Michel Ferreira Machado

Hypertension Severity Is Associated With Impaired Cognitive Performance

Background Most evidence of target‐organ damage in hypertension (HTN) is related to the kidneys and heart. Cerebrovascular and cognitive impairment are less well studied. Therefore, this study analyzed changes in cognitive function in patients with different stages of hypertension compared to nonhypertensive controls. Methods and Results In a cross‐sectional study, 221 (71 normotensive and 150 hypertensive) patients were compared. Patients with hypertension were divided into 2 stages according to blood pressure (BP) levels or medication use (HTN‐1: BP, 140–159/90–99 or use of 1 or 2 antihypertensive drugs; HTN‐2: BP, ≥160/100 or use of ≥3 drugs). Three groups were comparatively analyzed: normotension, HTN stage 1, and HTN stage 2. The Mini–Mental State Examination, Montreal Cognitive Assessment, and a validated comprehensive battery of neuropsychological tests that assessed 6 main cognitive domains were used to determine cognitive function. Compared to the normotension and HTN stage‐1, the severe HTN group had worse cognitive performance based on Mini–Mental State Examination (26.8±2.1 vs 27.4±2.1 vs 28.0±2.0; P=0.004) or Montreal Cognitive Assessment (23.4±3.7 vs 24.9±2.8 vs 25.5±3.2; P<0.001). On the neuropsychological tests, patients with hypertension had worse performance in language, processing speed, visuospatial abilities, and memory. Age, hypertension stage, and educational level were the best predictors of cognitive impairment in patients with hypertension in different cognitive domains. Conclusions Cognitive impairment was more frequent in patients with hypertension, and this was related to hypertension severity.

The role of metabolism in the ischemia associated with vasospasm following brain tumor resection

Alotaibi et al have reviewed cerebral vasospasm following resection of intracranial tumor. Vasospasm is unusual after intracranial tumor resections and is associated with high morbidity and mortality. In general, the pathogenesis of cerebral ischemia related to vasospasm is complex and may be linked to an uncoupling of cerebral blood flow and metabolism.1 – 4 We present the case of a 52-year-old woman with a 4-year history of periods of disorientation and cognitive deficits. A left sphenoid wing meningioma (figure 1) was diagnosed, and a Simpson III surgical resection was performed. On the first postoperative day, the patient developed reduced consciousness and motor deficits on the right side. CT was compatible with ischemia and swelling on left cerebral hemisphere associated with midline shift. The patient underwent a decompressive craniectomy to relieve the intracranial hypertension. On the same day, transcranial …

Higher arterial stiffness is associated with lower cognitive performance in patients with hypertension

Cognitive impairment and elevated arterial stiffness have been described in patients with arterial hypertension, but their association has not been well studied. We evaluated the correlation of arterial stiffness and different cognitive domains in patients with hypertension compared with those with normotension. We evaluated 211 patients (69 with normotension and 142 with hypertension). Patients were age matched and distributed according to their blood pressure: normotension, hypertension stage 1, and hypertension stage 2. Cognitive function was assessed using the Mini‐Mental State Examination, Montreal Cognitive Assessment, and a battery of neuropsychological evaluations that assessed six main cognitive domains. Pulse wave velocity was measured using a Complior device, and carotid properties were assessed by radiofrequency ultrasound. Central arterial pressure and augmentation index were obtained using applanation tonometry. The hypertension stage 2 group had higher arterial stiffness and worse performance either by Mini‐Mental State Examination (26.8±2.1 vs 27.3±2.1 vs 28.0±2.0, P=.003) or the Montreal Cognitive Assessment test (23.4±3.5 vs 24.9±2.9 vs 25.6±3.0, P<.001). On multivariable regression analysis, augmentation index, intima‐media thickness, and pulse wave velocity were the variables mainly associated with lower cognitive performance at different cognitive domains. Cognitive impairment in different domains was associated with higher arterial stiffness.

Catatonia, beyond a psychiatric syndrome

Although catatonia is a well-known psychiatric syndrome, there are many possible systemic and neurological etiologies. The aim of this case report was to present a case of a patient with cerebral venous sinus thrombosis and infarction in which catatonia was the clinical manifestation of a possible nonconvulsive status epilepticus. To our knowledge, only one such case has been reported in the literature, which had a simplified diagnostic investigation. It is important to correctly recognize the organic cause underlying catatonia in order to treat the patient as soon as possible thereby improving outcome. Therefore, physicians need to update their knowledge on catatonia, recognizing that it can be part of a psychiatric or neurologic condition.

Impact of hypertension severity on arterial stiffness, cerebral vasoreactivity, and cognitive performance

ABSTRACT. Aging, hypertension (HTN), and other cardiovascular risk factors contribute to structural and functional changes of the arterial wall. Objective: To evaluate whether arterial stiffness (AS) is related to cerebral blood flow changes and its association with cognitive function in patients with hypertension. Methods: 211 patients (69 normotensive and 142 hypertensive) were included. Patients with hypertension were divided into 2 stages: HTN stage-1 and HTN stage-2. The mini-mental state examination (MMSE), Montreal Cognitive Assessment (MoCA) and a battery of neuropsychological (NPE) tests were used to determine cognitive function. Pulse wave velocity was measured using the Complior®. Carotid properties were assessed by radiofrequency ultrasound. Central arterial pressure and augmentation index were obtained using applanation tonometry. Middle cerebral artery flow velocity was measured by transcranial Doppler ultrasonography. Results: Both arterial stiffness parameters and cerebral vasoreactivity worsened in line with HTN severity. There was a negative correlation between breath holding index (BHI) and arterial stiffness parameters. Cognitive performance worsened in line with HTN severity, with statistical difference occurring mainly between the HTN-2 and normotension groups on both the MMSE and MoCA. The same tendency was observed on the NPE tests. Conclusion: Hypertension severity was associated with higher AS, worse BHI, and lower cognitive performance.

Impact of hypertension on cognitive performance in individuals with high level of education

Education is considered to provide a cognitive and neurological reserve through neuronal changes or increased efficacy of processing networks. The hypothesis of cognitive reserve asserts that older individuals with greater experiential resources exhibit better cognitive functioning and are able to tolerate higher levels of brain pathology before displaying clinical symptoms. Hypertension is linked to cognitive impairment. We evaluated the impact of hypertension on cognitive performance in hypertensive patients with high level of education. In a cross-sectional study 163 patients (61 normotensive and 102 hypertensive) with 9 or higher schooling years were comparatively evaluated. Hypertension was defined as blood pressure (BP) levels ≥140/90 mmHg or use of antihypertensive drugs. The mini-mental state examination (MMSE), Montreal Cognitive Assessment (MoCA), and a validated comprehensive battery of neuropsychological tests that assessed 6 main cognitive domains were used to determine cognitive function. Hypertension group had higher weigh, BMI and lower education level and family income. Hypertension group performed worse either on MMSE (27.7 ± 1.9 vs 28.3 ± 1.7, p=0.049) or MoCA (25.2 ± 2.6 vs 26.1 ± 2.5, p=0.022); similar poorer performance in hypertensive group were also seen at different domains on neuropsychological evaluation. We concluded that even in those with high level of education, patients with hypertension have poorer cognitive performance compared to control pairs. Correspondence to: Henrique CS Muela. Department of Physiology, Faculty of Medicine, Agostinho Neto University, Luanda, Angola. POX: 116, Tel: +244 925141398. E-mail: henrimuela@hotmail.com