Русский
Dependence of cognitive profile of multimorbid elderly patients with hypertension from Charlson comorbidity index
DOI: https://dx.doi.org/10.18565/therapy.2024.5.22-30
Ostroumova O.D., Dzamikhov K.K., Kochetkov A.I., Ostroumova Т.М., Shastina V.R., Lyakhova M.A.
1) Russian Medical Academy of Continuous Professional Education of the Ministry of Healthcare of Russia, Moscow; 2) I.M. Sechenov First Moscow State Medical University of the Ministry of Healthcare of Russia (Sechenov University); 3) Hospital for War Veterans No. 2 of the Department of Healthcare of Moscow
The aim: to еvaluate cognitive function (CF) of multimorbid patients aged ≥ 60 years with arterial hypertension (AH) depending on the Charlson comorbidity index.
Material and methods. Study participants (n = 330) were divided into 3 groups depending on the Charlson index: group 1 – 0–4 points (n = 69, median age 72 years), group 2 – 5–7 points (n = 182, median age 80 years), group 3 – ≥ 8 points (n = 79, median age 82 years). All patients were assessed for QF using a range of cognitive tests.
Results. The Montreal Cognitive Assessment Scale (MoCA) revealed statistically significant differences between groups 1 and 2, 1 and 3 (p = 0.032 and p < 0.001, respectively; maximum in group 1, minimum in group 3), on the Mini-Mental State Examination (MMSE) – between groups 1 and 3 (27 and 26 points respectively, p = 0.014), on the Alzheimer’s Disease Assessment Scale – Cognitive subscale (ADAS-Cog) – between groups 1 and 2 (12 and 15 points respectively, p = 0.011). Group 3 patients scored statistically significantly lower on the Boston Test compared to groups 1 and 2 (p1–2–3 = 0.008). In the literal association’s subtest, group 3 patients named statistically significantly fewer words compared to patients in groups 1 and 2 (p = 0.002 and p = 0.006, respectively). In the Digit Symbol Substitution Test, statistically significant differences were recorded between groups 1 and 3 (p = 0.022). Statistically significant differences between the groups (p1–2–3 < 0.001) were also found when evaluating the results of the maximum digit series memorization test.
Conclusion. The obtained results indicate a direct influence of the number of certain comorbidities and age of patients, which reflects the Charlson comorbidity index, on the severity of cognitive impairment in polymorbid elderly and senile patients with AH.
Literature
1. Ушкалова Е.А., Ткачева О.Н., Рунихина Н.К. с соавт. Особенности фармакотерапии у пожилых пациентов. Введение в проблему. Рациональная фармакотерапия в кардиологии. 2016; 12(1): 94–100. (Ushkalova E.A., Tkacheva O.N., Runihina N.K. et al. Features of pharmacotherapy in elderly patients. An introduction to the problem. Ratsional’naya farmakoterapiya v kardiologii = Rational Pharmacotherapy in Cardiology. 2016; 12 (1): 94–100 (In Russ.)). https://doi.org/10.20996/1819-6446-2016-12-1-94-100. EDN: VRCVLH. 2. Williams B., Mancia G., Spiering W. et al. ESC Scientific Document Group. 2018 ESC/ESH Guidelines for the management of arterial hypertension. Eur Heart J. 2018; 39(33): 3021–3104. https://doi.org/10.1093/eurheartj/ehy339. PMID: 30165516. 3. Soraci L., Corica F., Corsonello A. et al. Prognostic interplay of kidney function with sarcopenia, anemia, disability and cognitive impairment. The GLISTEN study. Eur J Intern Med. 2021; 93: 57–63. https://doi.org/10.1016/j.ejim.2021.06.031. PMID: 34253448. 4. Ganesan V., Sethuraman K., Sureshkumar et al. Platelet glycogen synthase kinase 3β regulates plasma β amyloid and phosphorylated tau levels in chronic kidney disease patients with cognitive dysfunction; therapeutic role of erythropoietin. J Nephropathol. 2023; 12(4): e17238. https://doi.org/10.34172/jnp.2022.17238. 5. Шаталова Н.А., Дзамихов К.К., Кочетков А.И. с соавт. Состояние когнитивных функций у полиморбидных пациентов с артериальной гипертензией, фибрилляцией предсердий и хронической болезнью почек. Медицинский алфавит. 2023; (33): 50–56. (Shatalova N.A., Dzamikhov K.K., Kochetkov A.I. et al. Cognitive function status in polymorbid patients with arterial hypertension, atrial fibrillation and chronic kidney disease. Meditsinskiy alfavit = Medical Alphabet. 2023; (33): 50–56 (In Russ.)). https://doi.org/10.33667/2078-5631-2023-33-50-56. EDN: RCNCID. 6. Левин О.С., Чимагомедова А.Ш. Концепция переходного когнитивного синдрома в структуре когнитивных нарушений у пожилых лиц: подходы к диагностике и лечению. Современная терапия в психиатрии и неврологии. 2022; (1–2): 25–33. (Levin O.S., Chimagomedova A.Sh. The concept of transitional cognitive syndrome in the structure of cognitive disorders in the elderly: Approaches to diagnosis and treatment. Sovremennaya terapiya v psihiatrii i nevrologii = Modern Therapy in Psychiatry and Neurology. 2022; (1–2): 25–33 (In Russ.)). EDN: WLUCJR. 7. Charlson M.E., Pompei P., Ales K.L., MacKenzie C.R. A new method of classifying prognostic comorbidity in longitudinal studies: Development and validation. J Chronic Dis. 1987; 40(5): 373–83. https://doi.org/10.1016/0021-9681(87)90171-8. PMID: 3558716. 8. Nasreddine Z.S., Phillips N.A., Bédirian V. et al. The Montreal Cognitive Assessment, MoCA: A brief screening tool for mild cognitive impairment. J Am Geriatr Soc. 2005; 53(4): 695–99. https://doi.org/10.1111/j.1532-5415.2005.53221.x. PMID: 15817019. 9. Folstein M.F., Folstein S.E., McHugh P.R. “Mini-mental state”. A practical method for grading the cognitive state of patients for the clinician. J Psychiatr Res. 1975; 12(3): 189–98. https://doi.org/10.1016/0022-3956(75)90026-6. PMID: 1202204. 10. Rosen W.G., Mohs R.C., Davis K.L. A new rating scale for Alzheimer’s disease. Am J Psychiatry. 1984; 141(11): 1356–64. https://doi.org/10.1176/ajp.141.11.1356. PMID: 6496779. 11. Reitan R. Validity of the Trail Making Test as an indicator of organic brain damage. Percept Mot Skills. 1958; 8(3): 271–76. https://doi.org/10.2466/pms.1958.8.3.271. 12. Wechsler D. The measurement of adult intelligence. Baltimore, MD: The Williams & Wilkins Company. Psychoanalytic Quarterly. 1958; 27: 592–94. https://doi.org/10.1111/j.1939-0025.1939.tb05653.x. 13. Strauss E. A compendium of neuropsychological tests: Administration, Norms, and Commentary. E. Strauss. Oxford: Oxford University Press. 2006: 1240 pp. https://doi.org/10.1080/09084280701280502. ISBN: 0-19-515957-8. ISBN-13: 978-0-19-515957-8. 14. Kaplan E., Goodglass H., Weintraub S. The Boston Naming Test. Philadelphia, PA: Lea & Fibiger. 1983. 15. MacLeod C.M. Half a century of research on the Stroop effect: An integrative review. Psychol Bull. 1991; 109(2): 163–203. https://doi.org/10.1037/0033-2909.109.2.163. PMID: 2034749. 16. Wechsler D.A. Standardized memory scale for clinical use. J Psychol. 1945; 19(1): 87–95. https://doi.org/10.1080/00223980.1945.9917223. 17. Wei M.Y., Levine D.A., Zahodne L.B. et al. Multimorbidity and cognitive decline over 14 years in older Americans. J Gerontol A Biol Sci Med Sci. 2020; 75(6): 1206–13. https://doi.org/10.1093/gerona/glz147. PMID: 31173065. PMCID: PMC7243582. 18. Клинические рекомендации. Когнитивные расстройства у лиц пожилого и старческого возраста. Общественная организация «Российское общество психиатров», Общероссийская общественная организация «Российская ассоциация геронтологов и гериатров». Рубрикатор клинических рекомендаций Минздрава России. 2020. ID: 617. Доступ: https://cr.minzdrav.gov.ru/schema/617_1 (дата обращения – 26.05.2024). (Clinical guidelines. Cognitive disorders in the elderly and senile age. Russian Society of Psychiatrists, Russian Association of Gerontologists and Geriatricians. 2020. Rubricator of clinical guidelines of the Ministry of Healthcare of Russia. ID: 617. URL: https://cr.minzdrav.gov.ru/schema/617_1 (date of access – 26.05.2024) (In Russ.)). 19. Qian Y., Chen X., Tang D. et al. Prevalence of memory-related diagnoses among U.S. older adults with early symptoms of cognitive impairment. J Gerontol A Biol Sci Med Sci. 2021; 76(10): 1846–53. https://doi.org/10.1093/gerona/glab043. PMID: 33575783. PMCID: PMC8436977. 20. Sharma Y., Popescu A., Horwood C. et al. Relationship between vitamin C deficiency and cognitive impairment in older hospitalised patients: A cross-sectional study. Antioxidants. 2022; 11(3): 463. https://doi.org/10.3390/antiox11030463. PMID: 35326113. PMCID: PMC8944675. 21. Fogg C., Meredith P., Culliford D. et al. Cognitive impairment is independently associated with mortality, extended hospital stays and early readmission of older people with emergency hospital admissions: A retrospective cohort study. Int J Nurs Stud. 2019; 96: 1–8. https://doi.org/10.1016/j.ijnurstu.2019.02.005. PMID: 30850127. 22. Попов А.А., Изможерова Н.В., Гетманова Н.А. Когнитивная функция у постменопаузальных женщин с первичным остеоартрозом и полиморбидностью. Остеопороз и остеопатии. 2016; 19(2): 102–103. (Popov A.A., Izmozherova N.V., Getmanova N.A. Cognitive function in postmenopausal women with primary osteoarthritis and multimorbidity. Osteoporoz i osteopatii = Osteoporosis and Osteopathy. 2016; 19(2): 102–103 (In Russ.)). EDN: XSCOWP.
About the Autors
Olga D. Ostroumova, MD, Dr. Sci. (Medicine), professor, head of the Department of therapy and multimorbid pathology named after academician M.S. Vovsi, Russian Medical Academy of Continuous Professional Education of the Ministry of Healthcare of Russia, professor of the Department of clinical pharmacology and propaedeutics of internal diseases, I.M. Sechenov First Moscow Medical University of the Ministry of Healthcare of Russia (Sechenov University). Address: 125993, Moscow, 2/1 build. 1 Barrikadnaya St.
E-mail: ostroumova.olga@mail.ru
ORCID: https://orcid.org/0000-0002-0795-8225. eLibrary SPIN: 3910-6585
Kantemir K. Dzamikhov, MD, postgraduate student of the Department of therapy and multimorbid pathology named after academician M.S. Vovsi, Russian Medical Academy of Continuous Professional Education of the Ministry of Healthcare of Russia. Address: 125993, Moscow, 2/1 build. 1 Barrikadnaya St.
E-mail: kantemir.dk@mail.ru
ORCID: https://orcid.org/0000-0002-8941-7018. eLibrary SPIN: 9603-5881
Alexey I. Kochetkov, MD, PhD (Medicine), associate professor, associate professor of the Department of therapy and multimorbid pathology named after academician M.S. Vovsi, Russian Medical Academy of Continuous Professional Education of the Ministry of Healthcare of Russia. Address: 125993, Moscow, 2/1 build. 1 Barrikadnaya St.
E-mail: ak_info@list.ru
ORCID: https://orcid.org/0000-0001-5801-3742. eLibrary SPIN: 9212-6010
Tatyana M. Ostroumova, MD, PhD (Medicine), assistant at the Department of nervous diseases and neurosurgery, I.M. Sechenov First Moscow Medical University of the Ministry of Healthcare of Russia (Sechenov University). Address: 119048, Moscow, 8 build. 2 Trubetskaya St.
E-mail: t.ostroumova3@gmail.com
ORCID: https://orcid.org/0000-0003-1499-247X
Vera R. Shastina, MD, PhD (Medicine), chief physician of Hospital for War Veterans No. 2 of the Department of Healthcare of Moscow. Address: 109472, Moscow, 168 Volgogradsky Avenue.
E-mail: ShastinaVR@zdrav.mos.ru
ORCID: https://orcid.org/0000-00022933-7876. eLibrary SPIN: 7230-9602
Marina A. Lyakhova, MD, head of the Department of palliative care, Hospital for War Veterans No. 2 of the Department of Healthcare of Moscow. Address: 109472, Moscow, 168 Volgogradsky Avenue.
Similar Articles
