Orthostatic Hypotension and Cognitive Decline in Older People

Viramo, Petteri; Luukinen, Heikki; Koski, K; Laippala, Pékka; Sulkava, Raimo; Kivelä, Sirkka‐Liisa

doi:10.1111/j.1532-5415.1999.tb02576.x

Cited by 74 publications

(75 citation statements)

References 35 publications

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“…It has been identified as a risk factor for ischemic stroke (Eigenbrodt et al, 2000). As a potential indicator of underlying autonomic dysfunction that occurs with diabetes, Alzheimer's disease and dementia (Novak and Hajjar, 2010), OH may be associated with impaired cognitive performance, but these findings are inconsistent (Viramo et al, 1999,Rose et al, 2010,Allcock et al, 2006 and the link remains unclear (Novak and Hajjar, 2010).…”

Section: Introductionmentioning

confidence: 99%

Application of the Sit-Up Test for orthostatic hypotension in individuals with stroke

Tang

Eng

Krassioukov

2012

Autonomic Neuroscience

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Orthostatic hypotension (OH) is an important consideration for individuals with stroke, given the shared occurrence of mobility limitations, fall risk and association with adverse cardiovascular outcomes. This study aimed to 1) establish the application of a simple bedside test of orthostatic challenge to identify OH after stroke, 2) examine differences in characteristics between those with and without OH and 3) determine cardiovascular correlates with hemodynamic responses. Fortynine participants (n=29 men, mean±SD age 66±7 years, time post-stroke 4.5±3.1 years) performed an orthostatic challenge (Sit-Up Test). Eleven (22%) of the 49 participants presented with OH (n=7, of which 5 were asymptomatic) or symptoms of cerebral hypoperfusion with position change (n=4). Compared to participants without OH, those with OH had higher total:high-density lipoprotein cholesterol ratios (4.2 ± 0.9 vs. 3.3 ± 0.8, P=0.009) and triglyceride levels (2.2 ± 0.8 vs. 1.4 ± 0.5 mmol/L, P=0.001). Multivariate linear regression revealed that high-density lipoprotein cholesterol and triglyceride levels explained 20% of the variance of the change in systolic blood pressure from the Sit-Up Test (F(2,45)=5.68, P=0.006). In conclusion, we used a simple bedside test of orthostatic tolerance to identify that over 20% of individuals with stroke presented with OH or symptoms of hypoperfusion. They also had more impaired cardiovascular risk profiles relative to those without OH. These individuals may be at even higher risk for mobility limitations and falls beyond that associated with stroke-related deficits alone.

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Section: Introductionmentioning

confidence: 99%

Application of the Sit-Up Test for orthostatic hypotension in individuals with stroke

Tang

Eng

Krassioukov

2012

Autonomic Neuroscience

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“…OH is defined as a more than a 20 mmHg reduction in systolic blood pressure (SBP) and/or more than 10 mmHg reduction in diastolic blood pressure (DBP) during a period of 3 min after standing (10). Although OH is known to be one of the underlying causes of falls (1,2), it has also been shown to be an independent risk factor for cognitive dysfunction (3,4), cardiovascular disease, including stroke (5,6) and silent cerebral infarction (7), and mortality (8).…”

Section: Introductionmentioning

confidence: 99%

Orthostatic Systolic Hypotension and the Reflection Pressure Wave

et al. 2005

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“…An increase in the prevalence of OH in patients with dementia, 3 as well as increased risk of conversion to dementia, has been shown among patients with mild cognitive impairment and OH. 4 In general population, relationships between OH and cognitive impairments are highlighted [5][6][7][8] but without drawing substantive conclusions given the too short duration of the follow-up and insufficient number of subjects or as a result of an unequal distribution of the Mini-Mental State Examination score according to OH status. Given these results, there is currently no significant evidence to support the prospective relationship between OH and the risk of dementia.…”

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confidence: 99%

Orthostatic Hypotension and Risk of Incident Dementia

et al. 2017

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Abstract-Several studies indicate a potential link between orthostatic hypotension (OH) and incident dementia but without substantial evidence to date. Our objective is to study the association between OH and dementia in a cohort of elderly individuals. To do so, baseline lying and standing blood pressure measurements were taken from 7425 subjects in the Three-City study. These subjects were then followed-up for 12 years. Cox proportional hazard models, adjusted for potential confounders, were used to estimate the risk of incident dementia according to OH status. Sensitivity analysis was performed using the so-called illness-death model, a specific statistical method which takes into account competitive risk with death. OH frequency was found to be around 13%, and 760 cases of dementia were diagnosed during followup. We observed significant associations between the presence of OH at baseline and the occurrence of dementia during the follow-up, with an increased risk of at least 25% observed regardless of the OH threshold and the statistical method used. In conclusion, there is an association between OH and dementia. Considering that OH is a common condition and is easy to measure, OH measurements could help to identify subjects with higher risk of dementia. Moreover, reducing OH could be a step to prevent conversion to dementia.

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Orthostatic Hypotension and Cognitive Decline in Older People

Cited by 74 publications

References 35 publications

Application of the Sit-Up Test for orthostatic hypotension in individuals with stroke

Application of the Sit-Up Test for orthostatic hypotension in individuals with stroke

Orthostatic Systolic Hypotension and the Reflection Pressure Wave

Orthostatic Hypotension and Risk of Incident Dementia

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