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July 2008

Hypertension and Mild Cognitive Impairment Subtypes

Arch Neurol. 2008;65(7):992-996. doi:10.1001/archneur.65.7.992-c

Reitz et al1 reported the results of a very interesting longitudinal community-based study involving 918 older persons in northern Manhattan in which hypertension was associated with an increased risk of all-cause mild cognitive impairment (MCI) and nonamnestic MCI (NAMCI) after adjusting for age and sex. These associations were not significant after adjusting for sex, age, ethnic group, years of education, apolipoprotein E (APOE) genotype, stroke, diabetes mellitus, heart disease, current smoking, and low-density lipoprotein cholesterol level. There was no relation between hypertension history and the risk of incident amnestic MCI (AMCI), and there was no effect modification of the association between hypertension and any MCI subtype by APOEε4 genotype or use of antihypertensive medication. Reitz and colleagues described these results as consistent with those from studies showing an increased risk of MCI in persons with hypertension,2,3 although without distinction in MCI subtypes (AMCI and NAMCI). In the Italian Longitudinal Study on Aging, we evaluated 2963 individuals from a population-based sample and found no significant association between hypertension and incident MCI or between hypertension and progression of MCI to dementia.4 The neuropsychological requirements of AMCI include the demonstration of impaired memory and the relative preservation of other cognitive domains. Hence, our patients were identified on the basis of impaired memory that was objectively confirmed, and our MCI should reasonably be labeled as an amnestic variant of MCI. The recent findings by Reitz and colleagues confirmed those from the Italian Longitudinal Study on Aging,1,4 suggesting that in a predementia syndrome with a cognitive pattern similar to Alzheimer disease (AD) and with a central role for memory decline, hypertension did not influence the risk of incident AMCI. Moreover, hypertension in this elderly cohort from northern Manhattan was not related to the change over time in memory,1 suggesting that an AD-related cognitive pattern like AMCI could not be associated with increased blood pressure.

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