Khalid AR, Nashwan AJ. Methodological reflections on a nutritional status-based nomogram for predicting cognitive impairment in elderly hypertensive patients. World J Psychiatry 2025; 15(10): 110719 [DOI: 10.5498/wjp.v15.i10.110719]
Corresponding Author of This Article
Abdulqadir J Nashwan, MSc, Researcher, Department of Nursing, Hamad Medical Corporation, Al Rayyan Road, Doha 3050, Qatar. anashwan@hamad.qa
Research Domain of This Article
Psychiatry
Article-Type of This Article
Letter to the Editor
Open-Access Policy of This Article
This article is an open-access article which was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: http://creativecommons.org/licenses/by-nc/4.0/
World J Psychiatry. Oct 19, 2025; 15(10): 110719 Published online Oct 19, 2025. doi: 10.5498/wjp.v15.i10.110719
Methodological reflections on a nutritional status-based nomogram for predicting cognitive impairment in elderly hypertensive patients
Abdul Rauf Khalid, Abdulqadir J Nashwan
Abdul Rauf Khalid, Medical Officer, Bahria International Hospital Orchard, Lahore 54000, Punjab, Pakistan
Abdulqadir J Nashwan, Department of Nursing, Hamad Medical Corporation, Doha 3050, Qatar
Author contributions: Khalid AR wrote the original draft; Nashwan AJ critically reviewed the manuscript; All authors have read and approved the final version.
Conflict-of-interest statement: The authors declare that they have no conflict of interest.
Open Access: This article is an open-access article that was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution NonCommercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: https://creativecommons.org/Licenses/by-nc/4.0/
Corresponding author: Abdulqadir J Nashwan, MSc, Researcher, Department of Nursing, Hamad Medical Corporation, Al Rayyan Road, Doha 3050, Qatar. anashwan@hamad.qa
Received: June 13, 2025 Revised: June 25, 2025 Accepted: July 29, 2025 Published online: October 19, 2025 Processing time: 105 Days and 20.6 Hours
Abstract
This letter critiques the article by Xu et al in World Journal of Psychiatry, which developed a nomogram to predict cognitive impairment in elderly hypertensive patients using nutritional and biochemical parameters. While the model’s use of variables like body mass index, albumin, hemoglobin, alkaline phosphatase, and mini-nutritional assessment scores is promising, we raise concerns about the small validation cohort size, potential reverse causality in cross-sectional data, insufficiently discussed mechanisms for alkaline phosphatase as a risk factor, omission of key cognitive predictors, and possible overfitting given high area under the curve values. We suggest external validation, longitudinal studies, and calibration metrics to enhance the model’s robustness and clinical utility.
Core Tip: This critique highlights key methodological limitations in Xu et al’s predictive model for cognitive impairment in elderly hypertensive patients. Chief concerns include the small validation sample, potential reverse causality due to the cross-sectional design, insufficient discussion of alkaline phosphatase as a biomarker, omission of key cognitive risk factors, and possible overfitting. We recommend external validation, longitudinal analysis, incorporation of psychosocial and genetic variables, and rigorous calibration to improve reliability and clinical applicability.
