Why Should We Must Evaluate Cognitive Function in Hypertensive Patients

Abstract

Hypertension and dementia are two highly prevalent pathologies that affect the brain in the same period (persons over 60 years). One-third of patients with dementia have hypertension and, hypertension was reported in two-third of patients 65 years and older with dementia [1]. Thus, the brain is a target organ for hypertension and hypertension is the main modifiable vascular risk factor for developing cognitive impairment, dementia or Alzheimer's disease. Among the vascular risk factors, hypertension is the main cause of small vessel disease (leukoaraiosis, lacunar infarcts, microbleeds and dilated perivascular spaces) that mainly affects the cerebral subcortex. Vascular brain damage (hypoperfusion, hipoxia, ischemia, brainblood barrier disruption) affects the neurovascular unit (vascular, oligodendrocytes and neurons) and demyelinates the association fibers in the most vulnerable regions of subcortex (periventricular area has high density of long associating fibers), disconnecting the cortico-subcortical association circuits. The dorsolateral prefrontal cortex and the nuclei of the base is the most frequently circuit affected, resulting in impairment of executive functions [2].