Relationship Between Cognition And Microalbuminuria In Elderly Patients With Primary Hypertension

Objective: Currently, with the constant increasing of aging process in China, Alzheimer's Disease(AD) has become a serious public health problem which threatened to the physical and mental health of the old people. It mainly characterized as cognitive decline, behavioral problems and recess in activities of daily living. Therefore,great attention has been paid to the family and social burden generated by dementia. Cognition is an ability in the human body to know about the outside world, and also is one of the important functions of the senior center of f the brain, cognitive impairment is a major clinical features of early dementia. It is well known that hypertension is a major risk factors of cerebrovascular diseases and is closely related to cognitive decline and dementia. Microalbuminuria (MAU) not only represents the glomerular endothelial function impairment, but also as a sign of systemic vascular endothelial cell damage. It has important reference value for predicting and evaluating the progression and treatment of hypertension and cardiovascular disease and blood vessel-related diseases. This study was designed to detect the relationship between microalbuminuria and cognitive impairment in the aged patients with primary hypertension and to explore the risk factors impacting the cognitive function, thus providing a more sensitive, specific, cheap and practical indicator and monitoring measure.Methods: Totally 197 elderly hypertensive patients, male 98 cases , female 99 cases ,average (68.08±6.69) years old, who were hospitalized in the second Hosptital of Hebei Medical University from January 2009 to November 2009 were enrolled. All the patients were in accordance with the Guideline for the prevention and treatment of hypertension in China (2005), Excepting for secondary hypertension, diabetes, kidney disease, macroalbuminuria (UAER> 200 ug / min), cerebral vascular disease, mental disease, severe audiovisual and language disorder, and malignant tumors. By making use of the Mini Mental State Examination(MMSE) to evaluate the cognitive function, the patients were divided into two groups: impaired cognition group(n=38) and normal cognition group(n=159). Clinical information Including sex, age, marital status, profession , education labor nature before 60 years old,income, living behavior (smoking, drinking),chronic diseases and risk factors, associated complications, etc were collected, body height and weight were measured, blood pressure was classified into 3 levels. Total cholesterol, triglyceride,fasting plasma glucose, uric acid and urinary albumin excretion rate (UAER) were tested. UAER was applied to estimate microalbuminuria. And then to analyze the statistical results.Results:1 Univariant correlation analysis between the two groups showed that significant difference existed in age,culture,marital status, labor nature before 60 years old, drinking ,income, blood pressure classification, cholesterol and UAER in the two groups(P<0.05). There was no relationship of the other factors between the two groups(P>0.05).2 Age, cholesterol and UAER in impaired cognition group are all significantly higher than the value of the three indicators of normal cognition group, age (74.47±6.73) vs (66.55±5.72) years; cholesterol (5.09±1.20) vs (4.61±1.20) mmol / L and 24-hour urinary albumin excretion rate (42.52±36.61) vs (16.55±14.38) ug / min,),respectively(P < 0.05).3 In the surveyed 197 elderly people, there were 38 patients have cognitive disorder. 13 of them were illiterate(65%), 18 of them had primary school education(26.9%), 7 of them got middle school education(10.8%), none of the high school and above education group occured cognitive impairment (χ2 = 44.923, P = 0.000).4 Multiple logistic regression analysis demonstrated that age(OR = 2.990, 95% CI : 1.119-7.987, P<0.05), UAER (OR = 3.016, 95%CI : 1.032-8.816, P<0.05) and culture (OR = 0.324, 95%CI :0.141-0.747, P<0.05) were related to cognitive impairment. Conclusion: UAER levels of cognitive dysfunction group was significantly higher than normal cognitive function group (P<0.05),Microalbuminuria as a sign of endothelial cell damage is an important risk factor for the cognitive impairment in aged patients with hypertension(P<0.05).