CONCORDANCE BETWEEN MINI-MENTAL STATE EXAMINATION, MONTREAL COGNITIVE ASSESSMENT AND MEMORY AND EXECUTIVE SCREENING FOR THE ASSESSMENT OF COGNITIVE DECLINE IN HYPERTENSIVE PATIENTS

Abstract

Objective: To study the correlation and concordance between MMSE, MoCA and MES in the evaluation of cognitive impairement in hypertensive patientsDesign and method: We conducted a prospective, multicenter, cross-sectional study including patients over 40 years of age with confirmed essential hypertension for more than 3 years, without prior diagnosis of cognitive decline. All participants underwent neuropsychological assessment using three tests. The cut-offs used to define CI for MMSE, MOCA and MES were scores <24, <26 and<75 respectively. The correlation was analyzed using Pearson correlation coefficient(r). For the concordance study, we calculated Cohen’s Kappa coefficient. Results: We included 256 patients with a mean age of 65±9 years and a gender ratio of 0.77. Assessment of cognitive performance revealed cognitive decline in 40.6% of patients(n=104) by MMSE, 75% of cases(n=192) by MoCA and 80.8% of cases(n=207) by MES. Among the 104 patients who had a cognitivi deficit diagnosed by the MMSE test, no patient had a normal MoCA or MES score. 84.4% of patients(n=76) with mild cognitive impairment diagnosed by MoCA had normal MMSE scores. 88.6% of patients(n=52) with mild cognitive impairment diagnosed by MES had normal MMSE scores. We found a statistically significant positive correlation between MMSE and MoCA (r=0.86, p< 0.001), MMSE and MES (r=0.82, p<0.001) and MoCA and MES (r=0.84, p<0.001)(Figure1). Our study also showed fair agreement between MMSE and MoCA(kappa=0.367), MMSE and MES (kappa=0.275) and substantial agreement between MoCA and MES (kappa=0.627). Conclusions: Cognitive disorders were frequent in hypertensive patients. Our study showed a good correlation between the three tests, a fair agreement between MMSE and MES and a substantial agreement between MoCA and MES. Further studies are needed to validate and include MES in screening for cognitive decline in hypertensive patients in order to define the best tools for early prevention.