Clinical and instrumental peculiarities of the course of arterial hypertension in patients with cognitive function impairments

Objective: Cognitive impairments (CIs) appear to be commonly encountered in patients with arterial hypertension (AH). Hence, our study was aimed at examining the frequency of cognitive impairments (CIs) in the physician's outpatient practice, as well as at determining clinical and instrumental peculiarities of the course of AH in patients with and without CIs. Method: We carried out comprehensive examination of three hundred and fifty 50-to-80-year-old hypertensive patients followed up in the setting of a polyclinic and tested by means of neuropsychological scales (MMSE, Mini-Cog test, Montreal Cognitive Assessment Scale, Hospital Anxiety and Depression Scale), duplex scanning of extracranial vessels, and magnetic resonance tomography (MRT) of the brain. Results: The findings of neuropsychological testing demonstrated the presence of CIs in 83.5% of hypertensive patients, with CIs reaching the level of dementia in 16.9% and being combined with depressive symptoms in 40.3%. Hypertensive patients with CIs as compared with those without CIs were found to have more pronounced lesions to white matter of the brain: periventricular (71.1%) and/or subcortical (15.8%) leukoaraiosis. Subcortical leukoaraiosis of the frontal lobes of the brain was associated with an elevated level of systolic arterial pressure (SAP). It was confirmed that impaired circadian rhythm of AP with stable persistence of nocturnal hypertension resulted in the most pronounced structural and morphological damage of the brain. Conclusion: High incidence of CIs in hypertensive patients has been confirmed. Structural and morphological impairments of strategically important regions of the brain (subcortical leukoaraiosis of the frontal lobes) in hypertensive patients with CIs were associated with elevated SAP.