Abstract
Objectives. The aim of our study is to determine whether cerebral vasomotor reactivity is impaired in patients with arterial hypertension and cognitive impairment and how this hemodynamic parameter is associated with different functions of cognition. Materials and methods. We included 87 patients with arterial hypertension divided into two groups, one with neurocognitive impairment ranging from mild to severe aged between 47 and 90 years (70.2 ± 11.4) and the second group without cognitive impairment aged between 41 and 86 years (60.1 ± 11.4). We excluded patients with significant hemodynamic cervico-cerebral arterial stenoses, arrhythmias and other diseases that may impair cerebral vasomotor reactivity. All the patients underwent assessment of vasomotor reactivity and neurocognitive functions. Results. BHI values were significantly lower in the first group of patients compared to the second one. The percent of patients with impaired cerebral vasomotor reactivity was significantly higher in the group of patients with cognitive impairment, as compared to the other group (54.35% vs 29.27%, p=0.01). There was a significant statistical difference between the MMSE, MOCA and clock test scores among patients with and without impaired vasomotor reactivity. This difference was also maintained for visuospatial/executive, naming and language domains of the MOCA test. Conclusions. Impaired cerebral vasomotor reactivity is more frequent in patients with arterial hypertension and cognitive impairment. Patients with arterial hypertension and impaired vasomotor reactivity have poorer cognitive performance, cognitive functions most affected in patients with impaired vasomotor reactivity being language, visuospatial and executive ones.
Highlights
AND OBJECTIVESNeurocognitive impairment is defined according to DSM 5 published in 2013 by the American Psychiatric Association as a clinical syndrome characterized by a significant decline in cognition that affects one or more cognitive functions
The mean breath holding index (BHI) values were significantly lower in the group of patients with cognitive impairment as compared to the group of patients without cognitive impairment (1.01 ± 0.3 vs. 1.28 ± 0.3, p=0.0009) (Graph 1)
When we analyzed the results of the neuropsychological evaluation in the group of patients with and without impaired vasomotor reactivity (VMR) (Table 3), we found that there was a significant statistical difference between the MOCA (24.3 ± 4.6 vs. 21.3 ± 6.1, p=0.01) (Graph 3), Mini Mental State Examination (MMSE) (27 ± 2.6 vs. 25 ± 4.8, p=0.008) (Graph 4) and clock test (8.9 ± 1.7 vs. 7 ± 3.1, p=0.001) (Graph 5) scores for the two groups
Summary
Neurocognitive impairment is defined according to DSM 5 published in 2013 by the American Psychiatric Association as a clinical syndrome characterized by a significant decline in cognition that affects one or more cognitive functions. This decline should be reported by the patient, observed by a relative or a physician and it should be documented by neuropsychological tests. These cognitive deficits interfere with the patient’s independence regarding daily tasks and are not secondary to a mental disorder [1]. Vascular neurocognitive impairment is the second most common type after Alzheimer disease, research in the field regarding the underlying pathology, especially postmortem pathological studies, showing that most of the cognitive impairments are mixed [4,5]
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