Are vascular health measures linked to motor and cognitive function in prodromal Alzheimer's?

A cross-sectional look at vascular function in amnestic MCI

The paper asks whether vascular health tracks with movement and thinking in people whose memory profile fits prodromal Alzheimer's disease. It analyzes baseline, pre-intervention data from 73 older adults (mean age 74.6 ± 7.1 years) enrolled in the PARTNER trial who met ADNI criteria for amnestic mild cognitive impairment, classified as prodromal Alzheimer's disease by clinical phenotype rather than biomarker confirmation.

Because the design is cross-sectional, the study can show whether vascular measures and functional scores move together at one time point, not which came first. That boundary matters for every result below: an association here is a correlate, not evidence that arterial stiffening caused a functional decline.

Four vascular measures, four different physiological signals

Vascular health was captured non-invasively with the SphygmoCor XCEL system in morning sessions, with participants resting supine for 10 minutes and continuing their usual medications. The four indices are not interchangeable. Pulse wave velocity (PWV) measures how fast the arterial pulse travels between the carotid and femoral arteries, so higher values indicate stiffer central arteries. Aortic augmentation index (AIx) reflects wave reflection from the arterial tree, indexed to a heart rate of 75 bpm. Central mean arterial pressure (MAP) is the average pressure in the central arteries. Subendocardial viability ratio (SEVR%) compares the heart's oxygen supply and demand during the cardiac cycle.

Keeping these apart is essential, because the paper's findings differ by index. A result for PWV says nothing directly about SEVR%, and the authors note that SEVR is a systemic hemodynamic marker that does not directly measure cerebral perfusion.

Stiffer arteries tracked with poorer balance

The strongest vascular-functional relationship in the study was between PWV and balance. In multivariable models adjusting for age, sex, ethnicity, and antihypertensive medication use, higher PWV was independently associated with lower Mini-BESTest scores (β = -0.375, p = 0.025), meaning greater central arterial stiffness went with poorer postural control.

The authors frame this as consistent with reports that people with MCI and vascular features show greater balance and gait impairment, and they note that balance depends on integrating vestibular, visual, proprioceptive, and motor control systems. Bivariate correlations also appeared between PWV and single-leg stance and the Dynamic Gait Index, but none survived Benjamini-Hochberg false discovery rate correction, so the Mini-BESTest association is the one the paper treats as its main motor finding.

Narrow cognitive links, with limited explanatory power

Cognitive results were smaller and more fragile. Higher SEVR% was significantly associated with lower D-KEFS Inhibition/Switching scaled scores in the adjusted model (β = -0.053, p = 0.030), meaning a higher supply-demand ratio went with worse executive performance. The authors caution that the adjusted R² of 0.004 indicates limited explanatory power, so unmeasured factors likely drive most of the variability, and the bivariate SEVR–inhibition/switching relationship did not survive false discovery rate correction.

AIx was related to Montreal Cognitive Assessment scores at the threshold of significance (β = -0.079, p = 0.050, effect size 0.076), while the other vascular indices were not significantly associated with global cognition. The authors interpret this pattern as vascular influences on cognition in amnestic MCI being modest and domain-specific rather than broadly detectable.

Motor-cognitive performance showed no significant vascular link

Dual-task and rapid-stepping outcomes behaved differently from balance and executive function. After false discovery rate correction, no vascular measure was significantly associated with motor-cognitive outcomes in bivariate analyses, and no vascular measure was significant in multivariable models adjusting for age, sex, ethnicity, and antihypertensive use (all p > 0.05).

AIx came closest, with a non-significant association with Four-Square Step Test completion time (β = 0.063, p = 0.063, effect size 0.069), where higher arterial stiffness corresponded to slower performance. The authors attribute the overall null result to the multifactorial nature of dual-task performance, which draws on attentional capacity, task complexity, and compensatory strategies, and to limited statistical power in a modest sample.

Sex shaped the vascular profile, not the associations

Sex was significantly associated with two vascular indices: males had lower AIx than females (p = 0.038) and higher SEVR% (p = 0.045). Age was not significantly associated with PWV, AIx, SEVR%, or MAP, although AIx showed a borderline age relationship (B = 0.446, p = 0.059).

Importantly, sex-by-vascular interaction terms were not significant in any model, so the paper reads these as general physiological differences in vascular profile rather than evidence that vascular-function links differ by sex. Antihypertensive use was common, with 53.4% of participants reporting high blood pressure, and adjusting for it did not materially change the direction or significance of the main associations; the binary yes/no medication variable, however, cannot capture regimen, duration, or degree of blood pressure control.

What the selective pattern supports, and where it stops

The paper's own conclusion is that vascular measures are selectively associated with balance and specific executive functions in older adults with amnestic MCI, and that vascular health, including arterial stiffness, may be a relevant correlate of early functional changes. The pattern is the point: the same cohort showed a motor signal for PWV, a narrow executive signal for SEVR%, a threshold-level global cognition signal for AIx, and nothing for motor-cognitive outcomes.

Several limits qualify that reading. Prodromal AD was defined clinically without biomarker confirmation, so the amnestic MCI group may be etiologically mixed. The sample of 73 limits power to detect small effects and interactions, participants were volunteers from a clinical trial, and there was no cognitively unimpaired control group, so it remains unclear whether the findings are specific to amnestic MCI or reflect normative aging. Lipid profiles, smoking, body mass index, and other metabolic indicators were not systematically included, leaving residual confounding.

For readers weighing what to take from this, the priority is the split by outcome and by vascular index rather than a single summary verdict: PWV and balance is the most robust association reported, SEVR% and inhibition/switching is statistically significant but explains little variance, and motor-cognitive performance shows no significant vascular signal in this cohort. Confirming direction and clinical meaning requires longitudinal, biomarker-confirmed studies with control groups.

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