Clinical factors predicting the rate of cognitive decline in a US memory clinic: An electronic health record study

To the Editor,

We read the article entitled “Clinical factors predicting the rate of cognitive decline in a US memory clinic: An electronic health record study” that was published in 2025, by Roy Adams et al. in Translational Research & Clinical Interventions.¹ This study used real-world clinical data to examine predictors of cognitive decline after an initial memory care visit. It reveals that more rapid deterioration in Mini-Mental State Examination (MMSE) scores was linked to older age, a diagnosis of dementia, and the use of cholinesterase inhibitors or memantine. A slower decline was associated with the patient's total number of prescriptions. Neither race nor ethnicity was associated with rate of decline, and nor was baseline mild cognitive impairment, other non-dementia cognitive impairment, diabetes, hypertension, obesity, depression, anxiety, chronic pain, fatigue, or hearing loss. The authors utilized real-world electronic health records as the data foundation, which best reflects patients’ conditions in actual clinical settings. However, we note that some issues need to be further elucidated.

First, this study reveals that hypertension is not associated with a decline in cognitive scores, but some studies contradict this conclusion.^2-4 For example, a study by Ding L et al. showed that a longer hypertension duration was associated with worse memory test; in addition, the Framingham Offspring cohort study by McGrath et al. revealed that midlife hypertension is associated with increased risk of a late life dementia. We speculate that the reason this study¹ concluded that there is no association between hypertension and cognitive decline may be due to its relatively short follow-up period (6 months) and minimal changes in blood pressure. However, this does not definitively rule out a relationship between hypertension and cognitive decline, and further research is warranted.

Second, the authors mentioned in the abstract that faster decline in MMSE scores was associated with cholinesterase inhibitor or memantine prescription. We believe that this expression may mislead readers into thinking that the cognitive decline was caused by increased medication use. However, as the authors clarified in the discussion, this is expected and reflects increased prescribing in sicker patients.

In summary, we believe that this study offers valuable empirical evidence for the investigation of cognitive decline. Building on these findings, the authors could consider extending the follow-up duration and incorporating insights from additional studies^{5, 6} to account for the causal effects of these medications, so as to further clarify the risk factors for cognitive decline.

Yuchan Wang: manuscript writing, final approval. Qian Liu: revision for academic advice in the field of neurology. Wenyong Li: critical revision for important intellectual content.

The authors declare no conflicts of interest.