| Abstract | Oštećenje kognitivne funkcije daje značajan doprinos globalnoj smrtnosti i invaliditetu. Primarni aldosteronizam je stanje okarakterizirano neprimjereno visokim koncentracijama aldosterona koji dovodi do brojnih neželjenih učinaka, počevši od arterijske hipertenzije, hipokalemije do nepovoljnih učinaka na bubreg, srce i krvožilje. Dokazana je veća incidencija kardiovaskularnih i cerebrovaskularnih događaja u osoba s primarnim aldosteronizmom u komparaciji s pojedincima iste dobi i spola, ali s esencijalnom hipertenzijom. Aldosteron u centralnom živčanom sustavu djeluje na cerebrovaskularno remodeliranje, poticanje vaskularne upale i oksidativnog stresa s posljedičnim poremećajem regulacije protoka krvi u mozgu što može utjecati na pogoršanje kognitivne funkcije. Dodatno, mineralokortikoidni receptori izraženi su u hipokampusu koji ima značajnu ulogu za kognitivnu funkciju čovjeka. Proveli smo istraživanje na 15 pojedinaca s primarnim aldosteronizmom (PA) i arterijskom hipertenzijom i 15 kontrola iste dobi i spola, ali s esencijalnom hipertenzijom ne bi li utvrdili razliku u kognitivnoj funkciji u ispitanika s PA i posljedičnom hipertenzijom u odnosu na kontrole s esencijalnom hipertenzijom. Analizirali smo opće karakteristike ispitanika i rezultat testova za kognitivnu procjenu: mini mental testa (MMSE) i Montrealske ljestvice kognitivne procjene (MoCa). Između ispitanika i kontrola nije bilo statistički značajne razlike u godinama školovanja, u indeksu tjelesne mase, opsegu struka, kao niti u broju korištenih antihipertenzivnih lijekova. Osobe s PA očekivano su imali više vrijednosti arterijskog tlaka i niže vrijednosti serumskog kalija u odnosu na kontrole (155.3±17.9 vs 135.4±12.2 mmHg uz p=0.001 za sistolički tlak; 99.3±13.1 vs 87.6±4.9 mmHg uz p=0.005 za dijastolički tlak; 3.6±0.5 vs 4.4±0.4 mmol/l uz p<0.001 za serumski kalij). MMSE testom nije utvrđena značajna razlika između ispitanika i kontrola, međutim MoCa testom je nađena značajna razlika između ispitanika s PA i kontrola, i to na račun slabijeg uspjeha pojedinaca s PA (25.133 ±2.23 vs 27.133±2.23, p=0.021). Uočili smo trend nižih rezultata u pojedinaca s PA u domenama jezika i pažnje i koncentracije (2 (2-3) vs 3 (1-3), p>0.05 i 6 (3-6) vs 6 (5-6), p>0.05). Također uočili smo trend većeg broja osoba s patološkim ukupnim rezultatima MoCa testa u odnosu na kontrolnu skupinu (7 vs 3, p>0.05). Nismo utvrditi povezanost između rezultata kognitivnih testova i koncentracije aldosterona niti visine omjera aldosterona i renina u pojedinaca s primarnim aldosteronizmom kao niti korelaciju s arterijskim tlakom (p>0.05). Rezultati ovog istraživanja idu u prilog povezanosti primarnog aldosteronizma s kognitivnom disfunkcijom i dobar su temelj za istraživanje na većem broju ispitanika i s više analiziranih parametara. |
| Abstract (english) | Cognitive impairment contributes significantly to global mortality and disability. Primary aldosteronism (PA) is a condition characterized by inappropriately high aldosterone concentrations that lead to numerous adverse effects, ranging from arterial hypertension and hypokalemia to unfavorable effects on the kidney, heart, and vasculature. There is evidence of a higher incidence of cardiovascular and cerebrovascular events in individuals with PA compared to individuals of the same age and sex with essential hypertension. Aldosterone acts in the central nervous system to promote cerebrovascular remodeling, vascular inflammation and oxidative stress, resulting in impaired regulation of cerebral blood flow, which may impact cognitive function. Furthermore, mineralocorticoid receptors are expressed in the hippocampus, which plays a significant role in human cognitive function.We conducted a study on 15 individuals with PA and arterial hypertension, along with 15 age- and sex-matched controls with essential hypertension, in order to determine differences in cognitive function between individuals with PA and consequent hypertension compared to controls with essential hypertension. We analyzed the general characteristics of the participants and the results of cognitive assessment tests: Mini-mental state examination (MMSE) and Montreal cognitive assessment (MoCA). There were no statistically significant differences between the participants and controls in years of education, body mass index, waist circumference or the number of antihypertensive medications used. Individuals with PA had expectedly higher blood pressure values and lower serum potassium levels compared to controls (155.3 ±17.9 vs 135.4 ±12.2 mmHg, p = 0.001 for systolic blood pressure; 99.3±13.1 vs 87.6±4.9 mmHg, p=0.005 for diastolic blood pressure; 3.6±0.5 vs 4.4±0.4 mmol/l, p<0.001 for serum potassium). There was no difference in MMSE scores between the participants and controls. However, a significant difference was found in MoCA scores between individuals with PA and controls, with PA individuals exhibiting poorer performance (25.13±2.23 vs 27.13±2.23, p = 0.021). We observed a trend of lower scores in individuals with PA in the language and attention and concentration domains (2 (2-3) vs 3 (1-3), p > 0.05 and 6 (3-6) vs 6 (5-6), p > 0.05, respectively). We also noticed a trend of a higher number of individuals with pathological total MoCA scores compared to the control group (7 vs 3, p > 0.05). We did not find any significant associations between cognitive test results and aldosterone concentrations or the aldosterone-to-renin ratio in individuals with PA, nor did we observe correlations with blood pressure (p > 0.05).The results of this study support the association between hyperaldosteronism and cognitive dysfunction and provide a solid foundation for further research with a larger number of participants and more analyzed parameters. |
