Detection of Cognitive Impairment and Dementia in Clinical Practice

The brain of the hypertensive patient is an organ at risk. There is a significant body of evidence supporting the determinant role of high blood pressure in the development of cognitive impairment and dementia. Dementia is a multifactorial, incurable syndrome, which increases considerably every 20 years. The early detection of cognitive deterioration in hypertensive patients opens a window of opportunities to modify not only the course of the hypertensive disease but also to implement a preventive strategy to delay the onset of cognitive deterioration and dementia. The cognitive impairment of the hypertensive patient can be considered as a “surrogate” of the vascular brain damage hypertension-mediated. Many neuropsychological tests as the Mini-Mental Statement Examination (MMSE), Trial Making Test (TMT), Colours and words Stroop test, Clock Drawing Test (CDT), Digit Symbol Substitution Test (DSST), Verbal fluency, Memory Impairment Screen (MIS), the Montreal Cognitive Assessment (MoCA), Cambridge Cognitive Test, Addenbrooke’s Cognitive Examination (ACE), or abbreviate test batteries (Mini-Cog) are used to identify cognitive impairment, sharing similar sensitivity and diagnostic specificity. Limitations in its use are related to the time to expend in their performance, ranging from 20 to 30 min or even more, and their interpretation by a neuropsychologist. Therefore, its use in the hands of general practitioners is complex. It is necessary to identify a simple, quick, and easy test to administer in routine clinical practice to detect cognitive dysfunction in hypertensive patients. In this sense, the Clock Drawing Test (CDT) is a simple screening tool that may be used by general practitioners, clinicians, cardiologists, or hypertension specialists in the routine clinical practice.