The clock drawing test as a cognitive screening tool for assessment of hypertension-mediated brain damage.

INTRODUCTION: Hypertension (HTN) is the most frequent cause of subcortical vascular brain injury (VBI) and its cognitive consequences. The aims were to show the usefulness of the Clock Drawing Test (CDT) to detect cognitive impairment in hypertensive patients and to compare it with the Mini-Mental Test (MMSE). METHODS: A subset of hypertensive patients of the Heart-Brain Study in Argentina was included. Demographic characteristics, vascular risk factors, blood pressure (BP) and schooling level were recorded. The MMSE and CDT tests were used for neurocognitive assessment and Hospital Anxiety Depression scale (HAD) for mood disorder evaluation. RESULTS: 1414 hypertensive patients (age 59.7±13.8 years, female (62.3%). The prevalence of cognitive impairment was 20.7% (using MMSE) and 36.1% (using CDT). Among hypertensive patients with normal MMSE (>24) 29.3% had cognitive impairment (abnormal CDT). The CDT was associated with level of education but not with age or mood status. CONCLUSIONS: The CDT is a useful screening tool to detect hypertension-mediated brain damage earlier (especially in midlife) and is more sensitive than MMSE.

Neurocognitive disorder in hypertensive patients. Heart-Brain Study.

The relation between hypertension and cognitive impairment is an undisputable fact. The aims of this study were to determine the prevalence of cognitive impairment in hypertensive patients, to identify the most affected cognitive domain, and to observe the association with different parameters of hypertension and other vascular risk factors. A multicentre study was carried out, and 1281 hypertensive patients of both genders and ≥21 years of age were included. Data on the following parameters were obtained: cognitive status (Minimal Cognitive Examination), behavioural status (Hospital Anxiety and Depression Scale), blood pressure, anthropometry, and biochemical profile. The average age was 60.2±13.5 years (71% female), and the educational level was 9.9±5.1 years. Global cognitive impairment was seen in 22.1%, executive dysfunction in 36.2%, and semantic memory impairment in 48.9%. Cognitive impairment was higher in males (36.8% vs. 30.06%) within both the 70-79-year-old and the ≥80-year-old (50% vs. 40%) age groups. Abnormal Clock Drawing Test results were related to high pulse pressure (p<0.0036), and abnormal Mini-Boston Naming Test results to both high systolic blood pressure (p<0.052) and pulse pressure (p<0.001). The treated/uncontrolled hypertensive group showed abnormal results both in the Mini Mental State Examination (OR, 0.73; p=0.036) and the Mini-Boston Naming Test (OR, 1.36; p=0.021). Among patients without cognitive impairment (MMSE >24), 29.4% presented executive dysfunction, and 41.5% semantic memory impairment. Cognitive impairment was higher in hypertensive patients than in the general population. Executive functions and semantic memory were the most affected cognitive domains. High systolic blood pressure and pulse pressure were associated with abnormal results in cognitive tests.

Factores de riesgo vascular y estado cognitivo en mujeres adultas / Vascular risk factors and cognitive status in adult women

INTRODUCCIÓN La enfermedad cardiovascular es la primera causa de muerte en mujeres en países desarrollados y también en la Argentina. Existen diferencias regionales y locales en la prevalencia de los factores de riesgo vascular y en relación a la edad y al sexo. Conocer estos determinantes de enfermedad tiene una indudable importancia sanitaria permitiendo reducir su impacto sobre la salud cardio y cerebrovascular (Deterioro cognitivo). MÉTODOS Estudio epidemiológico, transversal con muestreo polietápico en dos centros urbanos. RESULTADOS Población de 2560 mujeres con 49,48±0,31 años. Se detectó una prevalencia de hipertensión del 39%, tabaquismo 27%, sobrepeso u obesidad 75%, obesidad abdominal 68%, diabetes 11%, dislipemias 76%, sedentarismo 76% y deterioro cognitivo 20%. Todos los factores guardan una relación inversa con el nivel de instrucción, excepto el tabaquismo (p<0,01). Existe una asociación directa entre el deterioro cognitivo y la edad e inversa con el nivel de educación. La prevalencia de deterioro cognitivo fue 28,9% en >60 años y 17,6% en ≤60 años (p<0,01). Todos los factores de riesgo son más prevalentes en la mujer menopáusica independientemente de la edad (p<0,01). DISCUSIÓN Existen diferencias en la prevalencia de factores de riesgo vascular a nivel local, siendo mayor a la reportada nacionalmente, el deterioro cognitivo se asocia inversamente con el nivel de educación y la menopausia se asocia con mayor prevalencia de factores de riesgo independiente de la edad.