Blood Pressure, EEG Neural Markers, and Cognitive Performance in Young and Older Adults: A 24-Month Prospective Longitudinal Cohort Study

Abstract

Background: Elevated blood pressure is an established modifiable risk factor for cognitive decline, yet longitudinal evidence simultaneously integrating blood pressure indices, electroencephalographic neural markers, and multidomain cognitive outcomes across age groups remains limited.

Objectives: This study investigated whether blood pressure level and variability predict cognitive performance and EEG markers over 24 months in young and older adults, and whether EEG markers mediate the blood pressure–cognition relationship.

Methods: A prospective longitudinal cohort study enrolled 100 participants — 50 young adults (18–35 years) and 50 older adults (60–75 years) — assessed at baseline, 12 months, and 24 months. Clinic and ambulatory blood pressure, a multidomain cognitive battery, resting-state EEG, and event-related potentials were recorded at each wave. Linear mixed-effects models and multivariable regression were employed for analysis.

Results: Higher systolic blood pressure independently predicted poorer performance across all cognitive domains and adverse EEG profiles, including reduced P300 amplitude, elevated frontal theta, and suppressed posterior alpha power. Significant SBP × Time interactions indicated accelerated decline in processing speed and working memory with higher blood pressure. Associations were substantially stronger in older adults. EEG markers partially mediated the blood pressure–cognition relationship.

Conclusion: Blood pressure elevation predicts both cross-sectional and longitudinal cognitive and neural deterioration across the adult lifespan. Early blood pressure management may represent a viable neuroprotective strategy, with EEG markers serving as sensitive early indicators of blood pressure–related brain dysfunction.