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Cognitive impairment in hypertension

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As the life expectancy of the population increases, cognitive impairment (CI) caused by cerebrovascular diseases is becoming an increasingly urgent problem. The leading role of hypertension in the development of CI of various origins has led to intense discussions about blood pressure control as a potential therapeutic strategy for achieving optimal brain perfusion and about the prevention of mild and moderate CI. Hypertension is the main modifiable risk factor for stroke and cerebral small vessel damage that results in nonstroke-related CI. Antihypertensive therapy plays an essential role in preventing the development and slowing down the progression of CI through blood pressure control. Neurometabolic and neuroprotective drugs (Vinpotropil®, Cholitilin®) are actively used to treat CI that does not reach the degree of dementia. When dementia develops, reversible NMDA receptor inhibitors (memantine) and central acetylcholinesterase inhibitors are used to correct CI.

About the Authors

Yu. A. Starchina
I.M. Sechenov First Moscow State Medical University (Sechenov University), Ministry of Health of Russia
Russian Federation

Yulia Aleksandrovna Starchina

Department of Nervous System Diseases and Neurosurgery, N.V. Sklifosovsky Institute of Clinical Medicine

11, Rossolimo St., Build 1, Moscow 119021

V. V. Zakharov
I.M. Sechenov First Moscow State Medical University (Sechenov University), Ministry of Health of Russia
Russian Federation

Department of Nervous System Diseases and Neurosurgery, N.V. Sklifosovsky Institute of Clinical Medicine

11, Rossolimo St., Build 1, Moscow 119021


1. Wardlaw JM, Smith C, Dichgans M. Mechanisms of sporadic cerebral small vessel disease: insights from neuroimaging. Lancet Neurol. 2013 May;12(5):483-97. doi: 10.1016/S1474-4422(13)70060-7

2. O'Brien J, Ames D, Gustafson L, et al., editors. Cerebrovascular disease, cognitive impairment and dementia. Second edition of Cerebrovascular disease and dementia. London: Martin Dunitz; 2004.

3. Chui H. Dementia due to subcortical ischemic vascular disease. Clin Cornerstone. 2001;3(4):40-51. doi: 10.1016/s10983597(01)90047-x

4. Chan SL, Sweet JG, Cipolla MJ. Treatment for cerebral small vessel disease: effect of relaxin on the function and structure of cerebral parenchymal arterioles during hypertension. FASEB J. 2013 Oct;27(10):3917-27. doi: 10.1096/fj.13-230797. Epub 2013 Jun 19.

5. Mills KT, Bundy JD, Kelly TN, et al. Global disparities of hypertension prevalence and control: a systematic analysis of population-based studies from 90 countries. Circulation. 2016 Aug 9;134(6):441-50. doi: 10.1161/CIRCULATIONAHA.115.018912

6. Sierra C, Domenech M, Camafort M, et al. Hypertension and mild cognitive impairment. Curr Hypertens Rep. 2012 Dec;14(6):548-55. doi: 10.1007/s11906-012-0315-2

7. Iadecola C, Gottesman RF. Neurovascular and Cognitive Dysfunction in Hypertension. Circ Res. 2019 Mar 29;124(7):1025-44. doi: 10.1161/CIRCRESAHA.118.313260

8. Pantoni L. Cerebral small vessel disease: from pathogenesis and clinical characteristics to therapeutic challenges. Lancet Neurol. 2010 Jul;9(7):689-701. doi: 10.1016/S14744422(10)70104-6

9. Van Uden IW, Tuladhar AM, de Laat KF, et al. White matter integrity and depressive symptoms in cerebral small vessel disease: the RUN DMC study. Am J Geriatr Psychiatry. 2015 May;23(5):525-35. doi: 10.1016/j.jagp.2014.07.002. Epub 2014 Jul 19.

10. McCarron MO, Nicoll JA. Cerebral amyloid angiopathy and thrombolysis-related intracerebral haemorrhage. Lancet Neurol. 2004 Aug;3(8):484-92. doi: 10.1016/S1474-4422(04)00825-7.

11. Koennecke HC. Cerebral microbleeds on MRI: prevalence, associations, and potential clinical implications. Neurology. 2006 Jan 24;66(2):165-71. doi: 10.1212/01.wnl.0000194266.55694.1e

12. Imaoka K, Kobayashi S, Fujihara S, et al. Leukoencephalopathy with cerebral amyloid angiopathy: a semiquantitative and morphometric study. J Neurol. 1999 Aug;246(8):661-6. doi: 10.1007/s004150050428

13. Birns J, Kalra L. Cognitive function and hypertension. J Hum Hypertens. 2009 Feb;23(2):86-96. doi: 10.1038/jhh.2008.80. Epub 2008 Jul 24.

14. Gasecki D, Kwarciany M, Nyka W, et al. Hypertension, brain damage and cognitive decline. Curr Hypertens Rep. 2013 Dec;15(6):547-58. doi: 10.1007/s11906-013-0398-4

15. Debette S, Markus HS. The clinical importance of white matter hyperintensities on brain magnetic resonance imaging: systematic review and meta-analysis. BMJ. 2010;341:c3666. doi: 10.1136/bmj.c3666

16. Cacciatore F, Abete P, Ferrara N, et al. The role of blood pressure in cognitive impairment in an elderly population. J Hypertens. 1997 Feb;15(2):135-42. doi: 10.1097/00004872199715020-00003

17. Elias MF, Wolf PA, D'Agostino RB, et al. Untreated blood pressure level is inversely related to cognitive functioning: the Framingham Study. Am J Epidemiol. 1993 Sep 15;138(6):353-64. doi: 10.1093/oxfordjournals.aje.a116868

18. Launer LJ, Masaki K, Petrovitch H, et al. The association between midlife blood pressure levels and late-life cognitive function. JAMA. 995 Dec 20;274(23):1846-51. doi: 10.1001/jama.274.23.1846

19. Kilander L, Nyman H, Boberg M, et al. Hypertension is related to cognitive impairment; a 20-year follow-up of 999 men. Hypertension. 1998 Mar;31(3):780-6. doi: 10.1161/01.hyp.31.3.780

20. Carmelli D, Swan GE, Reed T, et al. Midlife cardiovascular risk factors, ApoE, and cognitive decline in elderly male twins. Neurology. 1998 Jun;50(6):1580-5. doi: 10.1212/wnl.50.6.1580

21. Teles de Menezes S, Giatti L, Campos Brant L, et al. Hypertension, Prehypertension, and Hypertension Control. Association With Decline in Cognitive Performance in the ELSA-Brasil Cohort. Hypertension. 2021;77:672-81. doi: 10.1161/HYPERTENSIONAHA.120.16080

22. Sabayan B, Wijsman L, Foster-Dingley JC, et al. Association of visit-to-visit variability in blood pressure with cognitive function in old age: A prospective cohort study. Brit Med J. 2013 Jul 29;347:f4600. doi: 10.1136/bmj.f4600

23. Rawlings AM, Juraschek SP, Heiss G, et al. Association of orthostatic hypotension with incident dementia, stroke, and cognitive decline. Neurology. 2018 Aug 21;91(8):e759e768. doi: 10.1212/WNL.0000000000006027. Epub 2018 Jul 25.

24. Elliott WJ. Association of higher diastolic blood pressure levels with cognitive impairment. Yearbook Cardiol. 2010;2010:29-30. doi: 10.1016/S0145-4145(09)79798-9

25. Pavlik VN, Hyman DJ, Doody R. Cardiovascular risk factors and cognitive function in adults 30-59 years of age (NHANES III). Neuroepidemiology. 2005;24(1-2):42-50. doi: 10.1159/000081049. Epub 2004 Sep 24.

26. Singh-Manoux A, Marmot M. High blood pressure was associated with cognitive function in middle-age in the Whitehall II study. J Clin Epidemiol. 2005 Dec;58(12):1308-15. doi: 10.1016/j.jclinepi.2005.03.016

27. Reitz C, Tang MX, Manly J, et al. Hypertension and the risk of mild cognitive impairment. Arch Neurol. 2007 Dec;64(12):1734-40. doi: 10.1001/archneur.64.12.1734

28. Morris MC, Scherr PA, Hebert LE, et al. Association between blood pressure and cognitive function in a biracial community population of older persons. Neuroepidemiology. 2002;21(3):123-30. doi: 10.1159/000054809

29. Gottesman RF, Schneider AL, Albert M, et al. Midlife hypertension and 20-year cognitive change: The atherosclerosis risk in communities neurocognitive study. JAMA Neurol. 2014 Oct;71(10):1218-27. doi: 10.1001/jamaneurol.2014.1646

30. Kivipelto M, Helkala EL, Hanninen T, et al. Midlife vascular risk factors and late-life mild cognitive impairment: A population-based study. Neurology. 2001 Jun 26;56(12):1683-9. doi: 10.1212/wnl.56.12.1683

31. Freitag MH, Peila R, Masaki K, et al. Midlife pulse pressure and incidence of dementia: The honolulu-asia aging stud. Stroke. 2006 Jan;37(1):33-7. doi: 10.1161/01.STR.0000196941.58869.2d. Epub 2005 Dec 8.

32. Gottesman RF, Albert MS, Alonso A, et al. Associations between midlife vascular risk factors and 25-year incident dementia in the atherosclerosis risk in communities (aric) cohort. JAMA Neurol. 2017 Oct 1;74(10):1246-54. doi: 10.1001/jamaneurol.2017.1658

33. Goldstein FC, Levey AI, Steenland NK. High blood pressure and cognitive decline in mild cognitive impairment. J Am Geriatr Soc. 2013 Jan;61(1):67-73. doi: 10.1111/jgs.12067. Epub 2013 Jan 10.

34. Whelton PK, Carey RM, Aronow WS, et al. 2017 Guideline for the prevention, detection, evaluation, and management of high blood pressure in adults: A report of the American College of Cardiology / American Heart Association task force on clinical practice guidelines. Hypertension. 2018;71:1269-324. doi: 10.1161/HYP.0000000000000066

35. Starchina YuA, Parfenov VA, Chazova IE, et al. Cognitive disturbances in patients with arterial hypertension. Zhurnal nevrologii i psikhiatrii im. S.S. Korsakova. 2008;(4):19-23 (In Russ.).

36. Farmer ME, Kittner SJ, Abbott RD, et al. Longitudinally measured blood pressure, antihypertensive medication use, and cognitive performance: the Framingham Study. J Clin Epidemiol. 1990;43:475-80. doi: 10.1016/08954356(90)90136-D

37. Forette F, Seux ML, Staessen JA, et al. The prevention of dementia with antihypertensive treatment. New evidence from the Systolic Hypertension in Europe (Syst-Eur) study. Arch Intern Med. 2002 Oct 14;162(18):2046-52. doi: 10.1001/archinte.162.18.2046

38. Wei J, Yin X, Liu Q, Tan L. Association between hypertension and cognitive function: A cross-sectional study in people over 45 years old in China. J Clin Hypertens. 2018 Nov;20(11):1575-83. doi: 10.1111/jch.13393. Epub 2018 Sep 26.

39. Glynn RJ, Beckett LA, Hebert LE, et al. Current and remote blood pressure and cognitive decline. JAMA. 1999 Feb 3;281(5):438-45. doi: 10.1001/jama.281.5.438

40. Weidung B, Littbrand H, Nordström P, et al. The association between SBP and mortality risk differs with level of cognitive function in very old individuals. J Hypertens. 2016 Apr;34(4):745-52. doi: 10.1097/HJH.0000000000000831

41. The SPRINT MIND Investigators for the SPRINT Research Group. Effect of Intensive vs Standard Blood Pressure Control on Probable Dementia: A Randomized Clinical Trial. JAMA. 2019 Feb 12;321(6):553-61. doi: 10.1001/jama.2018.21442

42. Goldstein FC, Hajjar IM, Dunn CB, et al. The relationship between cognitive functioning and the jnc-8 guidelines for hypertension in older adults. J Gerontol A Biol Sci Med Sci. 2017 Jan;72(1):121-6. doi: 10.1093/gerona/glw181. Epub 2016 Sep 27.

43. Sikaroodi H, Yadegari S, Miri SR. Cognitive impairments in patients with cerebrovascular risk factors: A comparison of mini mental status exam and montreal cognitive assessment. Clin Neurol Neurosurg. 2013 Aug;115(8):1276-80. doi: 10.1016/j.clineuro.2012.11.026. Epub 2013 Jan 3.

44. Zakharov VV, Vakhnina NV, Parfenov VA. Cognitive impairments and their treatment for arterial hypertension. Meditsinskiy Sovet. 2017;(1S):6-12. doi: 10.21518/2079-701X2017-0-6-12 (In Russ.).

45. Zakharov VV, Voznesenskaya TG. Nervnopsikhicheskiye narusheniya: diagnosticheskiye testy [Neuropsychiatric disorders: diagnostic tests]. Moscow: MEDpress-inform; 2013. 320 p. (In Russ.).

46. Zakharov VV, Yakhno NN. Narusheniya pamyati [Memory impairment]. Moscow: GEOTARMed; 2003. 150 p. (In Russ.).

47. Smith EE, Muzikansky A, McCreary CR, et al. Impaired memory is more closely associated with brain beta-amyloid than leukoaraiosis in hypertensive patients with cognitive symptoms. PLoS One. 2018 Jan 30;13(1):e0191345. doi: 10.1371/journal.pone.0191345. eCollection 2018.

48. Tadic M, Cuspidi C, Hering D. Hypertension and cognitive dysfunction in elderly: blood pressure management for this global burden. BMC Cardiovasc Dis. 2016 Nov 3;16(1):208. doi: 10.1186/s12872-016-0386-0

49. McGuinness B, Todd S, Passmore P, et al. Blood pressure lowering in patients without prior cerebrovascular disease for prevention of cognitive impairment and dementia. Cochrane Database Syst Rev. 2009;4:CD004034. doi: 10.1002/14651858.CD004034.pub3

50. Tzourio C, Anderson C, Chapman N, et al. PROGRESS Collaborative Group. Effects of blood pressure lowering with perindopril and indapamide therapy on dementia and cognitive decline in patients with cerebrovascular disease. Arch Intern Med. 2003;163(9):1069-75. doi: 10.1001/archinte.163.9.1069

51. Coca A, Monteagudo E, Domenech M, et al. Can the treatment of hypertension in the middle-aged prevent dementia in the elderly? High Blood Press Cardiovasc Prev. 2016 Jun;23(2):97-104. doi: 10.1007/s40292-0160144-5. Epub 2016 Apr 13.

52. Levi Marpillat N, Macquin-Mavier I, Tropeano AI, et al. Antihypertensive classes, cognitive decline and incidence of dementia: a network meta-analysis. J Hypertens. 2013 Jun;31(6):1073-82. doi: 10.1097/HJH.0b013e3283603f53

53. Ngandu T, Lehtisalo J, Solomon A, et al. A 2 year multidomain intervention of diet, exercise, cognitive training, and vascular risk monitoring versus control to prevent cognitive decline in at-risk elderly people (FINGER): a randomised controlled trial. Lancet. 2015;385:2255-63.

54. Yakhno NN, Zakharov VV, Lokshina AB, et al. Dementsii: Rukovodstvo dlya vrachey [Dementia: A Guide for Physicians]. Moscow: MEDpressinform; 2010. 272 p. (In Russ.).

55. Gavrilova SI. Farmakoterapiya bolezni Al'tsgeymera [Pharmacotherapy for Alzheimer's disease]. Moscow: Pulse; 2003. 319 p. (In Russ.).

56. Bonfoco E, Krainc D, Ankarcrona M, et al. Apoptosis and necrosis: two distinct events induced, respectively, by mild and intense insults with N-methyl-D-aspartate or nitric oxide/superoxide in cortical cell cultures. Proc Natl Acad Sci USA. 1995 Aug 1;92(16):7162-6. doi: 10.1073/pnas.92.16.7162

57. Reisberg B, Doody R, StЪffler A, et al. Memantine in moderate-to-severe Alzheimer's disease. N Engl J Med. 2003 Apr 3;348(14):1333-41. doi: 10.1056/NEJMoa013128

58. Van Dyck CH, Schmitt FA, Olin JT. A responder analysis of memantine treatment in patients with Alzheimer's disease maintained on donepezil. Am J Geriatr Psychiatry. 2006 May;14(5):428-37. doi: 10.1097/01.JGP.0000203151.17311.38

59. Wilcock GK, Ballard CG, Cooper JA, et al. Memantine for agitation/aggression and psychosis in moderately severe to severe Alzheimer's disease: a pooled analysis of 3 studies. J Clin Psychiatry. 2008 Mar;69(3):341-8. doi: 10.4088/jcp.v69n0302

60. Russ TC. Cholinesterase Inhibitors Should Not Be Prescribed for Mild Cognitive Impairment. Evid Based Med. 2014 Jun;19(3):101. doi: 10.1136/eb-2013-101687. Epub 2014 Jan 30.

61. Zakharov VV. Vinpotropil in the treatment of dyscirculatory encephalopathy with cognitive impairment without dementia. Zhurnal nevrologii i psikhiatrii im. S.S. Korsakova. 2010;110(11):13-6 (In Russ.).

62. Lagunin AA. Otchet po sinergichnomu deystviyu vinpotsetina i piratsetama v sostave kombinirovannogo preparata Vinpotropil (Kanonfarma prodakshn, Rossiya) [Report on the synergistic action of vinpocetine and piracetam in the combined preparation Vinpotropil (Kanonfarma production, Russia)] (In Russ.).

63. Tayebati S, Di Tullio M, Tomassoni D, et al. Neuroprotective effect of treatment with galantamine and choline alphoscerate on brain microanatomy in spontaneously hypertensive rats. J Neurol Sci. 2009 Aug 15;283(1-2):187-94. doi: 10.1016/j.jns.2009.02.349. Epub 2009 Mar 21.

64. Kamchatnov PR, Yevzel'man MA, Morozova YuA. Possibilities of combination therapy for patients with chronic disorders of cerebral circulation. Poliklinika. 2017;(2):73-8 (In Russ.).

For citation:

Starchina Yu.A., Zakharov V.V. Cognitive impairment in hypertension. Neurology, Neuropsychiatry, Psychosomatics. 2021;13(1):113-118. (In Russ.)

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