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Preeclampsia doubles the risk of mild cognitive impairment – July 2017

Preeclampsia and cognitive impairment later in life

American Journal of Obstetrics and Gynecology July 2017 Volume 217, Issue 1, Pages 74.e1–74.e11
DOI: http://dx.doi.org/10.1016/j.ajog.2017.03.008 |


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Julie A. Fields, PhD' PhD Julie A. Fields PhD Julie A. Fields, Vesna D. Garovic, MD, Michelle M. Mielke, PhD, Kejal Kantarci, MD, Muthuvel Jayachandran, PhD, Wendy M. White, MD, Alissa M. Butts, PhD, Jonathan Graff-Radford, MD, Brian D. Lahr, MS, Kent R. Bailey, PhD, Virginia M. Miller, PhD

Background
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.

Objective
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.

Study Design
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.

Results
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).

Conclusion
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.

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