INTRODUCTION:

Cognitive function is a big term that refers to cognitive processes involved in the acquisition of knowledge, manipulation of information, and reasoning¹. Hypertension is one of the leading causes of death and disability among elderly². High blood pressure is a contributing factor in the development of many cases of heart disease, stroke, and kidney failure.

However, since hypertension has no symptoms itself, it is difficult to convince patients of the importance of taking antihypertensive medication according to the physician’s prescription.³Hypertension is a major health problem that is common in older adults. After decades of observational research, there's general agreement that high blood pressure in middle age is a risk factor for later-life cognitive decline, including overall cognition, memory, and processing speed.

Maintaining cognitive function and emotional well-being in the last decades of life becomes an important topic for our society. It is well known that some cognitive functions decline in older age, such as perceptual speed and working memory capacity³. Endy Juli Anto, Laura Octavina Siagian, Jekson Martiar Siahaan.et.al 2019 A study aimed to look at the relationship of hypertension with cognitive function in the elderly at the Karya-Kasih Nursing Homes, Medan. Analytic observational with cross-sectional research approach was used. 57 elderly from Karya Kasih Nursing Homes Medan who met the inclusion and exclusion criteria participated. Result shows that there is a significant relationship between the history of hypertension with impaired cognitive function. The results of the cognitive function examination with MMSE showed that among 57 elderly, 16 people (43.2%) were normal and 21 people (56.8%) had impaired cognitive function in the first degree hypertension group, besides that, 3 people were normal (15%) and 7 people (85%) had impaired cognitive function in the second degree hypertension group. Both hypertension and cognitive impairment increase in prevalence with advancing age and their relation to each other are attracting significant research interest⁴.

Antihypertensive drugs are a class of drugs that are used to treat hypertension (high blood pressure)^5.The effects of antihypertensive drug class in late life to prevent cognitive impairment however, remain unclear⁶. Hence Researcher felt that studies conducted regarding the topic is less in Indian scenario.

MATERIALS AND METHODS:

Research design:

A descriptive research (comparative) design was used to conduct this study.

Research setting:

The study has been conducted in urban areas Dashmesh Nagar, Janta Nagar, Sawraj Nagar of district Mohali, Punjab.

Population:

Target population comprised of elderly people (aged 60 years or above) residing at selected urban areas of district Mohali, Punjab.

Scoring Criteria
S. No.	Level of cognitive function	Range of scores
1	Severe impairment	0 – 7
2	Moderate impairment	8 – 15
3	Mild impairment	16 – 23
4	Normal cognitive function	24 – 30

Sample and Sampling technique:

The sample consists of 100 adults who fulfil the inclusion criteria (50 hypertensive elderly and 50 normotensive elderly from urban areas) selected via purposive sampling technique.

Description of Tool:

The tool consists of two parts:

Part-I: Socio - Demographic Performa: It consists of 9 items related to demographic data of the subjects such as Age, Gender, Education, Occupation, Type of Family, Dietary Habits, Lifestyle Practices, Family History of Hypertension, Comorbidities.

Part-II: Multicultural Cognitive Assessment scale, Rowland Universal Dementia Assessment Scale (RUDAS): A standardized tool, Multicultural Cognitive Assessment scale, Rowland Universal Dementia Assessment Scale (RUDAS) which has 30 items that needs responses of the elderly from the following areas such as Memory, Orientation, Praxis, Drawing, Judgment and Language.

Scoring of Items:

Every correct performance of the task is rewarded with the score of “one and incorrect and no response is given with score zero” and the total score is 30. Based on the scores, the levels of cognitive function will be graded as:

Method of data collection:

Formal permission from the ethical committee and written permission from the SDM of the selected urban areas ofdistrict Mohali, Punjab has been obtained. Written Informed consent was obtained from the elderly (50 hypertensive and 50 normotensive) of selected urban areas who were selected by purposive sampling technique has been obtained. Data collection has been done in the month of April 2022 by conducting interview by using RUDAS scale. The collected data were analysed using descriptive and inferential statistics.

RESULT:

Table 1: Frequency and percentage distribution of hypertensive and normotensive elderly according to demographic variables.

N =50+50=100

		Hypertensive elderly	Normotensive elderly
S. No	Demographic variables	Frequency (f) Percentage (%)	Frequency (f) Percentage (%)
1.	Age in years
a.	60-64	10 (20)	11 (22)
b.	65-69	13 (26)	14 (28)
c.	70-74	12 (24)	14 (28)
d.	75-79	9 (18)	7 (14)
e.	80 & above	6 (12)	4 (8)
2.	Gender
a.	Male	28 (56)	31 (62)
b.	Female	22 (44)	19 (38)
3.	Education
a.	Up to Primary level	22 (44)	20 (40)
b.	Up to secondary level	8 (16)	11 (22)
c.	Up to senior secondary level	7 (14)	5 (10)
d.	Graduate or above	13 (26)	13 (26)
4.	Working status
a.	Working	13 (26)		23 (46)
b.	Non-working	37 (74)		27 (54)
5.	Type of family
a.	Nuclear	17 (34)		18 (36)
b.	Joint	33 (66)		32 (64)
6.	Dietary habits
a.	Vegetarian	21 (42)		23 (46)
b.	Non-vegetarian	29 (58)		27 (54)
7.	Lifestyle practices
a.	Alcohol consumption	12 (24)		12 (24)
b.	Smoking	6 (12)		7 (14)
c.	Tobacco	2 (4)		0 (0)
d.	None	30 (60)		31 (62)

Table 2: Frequency and Percentage distribution related to Level of cognitive functioning among hypertensive elderly. N=50

S. No	Level of cognitive function	Range of scores	frequency	(%)
1	Normal cognitive function	24-30	9	18
2.	Mild impairment	16-23	36	72
3.	Moderate impairment	8-15	5	10
4.	Severe impairment	0-7	0	0

Table 3: Frequency and Percentage distribution related Level of cognitive functioning among normotensive elderly. N=50

S. No	Level of cognitive function	Range of scores	Frequency	Percentage (%)
1	Normal cognitive function	24-30	41	82
2.	Mild impairment	16-23	9	18
3.	Moderate impairment	8-15	0	0
4.	Severe impairment	0-7	0	0

Table 4: Mean, standard deviation and t value of level of cognitive function.

N=50+50=100

Cognitive function	Mean	Standard deviation	t-value	Df
Hypertensive	19.86	24.88	2.22432	98
Normotensive	3.806	2.623	2.22432	98

Table value (t) =1.99 p<0.05 * significant

Table 6: Association between levels of cognitive functioning of hypertensive and normotensive elderly with their selected socio-demographic variables. N=100

S. No	Socio-demographic variables	Hypertensive			Normotensive
		N	Mean	SD	N	Mean	SD
1.	Age (in years)
	60-64	10	23.4	3.18	11	26.36	2.55
	65-69	13	20.23	3.51	14	21.42	1.89
	70-74	12	20.66	3.14	14	20.92	1.60
	75-79	5	17.8	2.01	4	16.25	1.59
	Above 80 years	10	15.9	2.76	7	14.71	3.01
	Test	df =4, 49, f test =8.86*			df=4, 45, f test= 2.46
2.	Gender
	Male	28	19.96	3.32	31	25.51	2.61
	Female	22	19.7	4.63	19	25.58	2.55
	Test	df= 48, t test=2.28			df= 48, t test=0.21
3.	Education
	Up to primary	22	19.5	3.28	21	23.48	2.55
	Up to secondary	8	19.12	3.47	11	24.9	2.60
	Up to senior secondary	7	20	2.71	5	25.4	1.78
	Graduate or above	13	20.84	3.22	13	27.07	1.64
	Test	df = 3,49, f test = 0.44			df =3, 49, f test=2.55
4.	Working status
	Working	13	20.7	3.47	23	25.78	2.61
	Non- working	37	19.5	3.80	27	21.11	2.56
	Test	df=48, t test=1.00			df=48, t test=1.346
5.	Type of family
	Nuclear	17	20.41	3.51	18	25.61	2.55
	Joint	33	19.57	3.35	32	24.76	2.59
	Test	df=48, t test= 0.73			df=48, t test=1.49
6.	Dietary habits
	Vegetarian	21	19.23	3.73	23	25.08	2.55
	Non- vegetarian	29	20.31	3.51	27	24.7	2.61
	Test	df=48, t test= 0.98			df=48, t test=0.51
7.	Life-style practices
	Alcohol consumption	12	19.16	3.58	12	26	3.52
	Smoking	6	22.5	3.42	7	24.28	3.15
	Tobacco	2	21.5	2.47	0	0	0
	None	30	19.5	3.54	31	25.58	2.55
	Test	df=3,49, f test=1.33			df = 3,49, f test=2.73
8.	Family history of hypertension
	Yes	31	19.7	3.73	10	25.1	2.69
	No	19	20.1	3.51	40	24.8	2.56
	Test	df= 48, t test= 0.35			df =48, t test=0.29
9.	Comorbidities
	Yes	14	19.7	2.99	4	25.5	1.91
	No	36	20.1	3.80	46	24.8	2.62
	Test	df= 48,t test= 0.91			df= 48, t test= 0.48

NS-Non significant S –Significant

DISCUSSION:

In the present study, among hypertensive elderly, the level of cognitive function score showed that 36(72%) have exhibited mild cognitive impairment, 9(18%) have normal cognitive function, 5(10%) have moderate cognitive impairment and none of them have severe cognitive impairment. Among normotensive elderly, the level of cognitive function score showed that 41(82%) have normal cognitive function and 9(18%) have exhibited mild cognitive impairment with mean score 19.86 and 3.806 respectively.A similar study was conducted by Rashal Flavia Pinto (2019) in Mangaluru, Banglore on 80 hypertensive and normotensive elderly and the results showed that 22(55%) have mild cognitive impairment, 9(22%) have normal cognitive function, 7(17.5%) have moderate cognitive impairment and 2(5%) have exhibited severe cognitive impairment among hypertensive elderly whereas 24(60%) have normal cognitive function, 13(32.5%) have mild cognitive impairment and 3(7.5%) exhibited moderate cognitive impairment. It was concluded that Majority of the hypertensive elderly exhibited with mild Cognitive impairment, majority of had normal cognitive functioning among normotensive elderly.

There is a significant difference in cognitive function among hypertensive and normotensive elderly. The calculated ‘t’ value was 2.2243 which was greater than the table value 1.99, at 0.05 level of significance. Hence, the research hypothesis was accepted i.e., there is significant difference between level of cognitive function among hypertensive and normotensive elderly in selected areas of district Mohali.

A similar study was conducted by Frances Harrington, Brian K. Saxby, Ian G. McKeith, Keith Wesnes and Gary A (2000) to examine cognitive performance in hypertensive and normotensive subjects without dementia or stroke ≥ 70 years ofage in Frances Harrington. 107 untreated hypertensive subjects (164±9/89±7) and 116 normotensives (131±10/74±7;) were studied. Results of the cognitive assessment battery in hypertensive and normotensive groups shows that the hypertensive group was significantly slower in all tests except for choice reaction time, in which the slower response was of borderline significance. Accuracy of response in hypertensive subjects was also impaired for number vigilance, delayed word recognition, and spatial memory.

Association between cognitive function and demographic variables of hypertensive elderly revealed that there was significant association between cognitive functioning with their age (P < 0.05). Hence research hypotheses were accepted in this variable. However no significant association was found between cognitive score and sex, type of family, dietary habits, life style practice and, comorbidities family history of hypertension (P > 0.05). Hence the research hypothesis was rejected.

Association between cognitive function and demographic variables of normotensive elders revealed that there was no significant association between cognitive function with the demographic variables such as Age, Sex, Type of family, dietary habits, Life style practices and Family history of hypertension, hence the research hypothesis was rejected.

A similar cross-sectional study was conducted by Jiate Wei, Xin Yin, Qi Liu, Libo Tan, Chongqi Jia (2018) to evaluate the associations of characteristics of hypertension, including hypertension status, duration, blood pressure (BP), and pulse pressure (PP) in people aged over 45 years. Results showed that in people aged 45-59 years, there was no significant association between hypertension and cognition. In conclusion this study shows the correlation between hypertension and cognition was age-dependent with greater correlation in older people.

CONCLUSION:

The study revealed that the majority (72%) of the hypertensive elderly exhibited mild Cognitive impairment whereas among normotensive, the majority (82%) had normal cognitive functioning.

There was a significant difference (calculated ‘t’ value 2.22432) in cognitive function among hypertensive and normotensive elderly.

There was significant difference in the areas of cognitive function like Praxis, drawing, judgment and language among hypertensive and normotensive elderly in selected areas. Whereas there is no significant difference in the area of orientation and memory.

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Received on 12.01.2023 Modified on 30.03.2023

Int. J. Nur. Edu. and Research. 2023; 11(3):203-207.

DOI: 10.52711/2454-2660.2023.00046