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Updated: Dec 8, 2025
Evaluation of the Cognitive Performance of Hypertensive Patients with Silent Cerebrovascular Lesions
Published on: April 23, 2021
The clock drawing test as a cognitive screening tool for assessment of hypertension-mediated brain damage
G H Cerezo1, P Conti2, A E De Cechio3
1Cardiovascular and Epidemiology Department, ICBA Cardiovascular Institute of Buenos, Aires, Argentina.
Insights
The Clock Drawing Test (CDT) is a more sensitive tool than the Mini-Mental Test (MMSE) for detecting cognitive impairment in hypertensive patients, identifying brain damage earlier.
Area of Science:
- Neurology
- Cardiology
- Gerontology
Background:
- Hypertension (HTN) is a primary cause of subcortical vascular brain injury (VBI) and associated cognitive decline.
- Cognitive impairment in hypertensive individuals poses a significant public health challenge.
Purpose of the Study:
- To evaluate the efficacy of the Clock Drawing Test (CDT) in identifying cognitive impairment in hypertensive patients.
- To compare the diagnostic sensitivity of the CDT against the Mini-Mental Test (MMSE) for cognitive deficits in hypertension.
Main Methods:
- A cohort of 1414 hypertensive patients from the Heart-Brain Study in Argentina was analyzed.
- Neurocognitive function was assessed using the CDT and MMSE, alongside evaluation of mood disorders with the Hospital Anxiety Depression (HAD) scale.
- Demographic data, vascular risk factors, blood pressure, and education levels were recorded.
Main Results:
- The prevalence of cognitive impairment was 20.7% by MMSE and 36.1% by CDT.
- A significant proportion (29.3%) of hypertensive patients with normal MMSE scores exhibited cognitive impairment as indicated by an abnormal CDT.
- CDT performance correlated with education level but not with age or mood status.
Conclusions:
- The CDT serves as a valuable screening instrument for early detection of hypertension-mediated brain damage, particularly in midlife.
- The CDT demonstrates superior sensitivity compared to the MMSE in identifying cognitive impairment in hypertensive populations.
Introduction:
Hypertension (HTN) is the most frequent cause of subcortical vascular brain injury (VBI) and its cognitive consequences. The aims were to show the usefulness of the Clock Drawing Test (CDT) to detect cognitive impairment in hypertensive patients and to compare it with the Mini-Mental Test (MMSE).
Methods:
A subset of hypertensive patients of the Heart-Brain Study in Argentina was included. Demographic characteristics, vascular risk factors, blood pressure (BP) and schooling level were recorded. The MMSE and CDT tests were used for neurocognitive assessment and Hospital Anxiety Depression scale (HAD) for mood disorder evaluation.
Results:
1414 hypertensive patients (age 59.7±13.8 years, female (62.3%). The prevalence of cognitive impairment was 20.7% (using MMSE) and 36.1% (using CDT). Among hypertensive patients with normal MMSE (>24) 29.3% had cognitive impairment (abnormal CDT). The CDT was associated with level of education but not with age or mood status.
Conclusions:
The CDT is a useful screening tool to detect hypertension-mediated brain damage earlier (especially in midlife) and is more sensitive than MMSE.
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