JMIR Publications

ABSTRACT

Background:

There is a lack of research on the trajectories of cognitive performance in older people with hypertension, as well as possible contributing factors and correlations between cognitive performance and mental health.

Objective:

We aimed to conduct a nationally representative longitudinal study to investigate changes in the cognitive performance trajectories and associated factors.

Methods:

The data used in our study was retrieved from the Chinese Longitudinal Healthy Longevity Survey (CLHLS). The Chinese version of the Mini-Mental State Examination (C-MMSE) was used to assess cognitive function. The trajectories of hypertensive older individuals' cognitive performance were determined by using group-based trajectory modeling (GBTM). The binary logistic regression analyses were performed to examine how participant factors affected the trajectories of cognitive performance in hypertensive older individuals. The relationships between cognitive performance and mental health were investigated using multivariable linear regression models. Data were analyzed using SPSS 20.0 and Stata 16.0.

Results:

642 old people with hypertension were included. Cognitive performance was categorized into two trajectories according to GBTM: "rapid decline" (48, 7.9%) and "slow decline" (594, 92.1%). Binary logistic regression results showed that hypertensive old adults aged equal to and/or greater than 80 years had an elevated risk of rapid decline in cognitive performance (OR=5.484, 95%CI: 2.365-12.719), and higher score in mental health was the predictor of rapid decline in cognitive performance during the following 13 years (OR=0.918, 95%CI: 0.852-0.988). In the unadjusted model, mental health was positively associated with cognitive performance (β=0.246, 95% CI: 0.125-0.234, P<0.001), and this association was maintained after partial or complete adjustment for covariates (β=0.159, 95% CI: 0.059-0.174, P<0.001; β=0.138, 95% CI: 0.043-0.158, P=0.001). Subgroup analyses by age showed that this positive correlation was only seen in the 60-69 age group (β=0.183, 95% CI: 0.036-0.193, P=0.004), while subgroup analyses by sex revealed that the association between these two indicators was no longer presented among males in the fully adjusted model (β=0.082, 95% CI: -0.024-0.119, P=0.193).

Conclusions:

Our research showed that the decline in cognitive performance is associated with lower mental health and occurs more rapid in older adults with hypertension who are above 80 years of age. Clinical Trial: Data included in the study were retrieved from CLHLS. The CLHLS study was approved by the Research Ethics Committee of Peking University (IRB00001052-13074), and all written informed consent had been obtained from participants or their proxy respondents.