Nutritional status of elderly hypertensive patients and its relation to the occurrence of cognitive impairment

Abstract

BACKGROUND

Hypertension is a common chronic disease in the elderly population, and its association with cognitive impairment has been increasingly recognized. Cognitive impairment, including mild cognitive impairment and dementia, can significantly affect the quality of life and independence of elderly individuals. Therefore, identifying risk factors for cognitive impairment in elderly hypertensive patients is crucial for developing effective interventions and improving health outcomes. Nutritional status is one of the potential factors that may influence cognitive function in elderly hypertensive patients. Malnutrition or inadequate nutrition can lead to various health problems, including weakened immune system, increased susceptibility to infections, and impaired physical and mental function. Furthermore, poor nutritional status has been linked to increased risk of cognitive decline and dementia in various populations. In this observational study, we aimed to investigate the nutritional status of elderly hypertensive patients and its relationship to the occurrence of cognitive impairment. By collecting baseline data on general information, body composition, and clinical indicators, we hope to identify risk factors for cognitive impairment in this patient population. The results of this study are expected to provide more scientific basis for the health management of elderly patients with hypertension, particularly in terms of maintaining good nutritional status and reducing the risk of cognitive impairment.

AIM

To explore the differences between clinical data and cognitive function of elderly hypertensive patients with different nutritional status, analyze the internal relationship between nutritional statuses and cognitive impairment, and build a nomogram model for predicting nutritional status in elderly hypertensive patients.

METHODS

The present study retrospectively analyzed 200 elderly patients admitted to our hospital for a hypertension during the period July 1, 2024 to September 30, 2024 as study subjects, and the 200 patients were divided into a modeling cohort (140 patients) and a validation cohort (60 patients) according to the ratio of 7:3. The modeling cohort were divided into a malnutrition group (26 cases), a malnutrition risk group (42 cases), and a normal nutritional status group (72 cases) according to the patients’ Mini-Nutritional Assessment Scale (MNA) scores, and the modeling cohort was divided into a hypertension combined with cognitive impairment group (34 cases) and a hypertension cognitively normal group (106 cases) according to the Montreal Cognitive Assessment Scale (MoCA) scores, and the validation cohort was divided into a hypertension combined with cognitive impairment group (14 cases) and hypertension cognitively normal group (46 cases). The study outcome was the occurrence of cognitive impairment in elderly hypertensive patients. Univariate and multivariate logistic regression was used to explore the relationship between the general information of the elderly hypertensive patients and the influence indicators and the occurrence of cognitive impairment, the roadmap prediction model was established and validated, the patient work receiver operating characteristic curve was used to evaluate the predictive efficacy of the model, the calibration curve was used to assess the consistency between the predicted events and the actual events, and the decision curve analysis was used to evaluate the validity of the model. Pearson correlation analysis was used to explore the relationship between nutrition-related indicators and MoCA scores.

RESULTS

In this research, the modeling cohort comprised 140 cases, while the verification cohort consisted of 60 cases, with no notable discrepancy in the data between the two groups. In the modeling cohort, there were significant differences in body mass index (BMI), albumin (ALB), hemoglobin (Hb) and homocysteine levels among the malnourished group, the malnourished risk group and the normal nutritional status group. The results of univariate and multivariate analysis showed that BMI [odds ratio (OR) = 0.830, P = 0.014], ALB (OR = 0.860, P = 0.028), Hb (OR = 0.939, P = 0.035) and MNA score (OR = 0.640, P = 0.000) were independent protective factors for patients without cognitive impairment, and alkaline phosphatase (ALP) (OR = 1.074, P = 0.000) was an independent risk factor for patients with cognitive impairment. In this study, the prediction nomogram tailored for cognitive deterioration in elderly patients with hypertension demonstrated robust predictive power and a close correspondence between predicted and observed outcomes. This model offers significant potential as a means to forestall cognitive decline in hypertensive elderly patients. ALP was negatively correlated with MoCA score, while BMI, MNA score, Hb and ALB were positively correlated with MoCA score.

CONCLUSION

BMI, MNA score, Hb and ALB were independent protective factors for cognitive impairment in elderly hypertensive patients and were positively correlated with MoCA score. ALP was an independent risk factor for cognitive impairment in elderly hypertensive patients and was negatively correlated with the MoCA score. The column line graph model established in the study has a good predictive value.

Keywords: Elderly patients; Hypertension; Nutritional status; Cognitive impairment; Malnutrition

Core Tip: In summary, this study investigated the relationship between nutritional status and cognitive function in elderly hypertensive patients. By retrospectively analyzing data from 200 patients admitted for hypertension, the study divided them into modeling and validation cohorts, and further categorized them based on Mini-Nutritional Assessment Scale and Montreal Cognitive Assessment Scale (MoCA) scores. The results indicated that body mass index, Mini-Nutritional Assessment Scale score, hemoglobin, and albumin were independent protective factors for cognitive impairment, positively correlated with MoCA scores, while alkaline phosphatase was an independent risk factor, negatively correlated with MoCA scores. A predictive nomogram model for cognitive impairment was constructed and validated, exhibiting strong predictive accuracy and consistency in aligning predicted with actual events.