The Relationship between Hypertension and Cognitive Function Impairment in the Elderly

An Investigation of the Relationship Between Vascular Markers and Cognitive Functions in Early Hypertension

Background/Objectives: Controlling hypertension may reduce the risk of cognitive impairment. A marker for the identification of hypertensive patients who are more likely to suffer cognitive impairment would be of clinical benefit. In our research, 105 patients with newly diagnosed primary hypertension were assessed at the Department of Neurology, the University of Debrecen. Methods: The available data covered detailed medical history and data, the results of different tests, ambulatory blood pressure monitoring, the intima-media thickness, the flow-mediated dilatation, the augmentation index, the pulse wave velocity, and neuropsychological evaluation. Multiple linear regression models were created to evaluate the associations found in simple analyses (Spearman's rank correlation and Pearson's chi-squared test). Results: The flow-mediated dilatation showed significant correlations with working memory, attention, learning, and executive functions. The intima-media thickness showed significant correlations with attention and reaction time. The composite flow-mediated dilatation/IMT ratio showed a significant relationship with the overall index of cognitive functions. Based on our results, a flow-mediated dilatation/IMT ratio of 15 represents a cut-off value. The pulse wave velocity showed a significant correlation with working memory and attention. The augmentation index showed significant relationships with reaction time and executive functions. Conclusions: Based on our results, the intima-media thickness, flow-mediated dilatation, and their ratio are suitable for the identification of a particularly vulnerable subgroup of patients for whom a detailed cognitive examination is required for the early detection and treatment of functional disorders. The assessment of attention, executive functions, working memory, and reaction time is required in early hypertension.

Evaluation of Event-Related Potentials in Somatic Diseases - Systematic Review

Many somatic illnesses (e.g. hypertension, diabetes, pulmonary and cardiac diseases, hepatitis C, kidney and heart failure, HIV infection, Sjogren's disease) may impact central nervous system functions resulting in emotional, sensory, cognitive or even personality impairments. Event-related potential (ERP) methodology allows for monitoring neurocognitive processes and thus can provide a valuable window into these cognitive processes that are influenced, or brought about, by somatic disorders. The current review aims to present published studies on the relationships between somatic illness and brain function as assessed with ERP methodology, with the goal to discuss where this field of study is right now and suggest future directions.

A nomogram for predicting mild cognitive impairment in older adults with hypertension

BACKGROUND

Hyper- and hypotension increase the risk of cognitive dysfunction. As effective control of blood pressure can reduce the risk of mild cognitive impairment (MCI), early risk assessment is necessary to identify MCI in senile hypertension as soon as possible and reduce the risk of developing dementia. No perfect risk-prediction model or nomogram has been developed to evaluate the risk of MCI in older adults with hypertension. We aimed to develop a nomogram model for predicting MCI in older patients with hypertension.

METHODS

We selected 345 older patients with hypertension in Xixiangtang District, Nanning City, as the modeling group and divided into the MCI (n = 197) and non-MCI groups (n = 148). Comparing the general conditions, lifestyle, disease factors, psychosocial and other indicators. Logistic regression was used to analyze risk factors for MCI in older hypertensive patients, and R Programming Language was used to draw the nomogram. We selected 146 older patients with hypertension in Qingxiu District, Nanning City, as the verification group. The effectiveness and discrimination ability of the nomogram was evaluated through internal and external verification.

RESULTS

Multivariate logistic regression analysis identified 11 factors, including hypertension grade, education level, complicated diabetes, hypertension years, stress history, smoking, physical exercise, reading, social support, sleep disorders, and medication compliance, as risk factors for MCI in older patients with hypertension. To develop a nomogram model, the validity of the prediction model was evaluated by fitting the curve, which revealed a good fit for both the modeling (P = 0.98) and verification groups (P = 0.96). The discrimination of the nomogram model was evaluated in the modeling group using a receiver operating characteristic curve. The area under the curve was 0.795, and the Hosmer-Lemeshow test yielded P = 0.703. In the validation group, the area under the curve was 0.765, and the Hosmer-Lemeshow test yielded P = 0.234.

CONCLUSIONS

We developed a nomogram to help clinicians identify high-risk groups for MCI among older patients with hypertension. This model demonstrated good discrimination and validity, providing a scientific basis for community medical staff to evaluate and identify the risk of MCI in these patients at an early stage.

Association between cognitive function and self-reported antihypertensive medication adherence among middle-aged and older hypertensive women

DESIGN

This study applied a cross-sectional, descriptive correlational design.

AIMS AND OBJECTIVES

The purpose of the study was to examine the relationship between cognitive function and self-reported antihypertensive medication adherence in middle-aged and older hypertensive women.

BACKGROUND

Although medication adherence is an essential key for preventing complications from hypertension, poor medication adherence is common among middle-aged and older hypertensive women. Taking medications involves a cognitive process. Little is known about the contribution of cognitive function to adherence to antihypertensive medication in middle-aged and older women.

METHODS

This study used a convenience sample of 137 women aged ≥50 years recruited from a medical centre in southern Taiwan. Participants completed a survey of demographic and clinical information and self-reported medication adherence, and received cognitive function tests. Hierarchical regression analyses were used to evaluate the association between cognitive function and medication adherence. This study followed the STROBE guidelines.

RESULTS

More than one-fourth of the women (27%) reported poor adherence. Women with poor adherence appeared to have a significantly lower memory than women with good adherence. Memory was positively associated with antihypertensive medication adherence after controlling for age, blood pressure and duration of hypertension. Working memory, executive function and psychomotor speed were not significantly related to antihypertensive medication adherence.

CONCLUSIONS

Reduced memory function was associated with poorer antihypertensive medication adherence among middle-aged and older women. Middle-aged and older women with hypertension and poor memory performance are at risk of poor medication adherence. Future prospective studies examining the causal relationship between cognitive function and antihypertensive medication adherence are warranted.

RELEVANCE TO CLINICAL PRACTICE

Nurses could evaluate the memory of middle-aged and older hypertensive women when assessing antihypertensive medication adherence in clinical practice and provide relevant interventions.

Cognitive function and associated factors among postmenopausal women with hypertension and natural menopause in Taiwan

Hypertension is prevalent among postmenopausal women worldwide and is a risk factor for cognitive impairment. This study examined the cognitive differences between Taiwanese postmenopausal women with and without hypertension after natural menopause and identified factors associated with cognitive function in hypertensive postmenopausal women. A two-group comparative design study of 171 Taiwanese postmenopausal participants (mean age = 64.8±6.6) was conducted in southern Taiwan. Cognitive performance on neuropsychological tests was evaluated, and demographic, health, menopausal, and disease related variables were assessed. Compared to the non-hypertensive group, women with hypertension showed significantly worse performance and a higher percentage of impairment in global cognitive functioning and memory. Fewer years of education and longer duration of hypertension were associated with lower global cognitive function, and increased age was associated with lower scores in delayed memory. Cognitive screening as well as training on global cognitive functioning and memory are needed for postmenopausal hypertensive women. (148 words).