Abstract
Background: Hypertension is associated with poorer cognitive functions, but the mechanisms are unclear.Objective: This research aims to explore the cognitive status of elderly patients with hypertension and the possible mechanisms of hypertension affecting cognitive function.Methods: Data were obtained from the China Longitudinal Aging Study (CLAS), and a total of 128 residents, aged 60 years and above, were recruited in this study. Based on whether they had hypertension, these 128 people were divided into the hypertension (n = 64) and non-hypertension groups (n = 64). The Beijing version of the Mini-Mental State Examination (MMSE) and Montreal Cognitive Assessment (MoCA) were used to assess the overall cognitive function of the subjects, while digit span, language fluency, Wechsler mapping, and Wechsler wood block were used to assess their domain-specific cognitive function (both at baseline and follow-up stages). At the same time, we also examined baseline blood biochemical indicators (such as total protein, fasting plasma glucose (FPG), high-density lipoprotein (HDL), low-density lipoprotein (LDL), cholesterol, and triglyceride) and baseline MRI data of hippocampus and amygdala volume and temporal polar cortex thickness.Results: The total protein and thickness of temporal polar cortex in patients with hypertension were significantly higher than those in normal controls, but the scores on MMSE, MoCA, digit span, Wechsler mapping and Wechsler wood block at baseline were significantly lower than those in normal controls (p < 0.05). By linear regression analysis and correlation analysis (age and education were controlled), we found that baseline Wechsler mapping scores were negatively correlated with total protein (B = −0.243, t = −3,735, p < 0.001, 95% confidence interval (CI): −0.371 to −0.114); and both the follow-up MMSE score (B = 2.657, t = 2.002, p = 0.049, 95% CI: 0.009~5.306) and the change score of MMSE (r = −0.025, p = 0.047) were related to the thickness of the right temporal pole cortex. Then, by linear regression analysis (mediating model), we found that hypertension may influence follow-up MMSE scores by influencing the cortical thickness of the right temporal pole (B = 1.727, p = 0.022, 95% CI: 0.261–3.193).Conclusions: Elderly patients with hypertension exhibit poorer overall cognitive function and executive function, and the mechanism may be related to the effect of hypertension on the cortical thickness of the right temporal pole.
Highlights
Hypertension is a very common disease that affects one third of adults in the world and two-thirds of adults over the age of 65 [1]
By the single-sample Kolmogorov-Smirnov test, we found that the baseline scores on MOCA, digit span, Wechsler mapping, and Wechsler woodblock accorded with normal distribution, while the baseline scores on Mini-Mental State Examination (MMSE) did not accord with normal distribution
Through the linear regression analysis, we found that follow-up MMSE score was related to right temporal pole cortex thickness (B = 2.657, t = 2.002, p = 0.049, 95% CI: 0.009–5.306)
Summary
Hypertension is a very common disease that affects one third of adults in the world and two-thirds of adults over the age of 65 [1]. The association between dementia and mortality can be influenced by hypertension (coefficient −0.009, p = 0.02) [6], and there is the vast epidemiologic and mechanistic evidence linking the positive effects of blood pressure lowering on reducing the risk of post-stroke dementia and other types of dementia [7, 8]. There is little neuro-basic evidence for the relationship between hypertension and cognitive deterioration. It has been reported that the key brain structures for hypertension include cerebral white matter [10], hippocampal volume [11], cerebral gray matter [12], medial, temporal [13], posterior cingulate, and orbitofrontal [14]. The temporal pole is a part of the paralimbic system along with the insula, orbitofrontal cortex, anterior cingulate cortex, and other emotion-related regions [15]. Few studies have explored the relationship between hypertension and the temporal pole. Hypertension is associated with poorer cognitive functions, but the mechanisms are unclear
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