Hypertension Clinic, Division of Geriatric and Intensive Care Medicine, University of Florence and Azienda Ospedaliero Universitaria Careggi, Florence, Italy.
Geriatric Unit, Santa Maria Annunziata Hospital, Local Health Unit "Toscana Centro", Florence, Italy.
J Hum Hypertens. 2023 Nov;37(11):1000-1006. doi: 10.1038/s41371-023-00817-x. Epub 2023 Mar 17.
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.
高血压是痴呆的一个主要危险因素。然而，最适合高血压患者的认知筛查测试尚未确定。本研究调查了高血压老年患者的认知障碍，并比较了最广泛使用的认知筛查测试的判别能力。该研究纳入了来自意大利佛罗伦萨 Careggi 医院高血压诊所的无认知障碍既往史的 65 岁以上高血压患者。使用全面的神经心理学评估作为金标准，对每位患者进行简易精神状态检查（MMSE）、蒙特利尔认知评估（MoCA）、MiniCog 和画钟测验（CDT）。采用 ROC 曲线分析和配对卡方检验比较不同筛查工具对认知障碍的判别能力、敏感性和特异性。94 名参与者中有 37%（平均年龄 76 岁，55%为女性）被诊断为认知障碍，主要涉及注意力和执行功能障碍。MoCA（AUC=0.746）、MMSE（AUC=0.689）和 MiniCog（AUC=0.684）在检测认知障碍方面具有相似的能力，而 CDT 的判别能力较差（AUC=0.535）。MoCA（80%）和 MMSE/MiniCog 联合（74%）的敏感性高于 MiniCog 单独使用（49%，p=0.007 和 0.004），而 MiniCog 的特异性最高（88%，p<0.001 与所有）。在没有痴呆既往史的高血压老年患者中，有超过三分之一的患者被检测出认知障碍。MoCA、MMSE 和 MiniCog 对认知障碍具有相似的判别能力，其中 MoCA 和 MMSE 的敏感性更高，而 MiniCog 的特异性最高。
