CC BY
6Boev S. S.
candidate of Science (Medicine), Associate Professor of the Department of Cardiology, SI "Zaporizhzhya
Medical Academy of Postgraduate Education Ministry of Health of Ukraine";
Gerasimenko L. V.
candidate of Science (Medicine), Assistant of the Department of Cardiology, SI "Zaporozhye Medical Academy of Postgraduate Education Ministry of Health of Ukraine";
Shekhunova I. A.
candidate of Science (Medicine), Associate Professor of the Department of Cardiology, SI "Zaporozhye Medical Academy of Postgraduate Education Ministry of Health of Ukraine";
Dotsenko N. Ya.
doctor of Science (Medicine), professor of the Department of Cardiology, SI "Zaporozhye Medical Academy of Postgraduate Education Ministry of Health of Ukraine";
Yatsenko O. V.
Assistant of the Department of Internal Medicine №3, Zaporozhye State Medical University ;
Veksler A.S.
Doctor of therapy, Dnepropetrovsk Regional Hospital of the War Veterans.
ASSOCIATION BETWEEN THE STATE OF COGNITIVE FUNCTION AND NATURE OF NUTRITION, SMOKING AND USE OF ALCOHOL IN PATIENTS WITH ARTERIAL
HYPERTENSION
Abstract
Arterial hypertension is one of the most significant medical problems. In recent years, numerous studies have demonstrated the role of hypertension as an independent risk factor in the development and progression of cognitive impairment in the general population. The identification of modifiable factors that predispose and aggravate cognitive dysfunction in in patients with arterial hypertension is currently relevant.
Objective: to study the state of cognitive functions and psychoemotional status depending on lifestyle factors, such as smoking, nutrition, use of alcohol, in patients with arterial hypertension.
Material and Methods:
102 patients with hypertensive disease of the II stage, average age of 49.84 ± 0.83 years, were examined.
To assess cognitive functions, the Montreal Evaluation Scale (MoCA- test) was used. The level of reactive anxiety was determined using the Spielberger questionnaire. To assess the severity of depression, the Beck- depression scale was used.
Results: Analyzing the results of psychoemotional tests and cognitive function according to the overall score, a greater degree of anxiety and a greater degree of cognitive dysfunction were noted in the 2nd group of patients, who preferred meat, sweets, and few plant products. The absence of depression was least noticed in people who abused alcohol, and was noted in 43.3%, 43.3% and 33.3% of patients (p <0.05 when comparing groups 1 and 3 and comparison of groups 2 and 3, respectively).
Among the alcohol abusers, there were fewer with mild reactive anxiety, and those with cognitive impairment prevailed, with moderate alcohol consumption there were more people with mild anxiety.
The best psychoemotional background was detected with moderate smoking, and cognitive impairment was much more frequent among heavy smokers.
Conclusions: In patients with AH stage II who did not receive antihypertensive therapy or were treated irregularly in the presence of lifestyle factors such as a lack of preferences for rational nutrition, alcohol abuse, and smoking, cognitive impairment is found 2.2-4.2 times more often.
The most effective strategy in solving this problem can be with simultaneous exposure to several risk factors, including necessarily and effective treatment of arterial hypertension.
Key words: arterial hypertension, cognitive impairment, modifiable risk factors.
Introduction. In recent years, more attention has been paid to early manifestations of brain damage as a target organ in arterial hypertension (AH). It has been shown that brain damage can manifest not only by stroke, but also by impaired cognitive functions, which significantly increases the risk of developing dementia, whose frequency reaches 10-15% per year, and for a 5-year follow-up period in 70% of patients moderate cognitive impairment are transformed into dementia [1, 2, 3]. The frequency and severity of cognitive impairment in patients with AH increases with the development and severity of AH and brain damage as a target organ in AH [4]. Progressive growth of cognitive impairment and affective (anxiety, depression) disorders, which are
observed in the majority of patients with AH, which sometimes lead to the development of dementia. Even moderate cognitive impairment of vascular genesis, which are observed in AH, is considered by many authors to be prognostically unfavorable [5] and worsen the quality of life of patients, negatively affecting professional activity, behavior in the family and society, causing emotional distress.
It should be emphasized that the presence of cognitive impairment in a patient with AH does not automatically cause a causal relationship between them and the underlying disease [6]. Since not only the level of blood pressure, but also the way of life, plays an important role in these processes, not only because of the
influence on the aging processes, but also because it further determines how fully and independently the cognitive functioning will be in the elderly. Due to numerous studies, several factors have been identified that affect the biochemical, morphological and physiological processes of brain aging. In many cases, these factors affect the clinical manifestation of cerebrovascular and neurodegenerative diseases [7]. These factors include: the number of calories consumed, the composition and quality of nutrition, the presence of bad habits, physical and cognitive activity, social activity, the use of technical innovations for social communications, maintaining an active emotional life and controlling the negative impact of stressful life events, etc.. At the same time, there are many studies showing that an active, cognitive, rational lifestyle leads to a reduction in the risk of cognitive impairment and dementia [8, 9, 10].
Therefore, the identification of modifiable factors that predispose and aggravate cognitive dysfunction in patients with AH is currently relevant.
Objective: to study the state of cognitive functions and psychoemotional status depending on lifestyle factors, such as smoking, nutrition, use of alcohol, in patients with AH.
Material and methods.
We examined 102 patients with AH stage II who did not receive antihypertensive therapy or were treated irregularly (without achieving target arterial blood pressure levels) at the age of 49.84 ± 0.83 years. 40.2% of AH patients had grade 2, 59.8% had grade 3, and the average duration of the disease was 8.78 ± 0.60 years.
To assess cognitive functions, the Montreal Evaluation Scale (MoCA- test) was used, which is recommended by most experts in the field of cognitive impairment for broad use in everyday clinical practice. The system of formalized assessment of the MoCA-test does not provide for a gradation in terms of the severity of the violations, depending on the scores scored (26 points or more are considered normal) [11]. The level
* p <0.05
With a more detailed analysis of the results, it can be noted that the absence of depression was noted in 39.6% of the patients of the first group and 38.9% of the second group. In people who prefer healthier food, mild reactive anxiety was noted in 45.8%, moderate -43.8%, severe - 10.4% of patients. In the second group, severe anxiety was noted in 37.05%, moderate in 37.05%, and mild in only 25.9% of patients (p <0.05 for all levels of anxiety, respectively, in groups). On the MoCA-test scale: cognitive dysfunction was detected in 77.8 0% of patients of the second group and 18.5% of the first (p <0.05). Thus, a larger number of people
of reactive anxiety was determined using the Spiel-berger questionnaire (up to 30 points - low anxiety, 3045 points - moderate, 46 and higher - high anxiety) [12]. To assess the severity of depression, the Beck- depression scale was used (scores less than 11 - no depression, 11-18 points - subclinical depression, 19-25 points -mild depression, 26-30 points - mild depression, more than 30 points - severe depression) [13].
The diagnosis of essential hypertension was established according to the recommendations of the European Society of Cardiology and of the European Society of Hypertension [14]. The level of blood pressure was assessed in the office measurement and 24-hour blood pressure monitoring. The study did not include patients who underwent craniocerebral trauma, with a permanent form of atrial fibrillation, chronic obstructive pulmonary diseases (respiratory failure of grade 23), coronary heart disease, diabetes mellitus, severe liver, kidney impairment, obesity.
The research study is performed in accordance with the provisions of Council of Europe Convention for Protection of Human Rights and biomedicine. Statistical processing of the results of the study was carried out using the computer program "IBM SPSS Statistics 22".
Results
Food. According to the nature of nutrition, which was determined by questioning, the patients were divided into two groups: the 1st group, who preferred healthier food (fish, vegetables, fruits and a limited amount of meat) and the 2nd group, who preferred meat, sweets, and few plant products. Characteristics of patients are presented in Table I. Patients were similar in terms of age, duration of AH, mean daily blood pressure level according to the results of 24-hour blood pressure monitoring. Analyzing the results of psy-choemotional tests and cognitive function according to the overall score (Table I), a greater degree of anxiety and a greater degree of cognitive dysfunction were noted in the 2nd group of patients on the MoCA -test scale (p <0.05).
Table I
who prefer less healthy food have moderate and severe reactive anxiety, cognitive dysfunction.
Alcohol consumption. By the number of alcohol consumed per day, which was determined by questioning, the patients were divided into three groups depending on the doses (one dose = 25 ml of vodka or the equivalent amount of wine or beer). The first group did not use of alcohol or not more than 2 doses, the second - up to 4 doses (moderate consumption), the third -more than 5 doses per day (abuse). The main characteristics of the group differed only in the duration of AH, and there were more men in the group of alcohol abusers (Table II).
The indicators of the psychoemotional sphere and the cognitive function, depending on nutrition
Indicators, units of measurement Groups
1st group (n=48) 2nd group (n=54)
Beck scale, scores 12,71±0,99 12,13± 0,76
Test of Spielberger, scores 31,67±1,34 38,46±1,69*
MoCA test, scores 27,23±0,21 23,32±0,42*
Table ll
Characteristics of patients depending on the frequency of alcohol use
Indicators, units of measure- Groups
ment 1st group 2nd group 3rd group
(n=30) (n=30) (n=42)
Age, years 51,27±1,41 48,40±1,71 49,86±1,27
Sex, m/f 13/17 13/17 35/7
Body mass index, kg /m2 27,22±0,82 29,20±0,66 28,83±0,60
Duration of the disease, years 10,07±1,32 6,75±0,840 9,31±0,89*
average SBP, mmHg 139,77± 2,80 138,80±2,51 138,71±2,32
average DBP, mmHg 86,50±1,92 87,00±1,74 85,31±1,82
* p <0.05 when comparing groups 2 and 3; ◊ p <0.05 when comparing groups 1 and 2
At the general estimation of points, it is established (Table III), that authentic differences were available only on MoCA-test scale at persons of the third
■ p <0.05 when comparing groups 1 and 2; * p <0.05 when comparing groups 1 and 3
Attention is drawn to the fact that the absence of depression was least noticed in people who abused alcohol, and was noted in 43.3%, 43.3% and 33.3% of patients (p <0.05 when comparing groups 1 and 3 and comparison of groups 2 and 3, respectively). Mild anxiety was noted in 36.7% of patients of the 1st group, 46.7% in the 2nd group, and 26.2% in the third group of patients (p <0.05 in comparison of groups 1 and 2 and in comparison of 2 and 3 group, respectively). Thus, among the alcohol abusers, there were more people with depression and fewer with mild reactive anxiety, and those with cognitive impairment prevailed, with moderate alcohol consumption there were more people with mild anxiety.
■ p <0.05 when comparing 1 and 3 groups, * p <0.05 when comparing 2 and 3 groups, ° p <0.05 when comparing 1 and 2 groups.
Absence of depression was revealed in 43.1% of patients of the 1st group, 60.0% of the 2nd and 25.0% of the 3rd group (p <0.05, respectively between the 2nd
group. Moreover, in the first and second groups, cognitive impairment was noted in 23.3% and 26.7% of patients, respectively, and in cases of alcohol abuse, 88.1% of patients had impairment (p <0.05, respectively).
Tobacco smoking. By the number of cigarettes smoked per day, the patients were divided into three groups: the first group did not smoke, the second -smoked up to 1 pack, the third - smoked more than 1 pack of cigarettes (heavy smokers). Patients were comparable in age, duration of AH, mean daily blood pressure level by the results of 24-hour blood pressure monitoring. For all groups of patients (Table IV), with an overall score, the level of reactive anxiety and the degree of depression did not have a statistically significant difference (p> 0.05). Cognitive impairment was more pronounced in smoking groups (p <0.05). Cognitive impairment in groups according to the MoCA-test scale was detected in 31.7%, 40.0% and 70.8% of patients, (p <0.05 when comparing 1 and 3 groups and comparing 2 and 3 groups).
and 1st groups, the 2nd and the 3rd group). Severe and moderate reactive anxiety in 69.9% of patients of the 1st, 33.4%, 2nd and 56.7 3rd groups (p <0.05, respectively between the 2nd and 1st groups and 2- Th and 3rd groups). Thus, the best psychoemotional back-
Table lll
Influence of alcohol use frequency on indicators of psychoemotional status and cognitive funtion
Indicators, unit of measure- Groups
ment 1st group 2nd group 3rd group
(n=30) (n=30) (n=42)
Beck scale, scores 12,33±1,27 12,27±1,19 12,55±0,84
Test of Spielberger, scores 34,07±2,05 33,60±1,95 37,31±1,90
MoCA -test, scores 26,77±0,47 26,37±0,24 23,50±0,53*^
Table IV
Comparative characteristics of the indicators of the psychoemotional sphere and cognitive function in
nonsmokers and smokers
Indicators, units of measure- Groups
ment 1st group 2nd group 3rd group
(n=30) (n=30) (n=42)
Beck scale, scores 12,13±0,76 11,80±1,53 13,50±1,38
Test of Spielberger, scores 36,03 ±1,55 32,07±3,00 35,25±1,95
McNair memory self-evalua- 23,619±1,39 27,27±2,65° 35,71±1,92^*
tion questionnaire, scores
MoCA-test, scores 26,31±0,21 25,53±0,78 24,00±0,56-
ground was detected with moderate smoking, and cognitive impairment was much more frequent among heavy smokers. As we found, in the group of persons who did not have a preference for healthy eating, the percentage of smokers was higher by 17.5%, who consumed alcohol by 39%.
Discussion While the nature of nutrition, alcohol consumption and smoking - lifestyle factors - are potentially variable, the mechanisms through which they have a negative effect on the deepening of violations of cognitive functions have not been studied in detail. And information about the effects of various aspects of the diet (including various nutrients and vitamins, food or food groups) on reducing the risk of cognitive impairment is limited and contradictory. Most likely, in our opinion, this is due to the fact that the results may not be entirely accurate, since the consumption of certain products was assessed by questionnaires (questionnaires). And only adherence to the traditional Mediterranean diet, including whole grains, fruits, vegetables, fish and meat restriction, has a more convincing evidence base, indicating the possibility of counteracting the decline of cognitive functions [15, 16]. In our study, in patients with AH with a commitment to a more rational, healthy diet, the incidence of cognitive impairment was 4.2 times less than in those who were indiscriminate in nutrition, in 18.5% of patients. It should be understood that the nature of the diet often depends on other lifestyle factors and demographic variables that can also influence the extent and direction of its impact on cognitive functions [17, 18]. And first of all it concerns the use of alcohol and smoking.
We found that consumption of high doses of alcohol increases the disruption of cognitive functions. So in alcohol abusing alcoholic beverages were found in 3.3 times more often. This is consistent with a large-scale observation (40,435 people for 27 years) who showed that frequent alcohol consumption, but not abstinence from alcohol, is associated with an increased risk of cognitive impairment up to dementia [19]. At the same time, moderate alcohol consumption is consistently associated with a less severe decrease in cognitive functions [20]. Sufficient data based on a systematic review of meta-analyzes and controlled randomized studies proved the role of smoking in increasing the risk of developing cognitive impairment [21, 22, 23, 24]. Our study also shows that smoking with AH is associated with cognitive impairment. If non-smokers were found only in 31.7% of patients, then smokers met 2.2 times more often.
The impact of any one lifestyle factor on cognitive impairment seems to be strong enough. And prolonged and constant interaction throughout life can accumulate and exert additional or synergistic value, especially against the background of a risk factor such as AH [25]. Moreover, those who did not have a preference for healthy eating also have other bad habits, like smoking and alcohol abuse. The obtained data on the same occurrence of more severe AH during hypertensive crisis with abstinence and alcohol abuse, as well as in non-smokers and heavy smokers, can not be interpreted as usefulness of these habits, as further consequences are unpredictable and not always unambiguous. Despite
the fact that there are indirect studies showing that alcohol and tobacco use are associated with a higher risk of developing dementia [25].
As a result of the analysis of the current state of data on risk factors and the associated decline in cognitive functions, it is clear that there are still many unresolved issues and considerable uncertainty regarding the relationship between individual risk factors and cognitive impairment (eg, to what extent there is a cause-effect relationship) . These issues require further study and analysis. Thus, given that most of the above cardiovascular risk factors are interrelated and included in the general concept of a healthy lifestyle. By focusing on one of the factors of a lifestyle or health, we can not sufficiently influence the reduction in the risk of development and progression of cognitive impairment in AH. Therefore, the most effective strategy in solving this problem can be with simultaneous exposure to several risk factors, including necessarily and effective treatment of AH.
Conclusions.
1. In patients with AH stage II who did not receive antihypertensive therapy or were treated irregularly in the presence of lifestyle factors such as a lack of preferences for rational nutrition, alcohol abuse, and smoking, cognitive impairment is found 2.2-4.2 times more often.
2. Among those who did not have a preference for healthy eating, the share of smokers was higher by 17.5%, who consumed alcohol by 39%.
3. In the presence of lifestyle factors such as a lack of preference for rational nutrition, alcohol abuse, heavy smokers in a larger number of patients with stage II AH, there was a violation of the psychoemotional sphere.
Conflicts of Interest: None.
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Markovskyi V.D.
Doctor of medicine, professor the department of pathological anatomy Kharkiv National Medical University.
Zvereva I.S.
PhD student in Kharkiv National Medical University Марковский Владимир Дмитриевич доктор медицинских наук, профессор кафедры патологической анатомии Харьковского национального медицинского университета Зверева Ирина Сергеевна
заочный аспирант кафедры патологической анатомии Харьковского национального медицинского
университета
IMPACT OF MATERNAL INFECTION CAUSED BY KLEBSIELLA PNEUMONIAE ON MORPHOLOGICAL STATE OF OFFSPRINGS' PULMONARY ARTERY (EXPERIMENTAL
STUDY).
ВЛИЯНИЕ МАТЕРИНСКОЙ ИНФЕКЦИИ ВЫЗВАННОЙ KLEBSIELLA PNEUMONIAE НА МОРФОЛОГИЧЕСКОЕ СОСТОЯНИЕ ЛЕГОЧНОЙ АРТЕРИИ ПОТОМСТВА (ЭКСПЕРИМЕНТАЛЬНОЕ ИССЛЕДОВАНИЕ).
