Neurobiological Pathways Linking Acute Mental Stress to Impairments in Executive Function in Individuals with Coronary Artery Disease

• Type of Material: Article
• Authors: Kasra Moazzami, Emory University; Matthew T Wittbrodt, Emory University; Bruno B Lima, Emory University; Jeong H Kim, Emory University; Zakaria Almuwaqqat, Emory University; Amit Shah, Emory University; Ihab Hajjar, Emory University; Felicia Goldstein, Emory University; Allan Levey, Emory University; Jonathon Nye, Emory University; James Bremner, Emory University; Laura Vaccarino, Emory University; Arshed Quyyumi, Emory University
• Language: English
• Date: 2021-01-01
• Publisher: IOS Press
• Publication Version: Final Published Version
• Copyright Statement: © 2021 – The authors. Published by IOS Press
• License: Creative Commons Attribution-NonCommercial 4.0 International
• Final Published Version (URL): http://dx.doi.org/10.3233/ADR-200287
• Title of Journal or Parent Work: Journal of Alzheimer's Disease Reports
• Volume: 5
• Issue: 1
• Start Page: 99
• End Page: 109
• Grant/Funding Information: This work was supported by grants P01 HL101398, R01 HL109413, R01HL109413-02S1, R01HL125246, K24HL077506, K24 MH076955, UL1TR000454, KL2TR000455, K23HL127251, and T32HL130025 from the National Institutes of Health.
• Keywords: mental stress; vasoconstriction; Brain activation; cognitive impairment
• Research Categories: Health Sciences, Medicine and Surgery; Health Sciences, Epidemiology

Abstract

Background: Individuals with coronary artery disease (CAD) have worse executive function compared to the general population but the mechanisms are unknown. Objective: To investigate the role of acute mental stress (MS) on the executive function of patients with CAD. Methods: Participants with stable CAD underwent acute MS testing with simultaneous peripheral vascular function measurements and brain imaging using high resolution-positron emission tomography. Digital pulse wave amplitude was continuously measured using peripheral artery tonometry (PAT, Itamar Inc). Stress/rest PAT ratio (sPAT) of pulse wave amplitude during MS/baseline was calculated as a measure of microvascular constriction during MS. Plasma levels of catecholamine and interleukin-6 were assessed at baseline and after MS. Executive function was assessed both at baseline and at 2 years follow-up using the Trail Making Test parts A and B. Results: We studied 389 individuals with brain data available for 148 participants. Of this population follow-up cognitive assessments were performed in 226 individuals (121 with brain imaging). After multivariable adjustment for baseline demographics, risk factors, and medication use, a lower sPAT, indicating greater vasoconstriction, a higher inferior frontal lobe activation with MS, and increases in norepinephrine and IL-6 levels with MS were all independently associated with greater time to complete Trail B test.-38.4pt Conclusion: In response to acute MS, greater peripheral vasoconstriction, higher inferior frontal lobe brain activation, and increases in the levels of norepinephrine and IL-6 are associated with worse executive function.