Cognitive functions in patients suffering from hypertension and hypothyroidism with retrospective evaluation of control over disease compensation
Authors: Lesiv M.I.
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The aim of the study was to study the status of cognitive functions in hypertensive patients, patients with hypothyroidism, and in patients with combination of these diseases, taking into account the state of disease compensation. 67 patients (36 men and 31 women), average age – 49.84±2.83 years were examined. The control group (CG) consisted of 18 practically healthy individuals (8 men and 10 women). Patients who received appropriate nosology treatment were divided into 3 groups: Group I – 21 patients with hypertension, systolic blood pressure (SBP) – 134.26±5.23 mm Hg, diastolic blood pressure (DBP) – 84.37±4.51 mm Hg; Group II – 18 patients with hypothyroidism, thyrotropic hormone (TSH) – 3.16±0.79 mIU/L, stage of hypothyroidism compensation was diagnosed in 83.3%, subcompensation – in 16.7%; Group III – 28 patients with hypertension (SBP 145.52±5.45 mm Hg; DBP 82.41±3.86 mm Hg) with concomitant hypothyroidism (TSH – 2.92±0.78 mIU/L, stage of compensation for hypothyroidism was diagnosed in 85.7%, subcompensation – in 14.3% of cases. Information about visits to the therapist/cardiologist/family doctor and endocrinologist was used to analyze the therapeutic correction of the disease: ambulatory medical records of patients with measurement of blood pressure (BP) and TSH during the disease were processed. To assess cognitive functions, Mini Mental State Examination (MMSE) and the Addenbrooke’s cognitive examination (ACE-R) were used. The relationship of average blood pressure data in patients with hypertension and TSH in patients with hypothyroidism during the disease period and the level of cognitive function was investigated. The average level of office BP (SBP/DBP) in Groups I and III compared to CG during the examination was: SBP 134.26±5.23 mm Hg (p=0.047), DBP 84.37±4.51 mm Hg (p=0.041) in Group I; SBP 145.52±5.45 mm Hg (p=0.031), DBP 82.41±3.86 mm Hg (p=0.050) in Group III. Analyzing the TSH levels it was found that at the time of the physical examination of patients in Group II the TSH was 3.16±0.79 mIU/L (p=0.009), the stage of compensation was diagnosed in 83.3%, subcompensation – in 16.7%; in Group III the TSH was 2.92±0.78 mIU/L (p=0.027), the stage of hypothyroidism compensation was diagnosed in 85.7%, subcompensation – in 14.3%. When evaluating MMSE scores, the proportion of patients in Groups I-III who had cognitive impairment (CI) was 6.9%, 10.3% and 13.8% respectively. On individual assessment of ACE-R test scores, CI in Groups I-III was in 6.4%, 9.6% and 13.8% respectively. A detailed analysis of the patterns of the ACE-R scale revealed that patients in Group I had a significantly lower score in the memory domain (22.68±0.96, p=0.037); patients in Group II had a low score in the concentration domain (15.85±1.14, p=0.045) and executive functions domain (11.62±8.63, p=0.041). Taking into account the interaction of factors (hypertension and hypothyroidism), it was found that in 40% of patients in Group III the most affected cognitive domains were memory (21.12±0.98, p=0.012) and speech (22.41±2.32, p=0.038); 60% of patients had problems with executive functions (11.90±9.17, p=0.033) as well as with visual-spatial skills (14.40±8.15, p=0.045). MMSE test showed a significantly lower score in the memory domain (1.87±0.46, p=0.008) in Group I, patients of Group II had a significantly lower score in the concentration domain (2.53±0.54, p=0.018). Basing on the interaction of factors (hypertension and hypothyroidism), it was found that in 45% of patients the most affected cognitive domain was memory (2.3±0.38, p=0.028), and 55% suffer from impaired speech, praxis (7.48±0.59, p=0.018) and perception (2.45±0.67, p=0.028). A retrospective analysis of medical records regarding the control of patients’ diseases was conducted. It was found that the average level of SBP/DBP in Groups I and III was 154.38±5.11 (p=0.000) \ 96.47±3.49 (p=0.006) mm Hg; 158.26±5.64 (p=0.001) \ 98.42±4.93 (p=0.005) mmHg, respectively. The TSH level over the disease period in patients of Groups II and III was 7.14±2.37 mIU/L (p=0.002) and 8.03±3.77 mIU/L (p=0.000), respectively, which was different from the data obtained in the last study. Retrospective analysis of medical records made it possible to establish a real long-term control of blood pressure, TSH in patients with hypertension, in patients with hypothyroidism and in patients with combination of these diseases, which caused CI in 6.9% of patients with hypertension, in 10.3% of patients with hypothyroidism and in 13.8% of patients with combined pathology based on MMSE test results. The ACE-R test results show the same sequence. Individual assessment of ACE-R test scores revealed CI in Groups I-III: 6.4%; 9.6% and 13.8%, respectively. The MMSE scale evaluates the selective deficits of one or more cognitive domains; the ACE-R scale is a wide-ranging study tool but it should be noted that the implementation of this scale requires time outlays.