blood pressure variability and CSF phosphorylated tau but not total tau or β-amyloid, consistent with other studies relating hemodynamic factors to tau changes.
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How this classification was reachedexpand
Full frame machine prediction
Teacher imitationNot calibrated prevalence, not ground truth. Human validation pending. The Gemma side is a direct model label for every work in the frame, read from the title-only record. The Codex side is a classifier learned from the 10,348 direct Codex labels and calibrated to design-weighted sample rates; fields without enough sample support carry no Codex call. Candidate is the union of the two sides; consensus is their intersection. These outputs are machine_predicted_unvalidated and are not human labels.
Distilled classifier scores by category (both heads)
| Category | Codex | Gemma |
|---|---|---|
| Metaresearch | 0.001 | 0.002 |
| Meta-epidemiology (narrow) | 0.000 | 0.000 |
| Meta-epidemiology (broad) | 0.000 | 0.001 |
| Bibliometrics | 0.000 | 0.001 |
| Science and technology studies | 0.000 | 0.000 |
| Scholarly communication | 0.001 | 0.000 |
| Open science | 0.000 | 0.000 |
| Research integrity | 0.000 | 0.000 |
| Insufficient payload (model declined to judge) | 0.001 | 0.000 |
Machine scores (provisional)
The two teacher heads of the student model, read on this work. A score orders the frame for review; it never asserts a category, and the validation status ships verbatim with every row.
Baseline scores from an immature model (maturity gate not passed, 7 training rounds). Scores rank; they never assert a category.
score_only:v0-immature-baseline · verbatim from the scoring run: score_only means the number may rank works, and no category label ships from itClassification
machine, unvalidatedMachine predicted; a candidate call from one source (direct Gemma or distilled Codex), not a consensus.
How this classification was reached, model by model and score by score, is at the end of the page under "How this classification was reached".