Background. One of the issues of modern health care the frequent arterial hypertension (AH) in people of the so-called middle age. There is a decrease in the productivity of mental activity accompanied by anxiety in the form of «cognitive dissatisfaction» with the corresponding experiences. Features and causes of cognitive dysfunctions in patients with hypertension require special study. Its results are important not only for understanding the central mechanisms of the disease, but also for the development of diagnostic and therapeutic procedures, preventive, correctional and rehabilitation programs. They are determined by the relevance of clinical and psychological studies of the syndromes of cognitive dysfunctions and factors that determine cognitive functioning in hypertension in the middle age.
The Objective is the assessing of motivational and emotional factors to the qualitative characteristics of cognitive activity in the middle-aged patients with AH who are unaware of the medical qualifications of their disease.
Design. The study and interpretation of its results was carried out in accordance with the principles of psychological syndrome analysis (school of L.S. Vygotsky - A.R. Luria - B.V. Zeigarnik). The research program included the diagnosis of emotional and personal characteristics using the Russian-language version of the 16-factor Cattell personality questionnaire (Cattell, Schuerger, 2003; Kapustina, 2006) and the Pictogram methodology (Zeygarnik, 1962; Rubinstein, 1970), diagnostics of general intelligence using the “Raven’s Progressive matrices” (Raven, et al., 2012; Davydov, Chmykhova 2016), and also the study of “qualitative” features of cognitive processes using pathopsychological examination (Zeigarnik, 1986). We examined 48 patients (52.3±6.6 years) with Stage 2 hypertension, Grade 1-2, unaware of the diagnosis and 54 almost healthy people, comparable to patients by gender, age and educational level.
Results. 84% of hypertensive patients with high and medium intelligence showed signs of a decrease in cognitive activity. A meaningful interpretation of the results of the study using the methodological principles of psychological syndrome analysis (the school of L.S. Vygotsky - A.R. Luria - B.V. Zeygarnik) showed that in the structure of disturbances of cognitive processes in hypertension, disturbances in the dynamics of mental processes expressed by labile mental activity and rapid exhaustion, based on a decrease in neurodynamic support of mental activity. Reduced cognitive functioning is also influenced by the emotional and personal characteristics of patients, especially the deficiency of harmony in their motivational sphere. The study of thinking showed the diversity of opinions in 43% of patients and signs of distortion of the generalization process in 24% of patients with hypertension. Correlation analysis data have confirmed the relationship between the frequency of occurrence of these phenomena and the frequency of decrease in the productivity of cognitive activity. Patients with hypertension in the middle age unaware of the presence of this diagnosis, differ from healthy individuals in the greater disharmony of personality traits. They are characterized by a tendency to restrain affect, personal rigidity, lack of flexibility of emotional manifestations, with persistence in achieving goals and overall dominance, and also increasing values on the scales of anxiety and depression. The levels of anxiety and depression are statistically related to the productivity of the cognitive functioning in patients with hypertension.
Conclusion. Using the methodological principles of psychological syndrome analysis showed that the cognitive processes in untreated middle-aged hypertensive patients can be described as cognitive dysfunction syndrome, where two syndrome factors can be considered significant: neurodynamic and motivational ones. The research results contribute to the solution of personal and «actually intellectual» processes correlation in solving problems in normal and pathological conditions. They expand the understanding of the etiology and pathogenesis of hypertension, and allow individualizing strategies for medical and psychological care for patients with hypertension.
Keywords: syndrome-based approach by L.S.Vygotsky-A.R.Luria-B.V.Zeigarnik;
psychological syndrome analysis;
arterial hypertension (AH);
emotional and personal characteristics;
Available Online: 31.12.2019