Life science
Medical & healthcare, Aging research

The study on cognitive impairment in hypertensive individuals
in ambulatory care (Cherry study)
Department of Geriatric and General Medicine, Graduate School of Medicine
Professor Koichi Yamamoto				

https://researchmap.jp/kymt0410?lang=en

Professor Emeritus Hiromi Rakugi		

https://researchmap.jp/read0042763?lang=en

Life science

Abstract
The Cherry study is a multicenter cohort investigation aimed atexploring the prevalence and underlying factors of cognitive impairment in elderly hypertensive patients. A total of 312 hypertensive patients aged 65 and above, receiving outpatient care, wereexamined, revealing that approximately one-third of these patients
exhibited cognitive impairment based on cognitive function assessments. Advanced age and reduced instrumental activities ofdaily living (IADL) were associated with cognitive impairment. The
patients with cognitive impairment had relatively preserved IADL,
despite a higher number of antihypertensive medications whencomparing with patients in the national cohort of mild cognitive im主要pairment.

▍ Background & Results

図表

Background:
Hypertension, affecting more than half of individuals aged 65
and older, is the most common noncommunicable disease in theolder population. Cognitive impairment in hypertensive patients
can influence factors such as medication adherence and the riskof falls. However, detecting cognitive impairment without apparent symptoms remains challenging. The Cherry study, conductedacross six core hospitals nationwide, aimed to elucidate the relationship between hypertension and cognitive decline and optimize
patient care. This research employed initial registration data fromthe Cherry study to investigate the reality of cognitive impairment inhypertensive patients.
Results:
Among 312 hypertensive patients receiving outpatient care, 35%(n=109) and 7.7% (n=24) met the criteria for cognitive impairment
or dementia, defined by MMSE scores ≤ 27 and ≤ 23, respectively.
Patients with cognitive impairment were older and had lower 補足
educational levels compared to those without. Patients with cognitive
図表
impairment had lower basic activities of daily living (ADL) and instrumental ADL (IADL) scores. There was no significant difference
in hypertension management between the two groups. Patientswith cognitive impairment exhibited reduced grip strength andwalking speed. Multivariate logistic regression analysis revealed
that high age and low IADL scores were associated with cognitive impairment. When compared to the national cohort of mild
cognitive impairment, no significant differences in age, gender,education level, or MMSE scores were observed, but Cherry study
registrants had higher prevalence of diabetes, dyslipidemia, andseverer hypertension, with relatively preserved IADL.

▍ Significance of the research and Future perspectiveof lifestyle disease management with a heightened awarenessof age-related cognitive decline. The Cherry study’s longitudinal
investigation has yielded results suggesting the involvement ofmuscle weakness in the progressive deterioration of cognitive function, raising the possibility of a condition termed “cognitive frailty”
that warrants further exploration. Additionally, the development ofsimpler cognitive function assessments for screening purposes isneeded, and our research lab is actively working on methods tosimplify assessments of cognitive and physical function.

Graphical abstractCherry study

Hypertensive patients inoutpatient clinics(≥65y.o.)without prior diagnosis ofcognitive impairment.
Cognitive
impairment

YoungerPreserved IADL(MMSE≤ 27)

Older
Reduced IADL

Hypertensive patientsin the database of
mild cognitive
impairment(Orange registry)

35%

Reduced IADL

high antihypertensive
medication burdenDementia(MMSE≤ 23)

7.7%

Background

Conclusion: Older hypertensive patients areat a high risk of masked cognitive decline,
even if they are functionally independent.

Older people

Cognitive
Hypertension impairment
Frequency ?
Related factors ?
Interaction？
Impact on treatment ?
・・・ ?

This study revealed that older hypertensive patients frequently
have undiagnosed cognitive impairment. Similar findings havebeen reported in diabetes patients, underscoring the importanceP a t e n t
Tr e a t i s e

Yamamoto, Koichi; Akasaka, Hiroshi; Rakugi, Hiromi et al. Clinical characteristics of older adults with hypertension and unrecognized cognitiveimpairment. Hypertens Res. 2022, 45(4), 612-619. doi: 10.1038/s41440-022-00861-z

URL
K e y w o r d hypertension, cognitive impairment, geriatrics