INTRODUCTION:

In 1997, Peterson introduced the concept of Mild cognitive impairment (MCI), and defined it as a syndrome in which an individual's cognitive deterioration is higher than predicted for his/ her age and education level, but does not significantly impede with everyday tasks.¹ Whereas in dementia deterioration in mental capacities and cognitive processes (primarily decline in memory and thinking), severe enough to impair activities of daily living (ADL).²

Dementia prevalence is anticipated to expand exponentially in developing nations as people live longer and risk factors such as hypertension and stroke become more prevalent.³ With 4.1 million dementia patients, India is in third place globally, only behind the 4.2 million Americans and more than 9 million Chinese.⁴ People with MCI are at 10 times higher risk of developing dementia than cognitively healthy older adults, with estimated rates of conversion to dementia of 12% in 1 year 20% over 3 years⁵ and 50% at 5 years.⁵ Dementia have an astounding economic burden on society with an estimated rise of 2 trillion US$ by 2030.⁴ Therefore identifying dementia at an early stage (viz. MCI) is gaining concern especially for developing countries with inhomogeneous health coverage.

Hypertension (HTN) ranks third in importance for assignable disease burden in South Asia.⁶ We know that to address the dementia problem, both neural and vascular preventive strategies are required⁷ and hypertension plays a critical role in vascular health, making it a significant risk factor for developing MCI⁸ as well as dementia. Studies show that midlife hypertension is linked to late-life dementia (a decade later).⁷ The majority of data on the relationship between hypertension and CI are of European or American ancestry,⁹adjusting for risk factors reduced but did not eliminate disparities.¹⁰ Results for one ethnic group may not necessarily valid for other.^10-12 The studies related to association of hypertension and dementia/cognitive impairment have equivocal results, concluding both positive^5,11-15 and no/negative association^{16- 20} thus needs more investigation, especially in scarcely studied and vulnerable Indian subjects.

About 70% of Americans aged 60 and older have hypertension, and 15 to 18 million people in this age range are expected to have dementia by 2050.⁸ As per estimates HTN will affect 22.9 percent of Indian men and 23.6 percent of Indian women by 2025.²¹ About 63% of older Indians are prevalent to HTN.²⁰ According to a meta-analysis, hypertension affects 33 percent of people in urban areas and 25 percent of those in rural areas in India. Two-thirds of older Indian adults have hypertension, with the majority of cases going undetected or being poorly managed.²⁰

Serum creatinine levels were also measured, as serum creatinine had been linked to late-life incidence all-cause dementia.²²The two functional ACE gene variants namely rs1800764 and rs42915 are most significantly associated with increased angiotensin-converting enzyme activity. They also have an impact on cognitive decline risk and age of beginning of the amnestic phenotype of dementia caused by Alzheimer's disease. While the usage of ACE inhibitors was protective against changes in creatinine, each A allele of rs42915 caused an annual rise in creatinine of 0.044mg/dL.²³Preventing dementia to become an unchecked epidemic we must focus on submerged part of the iceberg, means identifying patients at risk of progressing from MCI to AD is critically essential. The current investigation aims to substantiate the equivocal cognitive impairment and hypertension association in Indian community. The current study enrolled participants high risk group subjects, such as aged with HTN and screened for MCI (a transitional phase in dementia development). Further investigate the role of compliance towards antihypertensive medicines in prevention of dementia development.

MATERIALS AND METHODS:

The above reported study was carried out at renowned hospitals located in northern part of India. In these hospitals patients mainly visits from Haryana, Punjab and Rajasthan states. The study is retro-prospective cohort and was approved by the Institutional Ethical Committee (Approval No. PTY/2017/484). The informed consent was obtained which clearly states purpose of study and that the participation was voluntary.

The study criteria included recruitment of subjects having age ≥50 years and pre diagnosed hypertension ≥ 5 years and do not meet the diagnostic criteria for dementia as defined by ICD-10.²Participants with past history of any reversible cause of dementia (vitamin B 12 insufficiency, hypothyroidism, or neuro-infections producing dementia) or with history of diabetes, AIDS, tuberculosis, stroke, tumor; Patients with history of kidney transplant or receiving any form of dialytic therapy were excluded.

To verify the above criteria, we retrospectively analyzed past prescriptions and medical records. Duration of hypertension and whether subjects were complaint with prescribed medication was also determined. Two blood pressure measurements were taken and their average was used in the study. GHQ (General Health Questionnaire) and BDS (Blessed Dementia Scale) were also applied as screening device for identifying minor psychiatric disorders and to assess activities of daily living respectively. The subjects were screened for MCI by using MMSE (Mini Mental State Examination) and MoCA/ MoCA-B (Montreal Cognitive Assessment/ Montreal Cognitive Assessment- Basic), under the proper guidance of the experts that was Neuro-Psychiatrist (MBBS, MD Psychiatry), Physicians (MBBS, MD Internal Medicine), Clinical Psychologist and Pharmacologist (PhD- Pharmacology).In prospective part of study, we followed up subjects for a mean duration of 28. 69±11.85 months and screened using above mentioned neuropsychological test for progression to dementia. Details of the prospective study will be given in a subsequent publication.

Study population had 168 participants and was divided into two groups. Group H was hypertensive patients (n=138), further divided into sub-groups: group Hc (hypertensives with compliance to Antihypertensive drugs; n=74); group Hnc (hypertensives with non-compliance; n=64). Group NT included normotensive subjects (n=30). According to Goldstein FC 2013, subjects having readings of SBP <140 mmHg and DBP <90mmHg were considered normotensive.¹³ High BP was defined as SBP ≥ 140mmHg or DBP ≥ 90mmHg on two or three occasions.¹³ Two-thirds of older Indians had HTN, with the majority undiagnosed or diagnosed but not adequately controlled.²⁰ Subjects in the noncompliance group had either diagnosed but uncontrolled HTN or undiagnosed hypertension ²⁰[defined as hypertensive BP measurements (from approx. 5yrs or more) but no physician diagnosis]. Screening in present investigation was further substantiated by various cognitive domain specific tests described below.

All of the information gathered was recorded into a pre- designed case record form, which contained the patient’s demographics, educational level, comprehensive scores of all cognitive tests administered, medicines prescribed, and co-morbid conditions.

Screening tests:

Blessed dementia scale (BDS) we used a modified version of the informant-derived Blessed Dementia Scale (BDS) to determine changes in ADL. ²⁴ BDS is only used to screen subjects for inclusion criteria, which state that patients must be dementia free and their daily living activities must be intact.

MMSE- a simplified version of the cognitive mental status assessment with eleven questions, which takes 5-10 minutes to conduct and yields a total score of 30. It concentrates only on the cognitive aspects of mental functions. ²⁵ In this study a cut off score ≤23 was used. ⁵

MoCA version 8.1 and MoCA –B was created as a quick screening tool to detect MCI. It is a paper-pencil tool with a total score of 30 points that takes around 10 minutes to administer. MoCA-B was developed to identify MCI in those with low levels of education or illiterate. Time to administer the MoCA-B is approximately 15 minutes. A cut off of < 26 was used. In accordance with education level of the patients, the MoCA scale scores are adjusted. ²⁶Both available online in Hindi language on www.mocatest.org.

Cognitive domain specific tests:

The tests below were selected in accordance with the ICD-10 diagnostic criteria for MCI, which specify that the predominant symptom is deterioration in cognitive performance, which mostly comprises memory loss, learning difficulty, or concentration issues.²BVRT - used to assess memory of nonverbal information. Individual participants are presented one or more visual designs (example simple geometric figures) and then asked to recall the design by drawing it.²⁷DST backward- It’s a tool for evaluating working memory. The patient was given a string of numbers and instructed to repeat the numbers backward. This task is repeated until the examinee either fails to repeat a pair of sequences or correctly repeats the highest sequence.²⁸ TMT A used to assess attention, had a score card with 29 sec (average score) and >78 sec (deficient in cognition).^11,29

STATISTICAL ANALYSIS:

Data was coded and compiled using Microsoft Excel sheets. IBM (Armonk, NY) SPSS software version 25.0 was used for the analysis. Range, frequency, percentage, mean, and standard deviation were used in the descriptive analysis. One way ANOVA and Krushal wallis ANOVA were used for parametric and non- parametric variables respectively. Chi square test was used for categorical variable. Pearson correlation was used to calculate correlation coefficient. Hazard Ratio (HR) was also calculated for survival analysis.

RESULTS:

Demographic parameter Mean age of the population was 59.92±8.52 years. Mean age of the subjects of group Hc+MCI (compliant hypertensives with MCI) was 64.92± 6.62 years with range of 54-80yrs, while that of group Hnc+MCI (non-compliant hypertensives with MCI) was 60.91±9.13yrs with range of 50-85yrs. Baseline readings of various study parameters of the population were illustrated in table 1.

Mean of formal education for study population was 6.57 years with 34.5% illiterates. Table 2 describes incidence of MCI in group H (hypertension group), on the basis of age, gender, education status and compliance. Further division of mean years of formal education for group Hc+ MCI was 3.95 yrs. and for Hc+ no MCI (compliant hypertensives+ no MCI) was 9.66yrs. Similarly, for Hnc+ MCI subjects was 4.13 yrs and for group Hnc+ no MCI (non-compliant hypertensives+ no MCI) subjects was 9.33yrs. Considering the BDS score except 5 participants (whose score was 0.5), remaining all participants scored a “zero”.

MMSE and MoCA Score A total 11.90% of the population had a MMSE score ≤23. Considering about the Montreal Cognitive Assessment test 72% of the population had score <26. Table 3 depicted a comprehensive illustration of various study parameters based on distinct study groups. The current study displays a statistically significant relationship between gender and education (p<0.001), males were more educated than females as per Pearson’s correlation coefficient. Likewise, males scored significantly more in MMSE (p=0.032) and MoCA (p= 0.053) test. Out of 355 hypertensive subjects screened, 168 participants were enrolled and 121 subjects were screened positive for MCI. Rest of the subjects were excluded due to one or more reason; diabetes was the most common cause of exclusion (Figure 1).

Hypertensive group from 138 retrospectively diagnosed hypertension patients, 46.38% (64) were those who didn’t show compliance with the prescribed anti-hypertensive drugs and 53.62% (74) were those who followed the prescription and showed compliance. Non-complaint group subjects were having high blood pressure as self- reported or from the history with a prescription, which they follow sporadically. In compliant group subjects had a diagnosed HTN and shows compliance towards the prescribed Antihypertensives.

Prevalence of MCI in compliance group (Hc) was 48.65% (95% CI: 0.369 to 0.606) and 85.94% (95% CI: 0.75 to 0.93) in non- compliance group (Hnc) (HR= 0.57, p<0.001). A significant higher mean MMSE score (table 3) for Hc group than Hnc group was observed (p<0.001). Likewise, for MoCA score (table 3) a significant higher mean was observed for Hc than both group Hnc (p<0.001) and group NT (p<0.001).

Table 1: Baseline data of factors associated with cognitive impairment of the study population.

Various study parameters	Baseline Readings (n=168)
Socio- demographic characteristics
Age (years)^α	59.92± 852
Females (%) ^β	54.8
Education (years)^α	6.57
Locality/ Family type^β Rural/Joint Rural/ Nuclear Urban/ Joint Urban/ Nuclear	46.4 (78) 11.30 (19) 26.80 (45) 15.5 (26)
Occupation^β Farming Unskilled Worker Skilled Worker Retired from employment Business Other Homemaker	8.3 (14) 5.4 (9) 22 (37) 6 (10) 4.8 (8) 10.1 (17) 43.5 (73)
Lifestyle Factors
Smoking Status (%) ^β Current Smoker Former Smoker	3.38 8.11
Alcohol/ Substance abuse (%) ^β Current Consumer Former Consumer	2.03 1.35
Clinical Characteristics
Mean SBP^α	146.40± 19.85
Mean DBP	88.23± 9.79
Duration of HTN (years)^α	6.83± 3.34
S. Cholesterol^α	151.50± 16.77
HDL^α	44.46± 6.89
S. Creatinine^α	1.10± 0.72
B. Urea^α	30.51± 7.79
Cognition Assessment
MMSE Score^α Mean± SD Range ≤23 (%)	26.55± 2.48 18- 30 11.90
MoCA Score^α Mean± SD Range < 26 (%)	23.52± 3.10 13- 30 72
TMT A Score^α Mean± SD Range	37.92± 11.10 21-66
BVRT Score^β Positive Score	42.9
DS backward (levels in %)^β Level 0 Level 3 Level 4 Level 5 Level 6 Level 7	23.4 48.3 19.3 8.3 0.0 0.7

Data is expressed by mean± Standard deviation (SD). Abbreviations: SBP (Systolic Blood Pressure), DBP (Diastolic Blood Pressure), HTN (hypertension), MMSE (Mini Mental State Examination), SD (Standard Deviation), MoCA (Montreal Cognitive Assessment), TMT A (Trial Making Test- part A), BVRT (Benton’s Visual Retention Test), DS (Digit Span); P< 0.05; α = Independent samples T-test ; β= Chi square test

Table 2: Incidence rate of MCI, according to age, sex, education and compliance for anti-hypertensive drugs investigated in group H (subjects with Hypertension).

Age (yrs)	% Of MCI diagnosed subjects		% Of MCI diagnosed subjects		Level of education	% Of MCI diagnosed subjects
Age (yrs)	Male	Female	Group Hc	Group Hnc	Level of education	Group Hc	Group Hnc
49-60	20.83	31.94	27.02	80	Illiterate	88.60	93.75
61-70	32.69	50	75.86	91	Primary	58.33	88.88
71-80	50	25	62.5	100	Upper primary + secondary	27.27	81.81
81-85	100	0	…	100	Higher secondary	33.33	50
Overall gender specific rate	28.99	37.68			Graduate	18.18	100
Overall gender specific rate	28.99	37.68			Post graduate	23.33	…

Abbreviations: MCI (Mild Cognitive Impairment), Hc (Hypertensive patient’s complaint to antihypertensive medicines), Hnc (Hypertensive patient’s non-complaint to antihypertensive medicines).

Table 3. To study the significance level of cognition related parameters in various study groups [hypertensive cohort (sub group Hc and Hnc) and normotensive subjects (group NT)].

Study parameter	Hypertensive Cohort Sub-group Hc Sub-group (n=74) Hnc (n=64)		Group NT (n=30)	pvalue (Hc vs Hnc)	pvalue (Hc vs NT)	pvalue (Hnc vs NT)
Age ^α (year) Range	61.41±8.27 50-80	60.25 ±8.77 50- 85	55.53 ±7.32 49-76	0.650	0.004	0.037
Education (years)^α	6.88± 5.73	5.06± 5.61	8.93± 5.95	0.154	0.225	0.007
Mean SBP^α	153.45± 17.88	150.34±15.95	120.63±8.04	0.485	<0.001	<0.001
Mean DBP ^α	90.49± 10.56	90.14± 7.95	78.57±4.01	0.971	<0.001	<0.001
Duration of HTN^β (years) Range	7.62±3.43 5- 20	5.92± 3.03 5- 18	---- ----	0.003	----	----
MMSE Score ^β (Mean± SD ) Range ≤23 (%)	27.30 ± 1.9 18- 30 2.70	25.53 ± 2.54 18- 30 21.88	26.87± 2.93 19- 30 13.33	<0.001	1.00	0.003
MoCA Score ^β (Mean± SD ) Range < 26 (%)	24.93 ± 2.42 18-30 49.9	22.39± 3.28 13-29 85.94	22.40± 2.80^* 15- 25 100	<0.001	<0.001	1.00
TMT A score^α (Mean± SD) Range (in seconds	38.18± 10.95 23- 61	44.62± 7.49 36- 66	29.78± 4.41 24-39	0.031	0.025	<0.001
S. cholesterol ^β (mg%)	148.98± 16.20	158.40± 18.41	151.70± 13.57	0.002	0.419	0.079
HDL^α(mg%)	45.36± 5.35	48.50± 8.22	39.20± 5.49	0.132	0.243	.004
B. Urea	31.83± 8.28	27.47± 5.97	---
S. creatinine (mg/dl)^β	1.19± 0.91	1.07± 0.22	0.96± 0.07	0.07	0.07	----

Data is expressed by mean± Standard deviation (SD). Abbreviation: SBP (Systolic Blood Pressure), DBP (Diastolic Blood Pressure), HTN (hypertension), MMSE (Mini Mental State Examination), SD (Standard Deviation), MoCA (Montreal Cognitive Assessment), TMT A (Trial Making Test- part A), HDL (High Density Lipoprotein); P< 0.05; α = One way ANOVA followed by Tukey HSD test.; β= Krushal wallis ANOVA followed by Bonferroni test.

Table 4: Significance level determination of various categorical variables between study groups using chi- square test.

Variables		Group Hc	Group Hnc	Group NT	P value
Gender	Males n (%) Females n(%)	34(45.9) 40 (54.1)	32 (50) 32 (50)	10(33.3) 20(66.7)	0.314
Locality/family type (%)	Rural/Joint Rural/ Nuclear Urban/Joint Urban/Nuclear	43.2	59.4	26.7	.066
		9.5	10.9	16.7
		32.4	18.8	30.0
		14.9	10.9	26.7
Occupation	Farming	8.1	9.4	6.7	.001
	Unskilled Worker	2.7	7.8	6.7
	Skilled Worker	20.3	9.4	53.3
	Retired from employment	2.7	7.8	10.0
	Business	6.8	4.7	0.0
	Other	8.1	17.2	0.0
	Homemaker	51.4	43.8	23.3
DS	Level 0	19.7	32.7	16	.204
	Level 3	43.7	49	60
	Level 4	21.1	16.3	20
	Level 5	14.1	2	4
	Level 6	1.4	0	0
BVRT	Positive score (%)	50	28.1	56.7	.003

Table 5: Mean scores of various cognitive domains of Montreal cognitive assessment (both MoCA and MoCA- B were used in the study population)

Cognitive Domains Sub Tests included	Memory Delayed recall	Executive Trail making test	Language Naming of animals Fluency Sentence repetition	Attention Digit span Serial 7s Vigilance Calculation	Education in years (Mean± SD)
Full marks	5	1	6	6
Compliance without MCI (Hc + no MCI)	4.24 ± .91	.45 ± .50	5.30 ± .61	5.47 ± .68	9.66± 4.80
No compliance without MCI (Hnc + no MCI)	4.11± .78	.67 ± .50	5.22 ± .67	5.56 ± .88	9.33± 5.87
Normotensive with MCI (NT)	3.39 ± 1.07	.39 ± .49	5.14 ± .89	4.79 ± 1.315	8.93± 5.95
Compliance with MCI (Hc +MCI)	3.56 ± 1.45	.20± .38	4.67 ± .80	4.14 ± 1.40	3.95± 5.19
No compliance with MCI (Hnc+ MCI)	3.46 ± 1.15	.18 ± .39	4.64 ± .90	3.54 ±1.57	4.13± 5.30

Data is expressed by mean± Standard deviation (SD). p< 0.05 (for group Hc+ no MCI V$ group Hc+ MCI and Hnc+ MCI). p< 0.01 (for group Hc+ no MCI V$ group NT) for memory and attention domain.

DISCUSSION:

As dementia has been reported as early as age 50 years ¹⁵ our study enrolled subjects at age ≥ 50. The study population is pre- geriatric with mean age of 59.92± 8.52 years¹⁵ and unlikely most of the studies.^5,12,30Advancing age act as a major risk factor for AD (Alzheimer’s Disease).³¹ A rise can be seen in percentage share of India’s population ages above 60 years from 8 percent in 2010 to 19 percent in 2050. ³²In the current study 46.38% participants did not show compliance to Antihypertensives treatment which is similar (48.7%) in previous studies.³⁰ The present study had a female dominated population (M/F Ratio=19/23) ²⁵ and females found to be more prone of being diagnosed with MCI (Table 2). Women education in India is miserable still hovering at 65% and this rate was just 15% in 1961.³⁴ In the present investigation mean years of education for males was 8.76 years and that of females was 4.73 years. 34.5% of the total participants were illiterate, 52% of women subjects were illiterate whereas men population has an illiteracy rate of 15.79%. Thus, it can be asserted that illiteracy and lack of education were important factors for poor compliance in this study.³⁰

The present investigation similarly showed uniform results, as shown in Table 2, for incident MCI ⁵, where age was determined to be a risk factor and education to be protective. At a similar education level if we look at the mean age of the MCI subjects of non- compliance group (mean education = 4.13 years) was 60.91±9.13 years and of compliance group (mean education = 3.95yrs) was 64.92±6.62yrs. After adjusting for education, and gender, as well as excluding other contributing factors (as described in exclusion criteria) which could be confounding, the results shows that Hnc subjects had 43% (HR: 0.57, p<0.001) increased risk of MCI prevalence than Hc group that too at an early age. This suggests that noncompliant subjects are more likely to develop MCI early in life and, eventually may lead to dementia. It can be asserted that Antihypertensives appear to protect against the development of cognitive impairment. According to previous studies, therapies capable of postponing the onset of Alzheimer's disease by one year would lower prevalence by 7% in ten years and 9% in thirty years, whereas delaying the onset by five years would reduce prevalence by 40% in ten years and nearly 50% in thirty years.

Many studies have found a considerable impact of vascular factors (such as HTN) to dementia,^5,11-15 while others have found to have inconsistent or negative results.^16-20 The current study supported an association between hypertension and risk of cognitive impairment. Various earlier studies investigated different duration of hypertension like 2 years,¹³ some with mean duration of 8.76 ±4.35yrs,³⁰ 6.7±5.8 years³⁵whereas present study had participants with mean duration of HTN = 6.83± 3.34 yrs. MCI incident rates in the Hnc and Hc groups were respectively determined to be 85.94% and 48.65%. This states that hypertensive patients without compliance to antihypertensive drugs are twice more prevalent of developing MCI as compared with compliance group. From different regions of the world, the prevalence of MCI reported varies widely between 3% and 42% ³⁶ whereas various Indian studies reports a rate between 15% and 33%.^15,37Total prevalence rate in present study was 65.94%³⁵cause of this high prevalence rate may be predominance of various earlier reported predisposing risk factors for MCI viz. HTN,¹³advancing age, female gender, illiteracy.^35,15,38According to the available data, compliance³⁰ (Table 2) to antihypertensive medicines as an important predisposing factor which also seems to be neuroprotective.^11,12,39 Pre –clinical studies suggest that ARBs may have AD modifying effect and may be neuroprotective via different mechanism like candesartan³⁹-prevention of glutamate upregulation or downregulation, telmisartan⁴⁰ -neuroprotective effect via PPAR stimulating activity or valsartan⁴¹ -lowers brain β amyloid protein levels. The present study may conclude ARBs as neuroprotective as 45% of compliance group participants are prescribed by ARBs with a significantly better MMSE and MoCA scores.

At a cutoff score 26, the MMSE had a sensitivity of 18 % to detect MCI and 78% to detect mild AD with a 100% specificity, whereas MoCA detected 90% of MCI subjects and in the mild AD group it detected 100%. Specificity was 87% for both,²⁶ we had used a cut off score ≤23 for MMSE.²⁵The validity of the MoCA in detecting MCI in individuals with AD and other diseases in cognitively impaired patients who scored in the normal range on the MMSE has been proven. The MoCA score of 26 or higher considered as normal. If we look at the means of MMSE score and of MoCA score (Table 3) it can be seen a noticeable higher mean of group Hc than of both group Hnc and group NT. The above results conclude that HTN is a risk factor for MCI ¹³ and points in direction of neuroprotective role of antihypertensive medicines.^11,12 Statistical significances of above results can be seen in Table 3.

TMT-A was used to assess attention by the number of seconds needed to sequence numbers using a pencil (Table 3).^11,13 Regarding DS-backward score, the compliance group had the longest repeated sequence of 6 (level 6) while Hnc or NT group subjects scored maximum up to level 5 (Table4).^11,13 BVRT records either a yes or no response. In group Hc 50% subjects responded a “yes” while group Hnc reported 28.1% responded a “yes”. Analyzing the scores of BVRT, DS, TMT-A exhibits that compliance towards antihypertensive drugs is necessary for a better cognitive performance. DS scoring points towards a neuroprotective role of anti-hypertensive drugs as only compliance group scored up to level 6 with no “zero” score in subjects of group Hc+ no MCI. No significant difference (p=0.07, 95% CI: -0.019 to 0.375) for serum creatinine values between compliance and non-compliance group was observed, this could be because the current study excluded CKD subjects and earlier reports state that older people with vascular burden, only chronic kidney disease (CKD stage 4), but not mild to modest kidney disease (CKD stage 3a and b), seem to be associated with cognitive impairment at baseline and cognitive decline over time.⁴²

The current study emphasizes the significance of adherence to antihypertension medications in lowering the prevalence of cognitive impairment in a susceptible cohort of elderly hypertensive participants and further demonstrating a neuroprotective role of antihypertensive medications.⁴⁰ In the lack of disease modifying pharmacotherapeutics options, the prevalence of dementia may be decreased by controlling the risk factors by showing compliance to the prescribed medications and by diagnosing the dementia in their earlier stages (viz. MCI). According to our knowledge, this study is the first from north- west India to integrate all the aforementioned cognitive evaluation tests and investigate the neuroprotective effects of compliance to antihypertensive medication. To reduce the sampling errors, we have selected a less variable population. Above study focused on hypertension, and tried to exclude other co morbidities. Additionally, rather than a single baseline reading we took average of B.P. measurements as well as past recordings was concerned.

A larger study sample in the future will be helpful as it will give an accurate representation of the entire population under study. Further biochemical markers are needed to be observed to rule out the neuroprotective pathway of Antihypertensives and to find out parameters for early diagnosis of dementia. Future research in this area can be conducted by replicating the current study with other Indian populations.

CONCLUSION:

According to above study, non-compliance with Antihypertensives has a deleterious effect on cognition and doubles the risk of acquiring MCI. Advancing age, female gender and low literacy rate found to be predisposing factors for MCI whereas education and compliance to Antihypertensives was protective.

ACKNOWLEDGEMENT:

The author acknowledges the organizational help and support provided by Dr. Kamal Kishore (MD Medicine) and Dr. Sandeep Suri (MD Medicine). We would also like to thank all participating subjects and caregivers for their cooperation.

CONFLICT OF INTEREST:

None declared.

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Received on 01.02.2024 Modified on 20.05.2024

Research J. Pharm. and Tech 2024; 17(11):5201-5209.

DOI: 10.52711/0974-360X.2024.00796