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Screening for cognitive impairment in older adults with hypertension: the HYPER-COG study

Journal of Human Hypertension volume 37, pages 1000–1006 (2023)Cite this article

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Abstract

Hypertension is a major risk factor for dementia. Yet, the most suitable cognitive screening test for hypertensive patients has yet to be identified. This study investigated cognitive impairment in hypertensive older adults and compared the discriminative ability of the most widely used cognitive screening tests. The study involved hypertensive patients aged 65+ without prior diagnosis of cognitive impairment, from the Hypertension Clinic of Careggi Hospital, Florence, Italy. Mini Mental State Examination (MMSE), Montreal Cognitive Assessment (MoCA), MiniCog and Clock Drawing Test (CDT) were administered, using a comprehensive neuropsychological assessment as gold standard. The ROC curve analysis and the paired chi-square test were used to compare the discriminative ability, sensitivity and specificity for cognitive impairment of the different screening instruments. Cognitive impairment was diagnosed in 37% of 94 participants (mean age 76, 55% female), mainly involving attention and executive functions. The MoCA (AUC = 0.746), the MMSE (AUC = 0.689) and the MiniCog (AUC = 0.684) showed similar ability in detecting cognitive impairment, while the CDT had a poorer discriminative capacity (AUC = 0.535). The sensitivity of MoCA (80%) and of MMSE/MiniCog combination (74%) was higher in comparison with MiniCog alone (49%, p = 0.007 and 0.004, respectively), while MiniCog achieved the highest specificity (88%, p < 0.001 vs all). Cognitive impairment was detected in more than one-third of hypertensive older adults without prior diagnosis of dementia. MoCA, MMSE and MiniCog showed similar discriminative ability for cognitive impairment, with MoCa and MMSE showing greater sensitivity and MiniCog the highest specificity.

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Fig. 1: Examples of Clock Drawing Test from three study participants performing differently at MMSE and MoCA.

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Data availability

The data that support the findings of this study are available from the corresponding author upon reasonable request.

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Author information

Authors and Affiliations

  1. Hypertension Clinic, Division of Geriatric and Intensive Care Medicine, University of Florence and Azienda Ospedaliero Universitaria Careggi, Florence, Italy

    Giulia Rivasi, Maria Flora D’Andria, Giada Turrin, Virginia Tortù, Antonella Giordano, Enrico Mossello & Andrea Ungar

  2. Geriatric Unit, Santa Maria Annunziata Hospital, Local Health Unit “Toscana Centro”, Florence, Italy

    Matteo Bulgaresi & Federica Sgrilli

  3. Department of Medical Sciences, Surgery and Neurosciences, University of Siena, Siena, Italy

    Giulia Casini

  4. Occupational Medicine Unit, Azienda Ospedaliero Universitaria Careggi, Florence, Italy

    Daniele Falzone

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  1. Giulia Rivasi
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  2. Maria Flora D’Andria
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Contributions

Study concept and design: GR, EM, and AU. Acquisition of data: all authors. Analysis and interpretation of data: GR, MB, FS, GC, DF, EM, and AU. Drafting of the manuscript: GR, EM, and AU. Critical revision of the manuscript for important intellectual content: all authors. Final approval of the version to be published: all authors. Agreement to be accountable for all aspects of the work: all authors.

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Correspondence to Giulia Rivasi.

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The authors declare no competing interests.

Ethical approval

The study was approved by the Local Ethic Committee (protocol number 16174_oss). All participants gave their informed consent to participate.

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Rivasi, G., D’Andria, M.F., Bulgaresi, M. et al. Screening for cognitive impairment in older adults with hypertension: the HYPER-COG study. J Hum Hypertens 37, 1000–1006 (2023). https://doi.org/10.1038/s41371-023-00817-x

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