Hypertension and cognitive decline: impact on executive function.

Abstract

Hypertension is a risk factor for mild cognitive deterioration and vascular dementia. Cognitive deterioration attributable to normal aging was distinguished from cognitive deterioration related to hypertension by means of neuropsychologic tests. Sixty hypertensive patients, aged 65-80 years, were compared with 30 normotensive individuals. Patients with a history of stroke and/or transient ischemic attacks, diabetes, atrial fibrillation, hypercholesterolemia, or bypass surgery, and those diagnosed with dementia, depression, or anxiety, were excluded. Neither gender differences, duration of hypertension (10.2+/-8.2 years), nor prescribed antihypertensive drug treatment had an influence on study results. Immediate recall was impaired in both groups. The hypertensive patients evinced impairment in all tests vs. the normotensive subjects. Mean deferred recall scores +/- SD were 5.68+/-2.6 vs. 7.13+/-2.4; p<0.01. Deficits in attention speed and executive function, as measured by nonperformance on the Trail Making Test Part B, were present in 46% of hypertensive patients vs. 13% of normotensive patients (p<0.005), with more errors made by the hypertensive patients (1.15+/-1.54 vs. 0.46+/-0.9; p<0.02). Scores on the Stroop Color and Word Test also revealed deficits in the hypertensive patients (24.7+/-7.6 vs. 32+/-10.7; p<0.005). Compared with the control group, the hypertensive participants revealed more deficits in skills involving delayed recall and prefrontal-region skills. The relevant neuropsychologic tests were sufficiently sensitive and proved easy to use in clinical practice.