Orthostatic hypotension as a risk factor for longitudinal deterioration of cognitive function in the elderly

Zimmermann, Milan; Wurster, Isabel; Lerche, Stefanie; Röeben, Benjamin; Machetanz, Gerrit; Sünkel, Ulrike; Thaler, Anna‐Katharina von; Eschweiler, Gerhard W.; Fallgatter, Andreas J.; Maetzler, Walter; Berg, Daniela; Brockmann, Kathrin

doi:10.1111/ene.14050

Cited by 18 publications

(15 citation statements)

References 27 publications

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“…45 It is generally believed that the COH of the elderly is related to the decline of cognitive function. Zimmermann et al 46 found that the executive and memory functions of elderly participants with COH deteriorated faster than those without COH. Cremer et al followed 7425 participants (aged 65 or above) for 12 years and observed a significant correlation between the presence of COH at baseline and the occurrence of dementia.…”

Section: Chd and CImentioning

confidence: 99%

The interaction and pathogenesis between cognitive impairment and common cardiovascular diseases in the elderly

Zuo

2022

Therapeutic Advances in Chronic Disease

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Both cognitive impairment and cardiovascular diseases have a high incidence in the elderly population, increasing the burden of care and reducing the quality of life. Studies have suggested that cognitive impairment interacts with cardiovascular diseases such as coronary heart disease, abnormal blood pressure, heart failure, and arrhythmia. On one hand, cognitive impairment in the elderly influences the progression and self-management of cardiovascular diseases and increases the risk of cardiovascular-related adverse events. On the other hand, coronary heart disease, heart failure, higher blood pressure variability, orthostatic hypotension, and atrial fibrillation may aggravate cognitive impairment. The role of blood pressure levels on cognition remains controversial. Several shared biological pathways have been proposed as the underlying mechanism for the association. Cardiovascular diseases may lead to cognitive decline even dementia through cerebral perfusion damage, brain structural changes, inflammation, β-amyloid deposition, and neuroendocrine disorders. It is of great significance to study the interaction and put forward effective interventions in an overall perspective to reduce care burden and improve the quality of life of the elderly patients.

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Section: Chd and CImentioning

confidence: 99%

The interaction and pathogenesis between cognitive impairment and common cardiovascular diseases in the elderly

Zuo

2022

Therapeutic Advances in Chronic Disease

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“…Interestingly, the studies using more than one cognitive task were more likely to find an association between OH and worse cognition, while the use of a single neuropsychological tool may underestimate this association (38). Furthermore, in a large longitudinal cohort of elderly subjects aged over 50 years, participants with OH showed a faster deterioration in executive and memory functions and presented a higher vascular burden as compared to participants without OH (39). However, it is still unclear whether the association between OH and poorer cognitive performance is causal, even in a general middle-aged population.…”

Section: Discussionmentioning

confidence: 99%

Relationship Between Orthostatic Hypotension and Cognitive Functions in Multiple System Atrophy: A Longitudinal Study

et al. 2021

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Introduction: The aim of this study is to investigate the impact of orthostatic hypotension (OH) on cognitive functions in patients with multiple system atrophy (MSA) followed over time.Methods: Thirty-two MSA patients were enrolled and underwent a comprehensive neuropsychological battery; at baseline (T0) 15 out of 32 patients presented OH, assessed by means of orthostatic standing test. All patients underwent a follow-up (T1) evaluation 12 months after baseline. Thirteen out of 32 patients also underwent a second follow-up (T2) evaluation at 24 months. Changes over time on different neuropsychological tasks were compared between patients with and without OH by means of Mann-Whitney's U-test. Moreover, clinical categories of normal cognition, mild cognitive impairment, and dementia were determined, and changes at T1 and T2 in global cognitive status were compared between patients with and without OH.Results: At T0, patients with OH had better performance on words/non-words repetition task (p = 0.02) compared to patients without OH. Compared to patients without OH, patients with OH performed worse on semantic association task (p < 0.01) at T1 and on Stroop test-error effect (p = 0.04) at T2. The percentage of patients with worsened cognitive status at T1 was higher among patients with OH than among patients without OH (93 vs. 59%, p = 0.03). OH (β = −4.67, p = 0.01), education (β = 0.45, p = 0.02), age (β = 0.19, p = 0.03), and Montreal Cognitive Assessment battery (MOCA) score at T0 (β = −0.26, p = 0.04) were significant predictors of global cognitive status worsening at T1.Discussion: We found that global cognitive status worsened at 1-year follow-up in 93% of patients with OH, and OH, along with age, education, and MOCA score, predicted cognitive worsening over time. To clarify the relationship between OH and cognitive dysfunction in MSA, we suggest the use of clinical categories of normal cognition, mild cognitive impairment, and dementia in further longitudinal studies on MSA patients with and without OH.

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“…Besides, it should not be overlooked that various medications such as alpha-blockers, anti-dementia drugs, antidepressants, opioids, antipsychotic drugs, and levodopa, which may often be used in the treatment of older people with dementia, and various comorbidities, such as HT, DM, frailty, and polypharmacy, may also play a role in the development of OH in older patients with dementia as well as in those without dementia [3, 11]. We found that following our adjustment by excluding these confounding factors in our cases, the risk of OH increased 2.23 times in AD, 3.68 times in DLB, and 3.56 times in VaD and that the risk of diastolic OH increased 4.19 times in VaD cases.…”

Section: Discussionmentioning

confidence: 99%

“…On the other hand, OH is considered a risk factor for dementia and cognitive decline [3]. The most favorable proposed mechanism linking OH to dementia is the recurrent transient cerebral hypoperfusion hypothesis, which causes leukoaraiosis underlying the neurodegeneration process in dementia [11].…”

Section: Introductionmentioning

confidence: 99%

The Relationship between the Most Common Subtypes of Dementia and Orthostatic Hypotension in Older Adults

Işık

Koçyiğit²,

Kaya

et al. 2020

Dement Geriatr Cogn Disord

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Background: It is crucial to evaluate the causes of morbidity and mortality in elderly patients with dementia, such as orthostatic hypotension (OH), which may affect their daily life activities, reduce the quality of life, and increase the caregiver burden. Objective: We aimed to investigate the relationship between OH and the most common subtypes of dementia in detail. Methods: A total of 268 older adults with dementia diagnosed with Alzheimer’s disease (AD), dementia with Lewy bodies (DLB), vascular dementia (VaD), and behavioral variant frontotemporal dementia (bvFTD), and 539 older adults without dementia were included in this prospective study. Comprehensive geriatric assessment including comorbidity, medication evaluation, and the head-up tilt test was also performed. Results: Of the participants, 13.8, 8.3, 6.4, and 4.8% had AD, DLB, bvFTD, and VaD, respectively. After adjusting for age, gender, the presence of comorbidities, and usage of OH-induced drugs; AD, DLB, and VaD were associated with OH (odds ratio [OR]: 2.23 confidence interval [CI] 95% 1.31–3.80; p = 0.003; OR: 3.68 CI 95% 1.98–6.83; p < 0.001, and OR: 3.56 CI 95% 1.46–8.69; p = 0.005, respectively). Furthermore, VaD was independently related to diastolic OH (OR: 4.19 CI 95% 1.66–10.57; p = 0.002), whereas AD and DLB were not. Conclusions: This study shows that elderly patients with DLB, AD, and VaD often have OH, a disabling autonomic dysfunction feature. Moreover, diastolic OH may play a role in the development of VaD. Therefore, considering potential complications of OH, it is essential to evaluate OH in the follow-up and management of those patients.

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Orthostatic hypotension as a risk factor for longitudinal deterioration of cognitive function in the elderly

Cited by 18 publications

References 27 publications

The interaction and pathogenesis between cognitive impairment and common cardiovascular diseases in the elderly

The interaction and pathogenesis between cognitive impairment and common cardiovascular diseases in the elderly

Relationship Between Orthostatic Hypotension and Cognitive Functions in Multiple System Atrophy: A Longitudinal Study

The Relationship between the Most Common Subtypes of Dementia and Orthostatic Hypotension in Older Adults

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