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Blood Pressure and Hypertension Studies / Cancer Related Cognitive Impairment Studies / Dementia and Cognitive Impairment Research · Review
Frontiers in Medicine · August 10, 2026
Early or partial results. Treat as a signal, not a conclusion.
This systematic review identified 25 models across 17 studies for detecting cognitive impairment in hypertensive patients, with discrimination performance (AUC 0.344–0.938) showing promise for prevalent cases but limited external validation and high bias. The field lacks standardized outcomes, reproducible methods, and prospective evidence, and no model is currently ready for clinical deployment.
Systematic review and critical appraisal. Studies of adults with hypertension that developed, updated, or validated models for cognitive impairment, mild cognitive impairment, cognitive decline, subjective cognitive decline, or dementia.. Intervention: Multivariable models, nomograms, scores, or machine-learning tools for identifying or predicting cognitive impairment in hypertensive patients.. Chinese and English language databases, inception to December 23, 2025; most included studies conducted in China..
Seventeen studies reporting 25 models were included; 16 studies judged at high risk of bias using PROBAST. Reported AUCs ranged from 0.344 to 0.938; most multivariable models exceeded 0.70. Internal validation reported in 15 studies; only 4 conducted external validation and 11 assessed calibration.
Common predictors included older age, lower education, depression, obesity, longer hypertension duration, greater hypertension severity, and adverse metabolic indicators.
Clinicians should not currently rely on any existing model to identify or predict cognitive impairment in hypertensive patients, as the reviewed models lack external validation, transparent reporting, and sufficient methodological rigor. Future adoption will require prospective validation, standardized cognitive assessments, and reproducible reporting of model equations and scoring rules.
A systematic review of 17 studies reporting 25 models for identifying cognitive impairment in hypertensive patients, finding substantial heterogeneity, high risk of bias in 16 studies, limited external validation (4 studies), and poor reproducibility (only 4 fully reproducible), indicating the field lacks mature, validated tools ready for clinical implementation.
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Quoted from the source exactly as published.
Clinicians should not currently rely on any existing model to identify or predict cognitive impairment in hypertensive patients, as the reviewed models lack external validation, transparent reporting, and sufficient methodological rigor. Future adoption will require prospective validation, standardized cognitive assessments, and reproducible reporting of model equations and scoring rules.
Graded across the dimensions that decide whether you should act, each from what the source actually supports. There is no single score, and where a dimension was not assessed it says so.
Background Hypertension is strongly associated with cognitive impairment. Existing tools include models designed to identify prevalent cognitive impairment and a smaller number developed to predict future risk. However, their methodological quality, validation status, and reproducibility have not been systematically assessed. We conducted a systematic review and critical appraisal of existing models designed to identify cognitive impairment in patients with hypertension. Methods Chinese and English databases were searched from inception to December 23, 2025. Studies that developed, updated, or validated a multivariable model, nomogram, score, or machine-learning tool for cognitive impairment, mild cognitive impairment, cognitive decline, subjective cognitive decline, or dementia among adults with hypertension were included. Data were extracted using CHARMS, and risk of bias was assessed with PROBAST. The synthesis emphasized model purpose, temporality, outcome definition, discrimination, calibration, validation, risk of bias, and reproducibility. Reported c-statistics were summarized descriptively because of substantial heterogeneity in study design, outcome definitions, cognitive assessment tools, and repeated model estimates from the same datasets. Results Seventeen studies reporting 25 models were included. Most models were developed in China using cross-sectional data, with cognitive outcomes assessed using varied instruments. Reported AUCs ranged from 0.344 to 0.938; most multivariable models exceeded 0.70. Internal validation was reported in 15 studies, whereas only four conducted external validation and 11 assessed calibration. Sixteen studies were judged at high risk of bias. Reproducibility was limited: four studies provided sufficient information for independent calculation, eight were partially reproducible, and five were insufficiently reported. Common predictors included older age, lower education, depression, obesity, longer hypertension duration, greater hypertension severity, and adverse metabolic indicators. Discussion Existing models show some ability to distinguish hypertensive patients with and without cognitive impairment, while evidence supporting future-risk prediction remains limited. Future work should prioritize prospective cohorts, standardized outcome definitions, external validation, calibration, and transparent reporting of equations, intercepts, scoring rules, code, and model objects. Systematic review registration https://www.crd.york.ac.uk/PROSPERO/view/CRD420251157136, identifier CRD420251157136.
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