The inclusion of cognition in vascular risk factor clinical practice guidelines

Kenneth Rockwood¹, Laura E Middleton², Paige K Moorhouse¹, Ingmar Skoog³, Sandra E Black⁴

¹Department of Medicine, Dalhousie University, Halifax, NS, Canada; ²Department of Psychiatry, University of California, San Francisco, CA, USA; ³Institute of Neuropsychiatry, Sahlgrenska Academy of Göteborg University, Göteborg, Västra Götaland, Sweden; ⁴Department of Medicine, University of Toronto, Toronto, ON, Canada

Background: People with vascular risk factors are at increased risk for cognitive impairment as well as vascular disease. The objective of this study was to evaluate whether vascular risk factor clinical practice guidelines consider cognition as an outcome or in connection with treatment compliance.

Methods: Articles from PubMed, EMBASE, and the Cochrane Library were assessed by at least two reviewers and were included if: (1) Either hypertension, high cholesterol, diabetes, or atrial fibrillation was targeted; (2) The guideline was directed at physicians; (3) Adult patients (aged 19 years or older) were targeted; and (4) The guideline was published in English. Of 91 guidelines, most were excluded because they were duplicates, older versions, or focused on single outcomes.

Results: Of the 20 clinical practice guidelines that met inclusion criteria, five mentioned cognition. Of these five, four described potential treatment benefits but only two mentioned that cognition may affect compliance. No guidelines adequately described how to screen for cognitive impairment.

Conclusion: Despite evidence that links cognitive impairment to vascular risk factors, only a minority of clinical practice guidelines for the treatment of vascular risk factors consider cognition as either an adverse outcome or as a factor to consider in treatment.

Keywords: clinical practice guidelines, evidence-based medicine, vascular risk, cognition, target organ damage