Cognitive impairment in arterial hypertension
Anatoly Ivanovich Fedin , MD, PhD, Professor Emeritus, Head of the University Clinic of Neurology at the N.I. Pirogov Russian National Research Medical University of the Ministry of Health of the Russian Federation, Scientific Director of the Khamovniki Rehabilitation Clinic, and Honored Doctor of the Russian Federation
Veronika Nikolaevna Shishkova - Doctor of Medical Sciences, Professor of the Department of Outpatient Therapy of the Faculty of Advanced Medical Studies, State Budgetary Healthcare Institution of the Moscow Region, Moscow Regional Scientific Research Institute named after M.F. Vladimirsky, Professor of the Department of Neuro- and Pathopsychology of the Institute of Psychology named after L.S. Vygotsky, Russian State University for the Humanities
Announcement:
Arterial hypertension is more than just a problem of high blood pressure; it's a systemic disease that affects the blood vessels in the brain and leads to cognitive impairment. In this video, neurology and cardiology experts Anatoly Ivanovich Fedin and Veronika Nikolaevna Shishkova discuss the mechanisms of brain damage in hypertension, early diagnosis methods, and evidence-based approaches to neuroprotective therapy.
Main topics:
- Epidemiology and relevance:
— 44% of the adult population of Russia suffers from hypertension, but only a quarter achieve target blood pressure values.
— Hypertension is the leading risk factor for stroke and vascular dementia in almost half of cases.
- Pathogenesis of brain damage:
— Chronic ischemia due to small vessel microangiopathy.
— Lacunar infarctions in the deep parts of the brain (shown on MRI).
— Impaired autoregulation of cerebral blood flow and hypoxic cascade.
- Clinical manifestations:
— Early symptoms: decreased concentration, “operational forgetfulness”, slowness of thinking.
— Progression to frontal dysfunction (impaired planning, rigidity).
— Association with asthenia, anxiety and depression.
- Diagnostics:
— Screening: Mini-COG test, Montreal scale (MoCA).
— Assessment of endothelial dysfunction and oxidative stress markers.
- Therapy:
o Basic treatment of hypertension:
- Cautious reduction of pressure in patients with critical carotid artery stenosis.
- Target values: 130–140/80 mmHg for the elderly.
- Neuroprotection:
o Mexidol (ethylmethylhydroxypyridine succinate):
Antioxidant and antihypoxant action.
- Scheme: 500 mg/day intravenously for 14 days → 250 mg × 3 times a day for 2 months.
- Results: improved cognitive functions, reduced asthenia.
- Clinical recommendations: included in the treatment of vascular cognitive impairment.
Key findings:
- Cognitive impairment in hypertension is not an “age-related norm”, but a consequence of cerebral microangiopathy.
- Screening with Mini-COG is mandatory for patients with blood pressure >140/90.
- The combination of antihypertensive therapy and Mexidol significantly improves the prognosis.
For whom: therapists, cardiologists, neurologists, general practitioners.
Practical value:
The video provides diagnostic and treatment algorithms based on evidence-based medicine. Particular attention is paid to patients with resistant hypertension and high risk of dementia.
Recommendation:
This material is a must-read for doctors working with older patients and striving to maintain not only physical but also cognitive health.