An overview of cognitive tests used in cardiovascular research

Objective: Cardiovascular status and risk factors such as hypertension, diabetes, smoking, and composite risk scores have been shown to impact cognitive performance. Yet, despite an abundance of available tests, there is no clear choice of cognitive test(s) to measure this impact, rendering direct comparison between studies difficult. The purpose of this study was to identify cardiovascular studies utilizing cognitive tests to detect mild cognitive impairment, in order to quantify the prevalence of different tests and analyse the authors’ comments regarding their applicability. Design and method: This was an overview of eligible cardiovascular studies systematically collected from the literature, which used at least one cognitive test on a sample representing either the general population, or hypertensive or metabolic syndrome population with increased risk for mild cognitive impairment. We excluded studies performed on children or including a significant share of the elderly. A total of 59 studies were collected, with key information extracted, and comments qualitatively analysed. Results: We identified 111 different cognitive tests. In 71% of studies 3 or more cognitive tests were used, while only 14% used a single test, mostly Mini-Mental-State-Examination (MMSE). Studies solely using MMSE had larger sample size compared to other studies: median (IQR) of 3282 participants (1326-6274) vs 539 (160-2727), p = 0.050. MMSE was used most frequently (29%), followed by Stroop-Colour-and-Word-Test (25%) and Trail-Making-Test-B (24%). Authors commented on cognitive tests in 48 studies (81%), generating 148 distinct remarks. MMSE had the most- 31 remarks across 16 studies of which 32% remarks were interpreted as negative: mostly due to being either insensitive/unable/unreliable for assessing cognition or certain cognitive domains such as executive function, verbal memory, and visuospatial domain; versus 32% positive: reliable/sensitive, widespread use in cardiovascular research. A large proportion (29%) of remarks focused on MMSE cut-offs as well. Conclusions: MMSE is still the most widespread test in the field of cardiovascular research, despite numerous reported shortcomings, and tends to be used in large sample studies. However, most studies use multiple tests simultaneously, allowing authors to compensate for the weaker areas of each individual test.