State of cognitive functions in elderly and senile patients with arterial hypertension, depending on the presence of concomitant chronic kidney disease stage G3a and G3b

Background: the frequent combination (comorbidity) of arterial hypertension (AH) and chronic kidney disease (CKD), each of which is a risk factor for the development of cognitive impairment (CI) and dementia, determines the need to diagnose cognitive deficits in these multimorbid patients. Aims: to assess the impact of concomitant CKD and its stages on cognitive functions (CF) of elderly and senile patients with arterial hypertension. Materials and methods: 330 patients aged 60 years and older with essential АH were included in the study and were divided into 2 groups depending on the presence of CKD: group 1 - without concomitant CKD (n=110, mean age 76 [69.8; 82.3] years, 50 (45.5%) women), group 2 - patients with CKD stages G3a and G3b (n=220, mean age 81 [73; 85] years, 118 (53.6%) women). All the patients underwent the assessment of CF using the Montreal Cognitive Assessment (MoCA), Mini-Mental Status Examination (MMSЕ), Alzheimer's Disease Assessment Scale - Cognitive Subscale (ADAS-cog), Trial Making Test (TMT), Digit Symbol Substitution Test (DSST), Verbal Association Test (literal (letter) and categorical (animal) associations), Boston Naming Test (BNT), Word-Color Interference Test (Stroop color-word conflict test). Results: compared to patients without CKD, patients with CKD stage G3a and G3b had statistically significantly lower average final scores on the MoCA test (23 [21; 25] versus 24 [22; 26] points, respectively, p=0.005) and on the MMSE (27 [25; 29] versus 28 [25.8; 29] points, respectively, p=0.002), among them, patients who scored the lowest number of points on the MoCA test (10-17 points) (p=0.032) and the MMSE (20-24 points) (р<0.001). Patients with concomitant CKD stage G3a and G3b scored a statistically significantly higher number of points when testing according to ADAS-cog (14 [11;18] versus 11 [9; 15] points in the group without CKD, p<0.001), named fewer literal associations (11 [10]; 13] words versus 12 [11; 13], respectively, p<0.001), and had fewer correctly filled cells when performing the DSST test (20 [17; 23] versus 21.5 [19; 25], respectively, p<0.001). Patients with CKD G3b compared with patients with CKD G3a and without CKD had worse results when tested using the MoCА test, MMSE, and ADAS-cog. Conclusion: the results obtained indicate an unfavorable effect of concomitant CKD stage G3a and G3b on the CF of elderly and senile patients with arterial hypertension and a worsening of CF as the severity of CKD increases.

когнитивные функции, когнитивные нарушения, артериальная гипертензия, хроническая болезнь почек, cognitive function, cognitive impairment, arterial hypertension, chronic kidney disease

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