Apollo Medicine (Jan 2023)
Cognitive impairment in diabetic adults with and without hypertension
Abstract
Background: Diabetes is a heterogeneous disease that is modified by many risk factors, most notably hypertension. Although its negative effects on the retinal, renal, cardiovascular, and peripheral nervous systems are well known, its impact on cognitive performance has received less attention. It has been shown that diabetes is linked to mild cognitive impairment, a transitional stage between normal aging and dementia. Methods: In this case–control study, 150 patients, which were further divided into three groups of 50 patients each with 50 patients who fulfilled the American Diabetes Association's (ADA) Guidelines 2018 for diabetes were in Group A, 50 patients who fulfilled both ADA Guidelines 2018 for diabetes and Joint National Committee 7 (JNC 7) Guidelines for hypertension in Group B while 50 healthy subjects in Group C, were included after applying the exclusion criteria and were subjected to cognitive assessment by Montreal cognitive assessment (MoCA) test. Results: In the diabetic arm of the study (n = 100), 65% (n = 65) of the patients had cognitive impairment as compared to the control group (n = 50), where only 12% (n = 6) of the patients had cognitive decline (P < 0.001). The mean MoCA scores were lowest in patients who had concomitant diabetes and hypertension (23.86 ± 1.78) as compared to patients having diabetes alone (24.76 ± 1.38) while the control group had the highest mean MoCA score (27.46 ± 1.69) (P < 0.001). Age correlated negatively with MoCA while no correlation was observed with gender distribution and area of residence. Duration of diabetes correlated negatively with MoCA scores in Group A (−0.874) (P < 0.001) and Group B (−0.801) (P < 0.001). Duration of hypertension also showed a negative correlation with MoCA scores in Group B (−0.745) (P < 0.001). A negative correlation was also observed between glycated hemoglobin and MoCA scores in Group A (−0.665) (P = 0.001) and Group B (−0.567) (P = 0.034). Conclusions: In conclusion, the incidence and severity of cognitive impairment was more in patients having concomitant diabetes and hypertension as compared to patients having diabetes alone, thus signifying the additional burden and contribution of hypertension to the cognitive decline.
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