Orthostatic hypotension in Parkinson's disease: association with cognitive decline?

Allcock, Liesl M.; Kenny, Rose Anne; Mosimann, Urs Peter; Tordoff, S; Wesnes, Keith; Hildreth, Anthony; Burn, David J.

doi:10.1002/gps.1562

Cited by 94 publications

(86 citation statements)

References 38 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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“…Although studies have suggested interdependence of these manifestations, the results have been inconsistent. [11][12][13][14] Among elderly individuals, cognitive decline and other neurobehavioral signs are associated with low blood pressure, pressure fluctuations, and nondipping. [15][16][17][18][19] The hypothesis tested in this study was that neurocirculatory abnormalities may contribute to cognitive abnormalities accompanying early PD.…”

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confidence: 99%

Association of cognitive dysfunction with neurocirculatory abnormalities in early Parkinson disease

et al. 2012

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Objective: Cognitive impairment and neurocirculatory abnormalities such as orthostatic hypotension (OH), supine hypertension (SH), and failure to decrease blood pressure at night (nondipping) occur relatively commonly in Parkinson disease (PD); however, whether cognitive dysfunction in early PD is related to neurocirculatory abnormalities has not been established. Cognitive dysfunction in PD is associated with white matter hyperintensities on MRI. We report results of an analysis of neuropsychological and hemodynamic parameters in patients with early PD.Methods: Among 87 patients, 25 had normal cognition, 48 had mild cognitive impairment, and 14 had dementia, based on comprehensive neuropsychological tests. Orthostatic vital signs and ambulatory 24-hour blood pressure monitoring were recorded, and brain magnetic resonance scans were obtained for all patients. Results:Cognitive impairment was associated with OH, SH, and white matter hyperintensities but not with nondipping. Dementia and white matter hyperintensities were common in SH. Of 13 patients with OH ϩ SH, every one had mild cognitive impairment or dementia. Conclusions:Cognitive dysfunction is related to neurocirculatory abnormalities, especially OH ϩ SH, in early PD, raising the possibility that early detection and effective treatment of those abnormalities might slow the rate of cognitive decline. Neurology It is increasingly being recognized that Parkinson disease (PD) involves prominent nonmotor manifestations such as dementia and autonomic failure.A variety of neurocirculatory abnormalities have been noted in PD, including orthostatic hypotension (OH), 1-4 supine hypertension (SH), 5-7 labile blood pressure, and the absence of a decrease in pressure during the night, a phenomenon called nondipping. 8 These abnormalities are related to each other. SH is found in a substantial proportion of patients with PD with OH.

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“…Orthostatic hypotension is one of the most common symptoms of PD and it is seen with a rate of between 20-50% and it is more common in the advanced stages of the disease. In another study, no association was found between the disease severity and orthostatic hypotension 21 . While there are studies which have not found an association between autonomic dysfunction and cognitive exposure 19,22 , there are also studies which show an association between the two 23 .…”

Section: Resultsmentioning

confidence: 89%

Effect of clinical autonomic dysfunction on cognitive functions in Parkinson’s disease

Aygün¹,

Akpınar²,

Yön³

et al. 2017

Dicle Tıp Dergisi

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Objective: Parkinson's disease (PD) is a chronic progressive neurodegenerative disorder characterized by tremor, rigidity, bradykinesia, and postural instability. PD also involves nonmotor manifestations such as autonomic failure, cognitive disorders, and sleep disorders. These clinical characteristics are not identical in severity, frequency, and onset time in all PD patients. We assessed whether there is a negative effect on cognition of clinical autonomic dysfunction in PD patients.Results: Mean age was 66,5±11.2 years. There was no correlation between cognitive test scores and SCOPA-OUT scores (p>0.05). However, H-Y scores were negatively correlated with the DSTf, DSTr, FAB, and MMSE scores (p50.005, r:-0.451; p50.025, r: -0.367; p50.040, r: -0.340; p50.044, r5-0.333, respectively). Training and Education Hospital, Neurology clinic, Samsun, Turkey e-mail: dr_ckakpinar@hotmail.com Original Article/Özgün Araştırma Conclusions: According to our results, clinical autonomic dysfunction did not seem to have an effect on cognition. In addition, severity of cognitive dysfunction showed a strong negative correlation with the stage of disease.

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Orthostatic hypotension in Parkinson's disease: association with cognitive decline?

Abstract: We conclude that there are differences in the neuropsychological performance of patients with PD and OH, supporting the hypothesis that OH might be a marker for disease progression and cognitive decline in PD.

Cited by 94 publications

References 38 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

Association of cognitive dysfunction with neurocirculatory abnormalities in early Parkinson disease

Effect of clinical autonomic dysfunction on cognitive functions in Parkinson’s disease

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