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CC BY-NC-ND 4.0 · Arq Neuropsiquiatr 2020; 78(07): 412-418
DOI: 10.1590/0004-282X20200039
Original Article

Systemic arterial hypertension and cognition in adults: effects on executive functioning

Hipertensão arterial sistêmica e cognição em adultos: efeitos no funcionamento executivo
Natália Cristina MORAES 
1   Universidade de São Paulo, Department of Neurology, São Paulo SP, Brazil.
,
Henrique Cotchi Simbo MUELA 
2   Universidade Agostinho Neto, Faculty of Medicine, Department of Physiology, Luanda, Angola.
,
Claudia Maia MEMÓRIA 
1   Universidade de São Paulo, Department of Neurology, São Paulo SP, Brazil.
,
Valéria Aparecida da COSTA-HONG 
3   Universidade de São Paulo, Hypertension Unit, Heart Institute, São Paulo SP, Brazil.
,
Michel Ferreira MACHADO 
3   Universidade de São Paulo, Hypertension Unit, Heart Institute, São Paulo SP, Brazil.
,
Mario Amore CECHINHI 
1   Universidade de São Paulo, Department of Neurology, São Paulo SP, Brazil.
,
Ricardo NITRINI 
1   Universidade de São Paulo, Department of Neurology, São Paulo SP, Brazil.
,
Luiz Aparecido BORTOLOTTO 
3   Universidade de São Paulo, Hypertension Unit, Heart Institute, São Paulo SP, Brazil.
,
Monica Sanches YASSUDA 
1   Universidade de São Paulo, Department of Neurology, São Paulo SP, Brazil.
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ABSTRACT

Background: Central nervous system changes associated to systemic arterial hypertension (SAH) are progressive and may cause negative effects on cognitive performance. The objective of this study was to investigate the relation between SAH and the components of executive functions (EF), inhibitory control (IC), updating and shifting, comparing a control group (without SAH) to patients with SAH, in two levels of severity. Methods: The protocol included the following tests to evaluate EF components: T.O.V.A. Test (IC), Backward Digit Span from Wechsler Adults Intelligence Scale (WAIS-III), Phonemic and Semantic Verbal Fluency (updating), and Trail Making Test Part B (shifting). Results: A total of 204 participants was included: 56 from the Control Group (CG), 87 SAH stage 1, and 61 SAH stage 2. The groups were not different for age (52.37±12.29) and education (10.98±4.06). As to controlled blood pressure (BP), duration of hypertension treatment and number of drugs, the SAH 2 group had a worse BP control, longer duration of hypertension treatment and use of more drugs when compared to the SAH 1. The findings revealed that patients with more severe hypertension presented worse performance in updating (Backward Digit Span, phonemic and semantics VF) and shifting (Trail Making Test Part B). Conclusion: The results suggest that patients with SAH have a significant impairment in EF, more specifically in updating and shifting. Besides that, such damage may be directly proportional to the severity of SAH. It is suggested that future studies include neuroimaging exams to exclude possible cerebrovascular diseases.

RESUMO

Introdução: As alterações do sistema nervoso central associadas à hipertensão arterial sistêmica (HAS) são progressivas e podem ocasionar efeitos negativos no desempenho cognitivo. O objetivo deste estudo foi investigar a relação entre a HAS e os componentes das funções executivas (FE), controle inibitório (CI), atualização e alternância, comparando um grupo controle (sem HAS) a pacientes com HAS, em dois níveis de gravidade. Métodos: O protocolo incluiu os seguintes testes para avaliar os componentes das FE: T.O.V.A. Test (CI), Dígitos Ordem Indireta da Escala de Inteligência Wechsler para Adultos (Wechsler Adults Intelligence Scale - WAIS-III), Fluência Verbal fonêmica e semântica (atualização) e Teste de Trilhas parte B (alternância). Resultados: Foram incluídos 204 participantes, sendo 56 do Grupo Controle (GC), 87 HAS estágio 1 (HAS 1) e 61 de HAS estágio 2 (HAS 2). Os grupos não foram diferentes em relação à idade (52,37±12,29) e escolaridade (10,98±4,06). Em relação à pressão arterial (PA) controlada, tempo de tratamento da HAS e número de medicações, o grupo HAS 2 apresentou pior controle de PA, mais tempo de tratamento da HAS e uso de maior número de medicações quando comparado ao grupo HAS 1. Os achados revelaram que os pacientes com HAS em estágio mais grave apresentaram pior desempenho nos testes de alternância (Teste de Trilhas parte B) e atualização (Dígitos Ordem Indireta, FV fonêmica e semântica). Conclusão: Esses resultados sugerem que pacientes com a HAS possuem prejuízo significativo em FE, especificamente em alternância e atualização, e que esse prejuízo pode ser diretamente proporcional à gravidade da HAS. Sugere-se que, em estudos futuros, incluam-se exames de neuroimagem com o objetivo de excluir possíveis doenças cerebrovasculares.

Keywords:

Hypertension - Cognition - Executive Function

Palavras-chave:

Hipertensão - Cognição - Função Executiva


Publication History

Received: 27 January 2020

Accepted: 30 March 2020

Article published online:
13 June 2023

© 2020. Academia Brasileira de Neurologia. This is an open access article published by Thieme under the terms of the Creative Commons Attribution-NonDerivative-NonCommercial License, permitting copying and reproduction so long as the original work is given appropriate credit. Contents may not be used for commecial purposes, or adapted, remixed, transformed or built upon. (https://creativecommons.org/licenses/by-nc-nd/4.0/)

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