Blood pressure is associated with cognitive impairment in young hypertensives.

AIMS: The present study was conducted to assess the effects of duration of hypertension, systolic hypertension, diastolic hypertension, drug compliance and class-of-drug on cognitive functions. METHODS AND RESULTS: A cohort of young hypertensive subjects was recruited after obtaining informed consent. Subjects with confounding factors, e.g., substance use, neurological disorders, endocrinopathies, inflammatory conditions, psychiatric illnesses, etc., were excluded. Their average systolic and diastolic blood pressure since onset of illness and prescribed drugs were noted from the records. Compliance was assessed with the help of information from subjects as well as the close relatives. MMSE and a battery of neuropsychological tests (Digit Span Test, Trail Making Test Form B, Stroop Test, Visuospatial Working Memory Matrix and Word Fluency Test) was applied to all the participants. Multivariate regression analysis was used for the assessment of associations and one-way ANOVA was performed to assess differences in the mean. Analysis showed that mean age of study subject was 52 years and average duration of hypertension was 9 years. Fourteen percent subjects had obvious cognitive impairment as suggested by MMSE score less than 23. However, when cut-off score was lowered to 20, only 6% subjects fell into this category. Diastolic blood pressure had significant negative association with all of the cognitive measures except Trail Making Test, which was, on the contrary, significantly and negatively associated with systolic blood pressure. Duration of hypertension did not influence cognitive performance in this study. Effect of drug compliance was somewhat variable, but in general good compliance was associated with better cognitive performance. Beta-Blocker therapy hampered cognitive performance, whereas the best performance, especially on tests of semantic memory and pre-frontal functions was seen in subjects taking calcium channel blockers. CONCLUSIONS: Diastolic hypertension was associated with significant impairment of cognitive functions in younger subjects. On the other hand good compliance and calcium channel blockers had protective effect on hypertension induced cognitive impairment, especially on the prefrontal functions.     

Relationship between retinopathy and cognitive impairment among hypertensive subjects. A case-control study in the ankara-pursaklar region

BACKGROUND: The relationship between hypertension and cognitive impairment has been investigated in the literature; several clinical studies suggested a relationship between hypertension and retinopathy. METHODS: We examined the relationship between the retinopathy status and cognitive functions by using the Mini-Mental State Examination (MMSE) among hypertensive subjects older than 40 years who were admitted to our Family Medicine, Internal Medicine and Ophthalmology clinics. The subjects were categorized into three groups: group 1 = control subjects (n = 39), group 2 = hypertensive patients without retinopathy (n = 32), and group 3 = hypertensive patients with retinopathy (n = 25). RESULTS: The number of patients with total MMSE scores less than 24 was distributed as follows: group 1: 3 patients (7.7%), group 2: 4 patients (12.5%), and group 3: 14 patients (56%). Hypertension was found to be related with a significant decrease in total MMSE scores in comparison with group 1 subjects (p < 0.001). Furthermore, retinopathy significantly correlated with lower MMSE scores among hypertensive patients (p = 0.001). Compared with group 1, group 3 showed a significant decrease in orientation (p = 0.001), registration (p = 0.001), attention and calculation (p = 0.004), recall (p = 0.009), and total (p < 0.001) MMSE scores. We also found a significant decrease in recall (p = 0.032) and total (p = 0.034) scores in group 3 when compared with group 2. There was a significant decrease in registration (p = 0.002) and total (p = 0.029) MMSE scores in group 2 when compared with group 1. We also observed negative correlations between duration of the disease and orientation (R = -0.597, n = 32, p = 0.001), and between duration of the disease and total (R = -0.495, n = 32, p = 0.006) scores in group 2. CONCLUSIONS: Hypertension was found to be related with a decline in MMSE scores. This relation was even more significant in the group of hypertensive patients with retinopathy. Thus, we suggest that cognitive tests be routinely used in the follow-up of hypertensive patients.     

Magnetic resonance imaging white matter lesions and cognitive impairment in hypertensive individuals

To search for a morphologic basis of cognitive impairment possibly associated with essential hypertension, we studied 35 otherwise asymptomatic hypertensive individuals (mean age, 38.7 years; range, 22 to 49 years) and 20 normotensive control subjects (mean age, 37.9 years; range, 26 to 49 years) using neuropsychologic tests and magnetic resonance imaging. Irrespective of drug treatment, hypertensive individuals performed significantly worse than did control subjects when assessed for verbal memory and total learning and memory capacity, while there were no differences in test results of visual memory, attention, vigilance, and reaction time. The hypertensive individuals also described themselves as less active but ranked similar on five other mood subscales. Punctate high-signal intensities of the white matter were found almost twice as often in the hypertensive group (38%) as in the control group (20%). There was no difference in test performance between hypertensive individuals with and those without white matter lesions, however. Our results confirm the presence of subtle neuropsychologic deficits and indicate a higher frequency of white matter signal abnormalities in essential hypertension, as shown on magnetic resonance imaging, but do not indicate a correlation of these findings with each other.     

Cognitive function in recent-onset demyelinating diseases

To determine cognitive disturbances in recent demyelinating disease, we studied 21 patients with definite or probable multiple sclerosis (MS) of less than two years' duration and nine patients with recently isolated optic neuritis. None had any clinical or social evidence of cognitive impairment. Mild to moderate cognitive impairment. Mild to moderate cognitive impairment was present in 18 (60%) of 30 cases, affecting visual and/or verbal efficiency. These abnormalities were statistically significant when compared with the results of a control group of 29 patients. There was no correlation with a depressive status, between the presence of cognitive impairment and either the degree of handicap or the activity of the disease. The frequency of cognitive dysfunction (60%) appears to be comparable to that reported in other series in which MS evolution is over ten years. The natural history of cognitive functions in MS has to be identified. Neuropsychologic tests could be useful in the diagnosis of monosymptomatic or paucisymptomatic forms of MS (ie, visual or medullary).     

同型半胱氨酸与高血压患者轻度认知障碍的相关性

目的 探讨同型半胱氨酸（homocysteine，Hcy）与高血压患者轻度认知障碍的相关性。 方法 回顾性纳入2017年1月-2018年2月邯郸市第一医院神经内科连续收治的原发性高血 压患者，根据其血浆Hcy水平，将患者分为单纯型高血压组（Hcy<15 μm m ol/L）与H型高血压组 （Hcy≥15 μmmol/L），采用Spearman秩相关分析Hcy与MMSE和MoCA评分的相关性，并采用Logistic回归 分析高血压患者轻度认知功能障碍的影响因素。 结果 共纳入原发性高血压患者113例，其中单纯型高血压组49例，H型高血压组64例。H型高血压 组患者的MMSE和MoCA评分均低于单纯型高血压组（分别为24.94±1.83 vs 27.96±1.54和23.45±2.47 vs 27.24±1.80，均P <0.001）。相关分析显示，Hcy水平与MMSE和MoCA评分存在负相关性（分别为r =- 0.513和r =-0.500，均P＜0.001）。多因素Logistic回归分析显示，高龄（OR 1.236，95%CI 1.124～1.361）、 H型高血压（OR 22.218，95%CI 8.243～59.654）是高血压患者轻度认知功能障碍的独立危险因素。 结论 Hcy水平升高是高血压患者轻度认知功能障碍发生的独立危险因素。     

Effect of antihypertensive therapy on cognitive functions of patients with hypertension

Objectives:

Hypertension is known to be associated with cognitive decline. Many studies revealed that control of hypertension with antihypertensive therapy controls the cognitive decline associated with hypertension. While there are reports that suggest that antihypertensive drugs do not provide protection from cognitive decline, the present study is designed to evaluate the cognitive status of patients recently diagnosed as hypertensive and effect of 3 month long antihypertensive therapy on cognitive functions.

Materials and Methods:

A predesigned pretested questionnaire was used to collect the information. The PGI memory scale (PGIMS) was employed to assess memory function of patients. Baseline memory functions were evaluated before starting the treatment with antihypertensive and compared with the cognitive function scores of healthy volunteers. After the 3 months of treatment, cognitive functions were evaluated again by the same scale. The unpaired t-test was used to compare the cognitive functions between case and control and the paired t-test was used to compare pre- and post-treatment score.

Results:

This study revealed that mean scores of six subtests of cognitive functions were less in cases as compared to subjects in comparison group. After 3 months of antihypertensive therapy, scores of five sub-tests were found to be increased. Among these five subtests, four were those which were found declined at the baseline.

Conclusion:

This suggests that antihypertensive therapy given for 3 months improved the score of those cognitive function tests in which hypertensive patients perform poorly during recruitment and there was no deterioration of any test after 3 months of antihypertensive therapy.     

Huntington chorea. Clinical correlations and preliminary neuropsychological data]

One of the cardinal features of Huntington's disease (HD) is the progressive cognitive deterioration. However, studies carried out on the neuropsychological profile in HD are discordant because there are differences in study designs, stage of disease and because of the coexistence of psychiatric disorders and cultural and educational background of subjects. Aim of this study is to relate the neuropsychological assessment with duration of illness and severity of motor impairment. Fourteen patients are given a neuropsychological battery, the results were statistically related to age and schooling. The data demonstrate very slow progression of cognitive deterioration without focal impairment of cognitive functions and without correlation with the severity of disease.     

同型半胱氨酸与高血压患者轻度认知障碍的相关性

目的 探讨同型半胱氨酸（homocysteine,Hcy）与高血压患者轻度认知障碍的相关性。
方法 回顾性纳入2017年1月-2018年2月邯郸市第一医院神经内科连续收治的原发性高血
压患者,根据其血浆Hcy水平,将患者分为单纯型高血压组（Hcy<15 μm m ol/L）与H型高血压组
（Hcy≥15 μmmol/L）,采用Spearman秩相关分析Hcy与MMSE和MoCA评分的相关性,并采用Logistic回归
分析高血压患者轻度认知功能障碍的影响因素。
结果 共纳入原发性高血压患者113例,其中单纯型高血压组49例,H型高血压组64例。H型高血压
组患者的MMSE和MoCA评分均低于单纯型高血压组（分别为24.94±1.83 vs 27.96±1.54和23.45±2.47
vs 27.24±1.80,均P <0.001）。相关分析显示,Hcy水平与MMSE和MoCA评分存在负相关性（分别为r =-
0.513和r =-0.500,均P＜0.001）。多因素Logistic回归分析显示,高龄（OR 1.236,95%CI 1.124～1.361）、
H型高血压（OR 22.218,95%CI 8.243～59.654）是高血压患者轻度认知功能障碍的独立危险因素。
结论 Hcy水平升高是高血压患者轻度认知功能障碍发生的独立危险因素。     

Quantified neuropsychological study in senile dementia of Alzheimer's type

Forty six patients affected by senile dementia of the Alzheimer type and 20 control subjects of similar age, sex and educational level have been studied, using a quantified neuropsychological battery (Wechsler memory scale, Raven progressive matrices and quantified tests for aphasia, apraxia and agnosia). There was a significant correlation between the scores of all cognitive functions with one another and with the Mini Mental State. The results show a rather global impairment of cognitive functions in these patients and suggest that intellectual impairment progresses as a continuum in senile dementia of the Alzheimer type.     

Neuropsychological performance,disease severity,and depression in progressive supranuclear palsy

To investigate the relationship between disease severity, cognitive impairment and depression in progressive supranuclear palsy (PSP) we studied a group of 25 patients who fulfilled strict research criteria and 25 matched controls. Disease severity was judged from the duration of symptoms, level of physical disability using the Columbia Rating Scale (CRS), and the degree of eye movement abnormality. The neuropsychological battery was designed to assess attention and executive function, visual and auditory perception, semantic memory and language production. Although the PSP group were significantly impaired on almost all of these measures, the most profound deficits were on tests of sustained and divided attention. There was no correlation between cognitive impairment and either disease duration or scores on the CRS, but performance on tests of attention correlated significantly with the degree of ocular motor impairment. Depression was found to be common in PSP but did not correlate with any other parameters. It is concluded that the cognitive deficit in PSP is widespread and independent of depression. The association between the severity of eye movement disorder and deficits in sustained and divided attention leads us to postulate that pathology involving the midbrain periaqueductal region may be critical for breakdown in these fundamental processes.     

Cognitive decline in temporal lobe epilepsy due to unilateral hippocampal sclerosis

ObjectiveWe assessed the cognitive performance of patients with temporal lobe epilepsy (TLE) caused by unilateral hippocampal sclerosis (HS), in comparison with that of matched, healthy controls. We report the relationship between cognitive measures and duration of epilepsy, correlating with hippocampal volumes, and the impact of educational level on cognitive decline.MethodsThis study involved 61 outpatients (40 with ⩽8 years and 21 with >8 years of formal education) with unilateral HS and 61 controls. Volumetric MRI was performed on all patients and 10 controls. The results (mean, SD) of the neuropsychological tests of healthy subjects and patients were compared using the Student t and Mann–Whitney tests.ResultsPatients performed worse than controls in the neuropsychological evaluation. When adjusted z scores were used to calculate the impairment index, patients had a greater percentage of abnormal tests compared with controls. The cognitive decline, assessed through the impairment index, correlated with duration of epilepsy. Higher level of education did not protect against this decline, thus not supporting the hypothesis of cerebral reserve in this population. A significant correlation between hippocampal volumetric measures and duration of epilepsy was observed only in patients with left HS.ConclusionPatients with TLE caused by HS present with cognitive morbidity that extends beyond memory deficits. Cognitive decline is associated with duration of epilepsy, and in patients with left-sided HS, duration may correlate with volumetric hippocampal loss.     

脑白质病变相关性轻度认知功能障碍患者神经心理学特征分析

目的观察脑白质病变(WML)对轻度认知功能损害(mild cognitive impairment,MCI)患者神经心理学的影响。方法 WML-MCI患者和健康对照者进行常规核磁共振及神经心理学检查,观察WML对MCI患者神经心理学的影响,并对其机制进行探讨。结果 WML-MCI组与对照组相比,高血压、糖尿病和冠心病比例明显增高;词语流畅性测验、积木测验和画钟测验评分均明显降低(P<0.05);而2组间MMSE、数字广度测验和词语延迟回忆测验评分无明显差异。结论 WML影响MCI患者的认知功能,主要表现为视空间及执行功能。血管危险因素是MCI发病的危险因素。     

Prolonged visual fixation as a surrogate marker of cholinergic deficit in Parkinson's disease: A 2-year follow-up study

IntroductionThe search for biomarkers of cognitive impairment in Parkinson's disease is driven by the potential clinical applications in disease prognostication. Various eye tracking studies on cognitive functions in Parkinson's disease suggest a promising role of eye movement parameters as a biomarker for cognitive decline but the clinical utility has not been validated in longitudinal studies. The present study aims to investigate the longitudinal progression of eye fixation duration in a visual search task and its correlation with domain-specific cognitive impairment.MethodThis is a 2-year follow-up study on a group of non-demented Parkinson's disease patients, with baseline eye movement metrics and multi-domain cognitive functions measured, to assess the association between domain-specific cognitive impairment and progression of visual fixation duration.ResultsA total of 49 from the original 62 non-demented Parkinson's disease patients were re-examined at a 2-year follow-up. 15 cases (31%) were classified as having mild cognitive impairment. Visual fixation duration was significantly prolonged after 2 years. Using repeated measures ANOVA, impairment in semantic verbal fluency, visual and verbal recognition memory and orienting function of attention had a significant effect on prolonging visual fixation over time.ConclusionCorrelation between prolonged visual fixation and multiple domains of cognitive impairment related to cholinergic dysfunction in repeated measures over two years provides preliminary evidence for the eye tracking paradigm as a surrogate marker for cholinergic deficit in Parkinson's disease. The clinical utility in terms of disease prognostication is yet to be confirmed in prospective longitudinal studies with longer follow-up periods.     

Cognitive impairment and white matter damage in hypertension: a pilot study

Objectives – Hypertension has been associated with impaired cognition. Diffusion tensor imaging (DTI) and magnetic resonance spectroscopy were applied to assess white matter abnormalities in treated vs untreated hypertension and if these correlated with neuropsychological performance. Methods – Subjects were 40 patients with medically treated hypertension (mean age 69.3 years), 10 patients with untreated hypertension (mean age 57.6 years) and 30 normotensive controls (mean age 68.2 years). Hypertension was defined as a previous diagnosis and taking hypertensive medication, or a resting blood pressure of >140/90 mmHg on the day of assessment. Results – Patients with treated hypertension performed worse on immediate (P = 0.037) as well as delayed memory tasks (P = 0.024) compared with normotensive controls. Cognitive performance was worse in untreated compared with treated hypertension on executive functions (P = 0.041) and psychomotor speed (P = 0.003). There was no significant correlation between cognition and any of the imaging parameters in treated hypertension. However, in untreated hypertension the results revealed a positive correlation between an executive functioning and attention composite score and DTI mean diffusivity values (P = 0.016) and between psychomotor speed and spectroscopy NAA/tCr levels (P = 0.015). Conclusions – These results suggest there is cognitive impairment in hypertension. Treated hypertension was associated with deficits in memory while untreated hypertension revealed a more ‘subcortical’ pattern of cognitive impairment.     

Clinical heterogeneity in Parkinson's disease revisited: a latent profile analysis

Objective – The heterogeneity of Parkinson’s disease (PD) is increasingly recognized, and several attempts have been made to subclassify subjects on clinical or cognitive features. We explored the utility of latent profile analysis (LPA) as a means of classifying patients with PD on clinical features and test validity of these subclasses against neuropsychological data. Methods – LPA utilizing clinical variables while controlling for age was applied to a cohort of 71 outpatients with PD. The resultant subgroups were validated via comparison to 30 control subjects on neuropsychological tests of executive, memory, and visuospatial functions. Results – The LPA resulted in a three‐class solution identifying a ‘younger onset, mild motor impairment group’, a ‘moderate motor impairment group’, and an ‘old onset, fast progression group’. The groups were distinguishable on cognitive variables with the ‘younger onset mild motor impairment subgroup’ displaying deficits pertaining verbal acquisition, visuospatial construction, and set maintenance. The ‘moderate motor impairment group’ exhibited widespread cognitive impairment, and the ‘old onset, fast disease progression group’ had extensive cognitive impairment but outperformed the former group on verbal acquisition and visuospatial function. Conclusion – LPA holds promise in PD research as it uncovered three PD subtypes distinguished by motor symptoms and disease progression and validated by cognitive variables.     

Cognitive behavior in asymptomatic (CDC stage II and III) HIV — seropositive intravenous drug users (IVDUs)

To evaluate cognitive impairment in the early stages of HIV infection in intravenous drug users (IVDUs) we have studied 39 consecutive HIV-infected subjects (CDC stage II–III) whose only known risk factor for the infection was intravenous heroin addiction. The control group was represented by 30 seronegative IVDUs. All subjects were tested with an extensive neuropsychological battery assessing general intellectual abilities and single cognitive functions. The patients differed from controls only for tests of attention and visual-motor abilities: 20% of asymptomatic seronegative and PGL patients showed alterations in two or more cognitive tests, as opposed to 3% of controls (p<0.001). Our findings suggest that cognitive deficits seem to be present in a substantial percentage of IVDUs with asymptomatic HIV infection. Cognitive damage at this stage seems to selectively involve attention and visual-motor abilities, sparing general intellectual performances.     

Cortical thinning associated with mild cognitive impairment in Parkinson's disease

The aim of this study was to investigate patterns of cortical atrophy associated with mild cognitive impairment in a large sample of nondemented Parkinson's disease (PD) patients, and its relation with specific neuropsychological deficits. Magnetic resonance imaging (MRI) and neuropsychological assessment were performed in a sample of 90 nondemented PD patients and 32 healthy controls. All underwent a neuropsychological battery including tests that assess different cognitive domains: attention and working memory, executive functions, memory, language, and visuoperceptual‐visuospatial functions. Patients were classified according to their cognitive status as PD patients without mild cognitive impairment (MCI; n = 43) and PD patients with MCI (n = 47). Freesurfer software was used to obtain maps of cortical thickness for group comparisons and correlation with neuropsychological performance. Patients with MCI showed regional cortical thinning in parietotemporal regions, increased global atrophy (global cortical thinning, total gray matter volume reduction, and ventricular enlargement), as well as significant cognitive impairment in memory, executive, and visuospatial and visuoperceptual domains. Correlation analyses showed that all neuropsychological tests were associated with cortical thinning in parietotemporal regions and to a lesser extent in frontal regions. These results provide neuroanatomic support to the concept of MCI classified according to Movement Disorders Society criteria. The posterior pattern of atrophy in temporoparietal regions could be a structural neuroimaging marker of cognitive impairment in nondemented PD patients. All of the neuropsychological tests reflected regional brain atrophy, but no specific patterns were seen corresponding to impairment in distinct cognitive domains. © 2014 International Parkinson and Movement Disorder Society     

Validity of the Italian telephone version of the mini-mental state examination in the elderly healthy population

The biggest challenge regarding cognitive prospective evaluations in the elderly is the identification of subjects that go on to develop cognitive impairment. In this study, we compared the Italian telephone version of the MMSE (Itel-MMSE) with both the MMSE and a battery of neuropsychological tests in a group of 107 healthy elderly subjects. The aim of the study was to identify a subset of subjects who, despite having an overall score within the normal range, performed poorly in the cognitive neuropsychological evaluation. The Itel-MMSE score showed a good internal consistency as well as a significant correlation with the MMSE score, age and education. A score of < or = 21 on the Itel-MMSE was the score which reflected the highest degree of sensitivity in the neuropsychological tests. There was a statistically significant difference between subjects with an Itel-MMSE score of < or = 21 and those with a score of 22 in age, education, Attentional Matrices and Copying Drawings. Despite some potential limitations, our results strongly suggest that the Itel-MMSE may be used as a screening test to identify healthy elderly subjects whose cognitive performance is poor.     

Link between non-motor symptoms and cognitive dysfunctions in de novo, drug-naive PD patients

Little is known about the relationship between cognitive dysfunctions and the non-motor complex in subjects with newly diagnosed untreated Parkinson's disease (PD). The aim of this study was to explore the association between non-motor symptoms (NMS) and cognitive dysfunctions in an incident cohort of de novo, drug-naive, PD patients. Sixty-six non-demented, early, untreated PD patients completed a semi-structured interview on NMS and a battery of neuropsychological tests that assess verbal memory, visuospatial abilities, and attention/executive functions. Scores were age- and education-corrected. Patients who failed at least two tests for each cognitive domain were diagnosed as having mild cognitive impairment (MCI). All but three (95.4%) PD patients complained of at least one NMS. A total of 37.8% was diagnosed with MCI. There was a relationship between sleep-NMS and cognitive dysfunctions. Specifically, both REM behavioral sleep disorders (RBD) and insomnia were associated with lower scores on several cognitive tests. Moreover, RBD was closely related to MCI. NMS and MCI are very common even in the early phase of PD, before patients are treated. Given the correlation between sleep disturbances and cognitive impairment, it is possible that sleep symptoms in PD patients might be considered as an early marker of dementia.     

Plasma concentrations of platelet-specific proteins in different stages of essential hypertension: interactions between platelet aggregation, blood lipids and age

Plasma beta-thromboglobulin (beta TG) and platelet factor 4 (PF4) were significantly higher in a group of 116 hypertensive men than in a normotensive group of 142 men. They increased with the stage of hypertension but the level did not correlate with the age of the subjects. Platelet aggregation was similar in the two groups and positively correlated with the age of the subjects in the normotensive group but not in the hypertensive group. A strong positive correlation was observed between the levels of plasma beta TG and PF4 and between platelet aggregation to ADP and that to epinephrine in both the hypertensive and normotensive groups. However, there was no correlation between the level of plasma beta TG or PF4 and platelet aggregation. Plasma antithrombin III was lower in the hypertensive group than in the normotensive group. These studies suggest that plasma levels of beta TG and PF4 are closely related to the stage of hypertension and are better indicators than aggregation of in vivo platelet activation in hypertensive subjects. Enhanced platelet activation may be involved in the acceleration of hypertensive arteriovascular damage and atherosclerosis.