Abstract
BackgroundCognitive impairment may be correlated with cardiovascular dysautonomia, including blood pressure (BP) dysregulation, in Parkinson’s disease (PD), but the association between these factors in dementia with Lewy bodies (DLB) is uncertain. This study aimed to clarify whether cardiovascular dysautonomia had an influence on cognitive function in Lewy body disease or not.MethodsNinty-nine patients with de novo PD (n = 75) and DLB (n = 24) were evaluated using the Mini-Mental State Examination (MMSE) and Frontal Assessment Battery (FAB). Cardiac 123I-metaiodobenzylguanidine (MIBG) scintigraphy, orthostatic hypotension (OH), supine hypertension (SH), postprandial hypotension (PPH), nocturnal BP fall in 24-h ambulatory blood pressure monitoring (ABPM) and constipation were estimated. Associations of these factors with cognitive and executive dysfunction were examined.ResultsIn DLB, MIBG uptake was reduced and OH, PPH and SH were severely disturbed, compared to PD. The nocturnal BP fall in ABPM was lower in DLB, and the failure of nocturnal BP fall in PD was associated with MMSE, after adjustment for other clinical features. FAB was significantly associated nocturnal BP fall, age and SH in PD, but no significant correlations among factors were found for DLB.ConclusionThe significant association between nocturnal BP dysregulation and cognitive or executive decline in PD might be due to impaired microvascular circulation or invasion of α-synuclein in the CNS. The lack of a correlation of BP insufficiency with cognitive impairment in DLB suggests initial involvement of Lewy body pathology in the neocortex, regardless of Lewy body invasion of the autonomic nervous system.
Highlights
Cognitive impairment may be correlated with cardiovascular dysautonomia, including blood pressure (BP) dysregulation, in Parkinson’s disease (PD), but the association between these factors in dementia with Lewy bodies (DLB) is uncertain
DLB patients were older than PD patients, but there was no significant difference in the duration of PD and DLB
There were no significant differences in Unified Parkinson’s Disease Rating Scale (UPDRS) motor scores and motor subtype between PD and DLB cases
Summary
Cognitive impairment may be correlated with cardiovascular dysautonomia, including blood pressure (BP) dysregulation, in Parkinson’s disease (PD), but the association between these factors in dementia with Lewy bodies (DLB) is uncertain. This study aimed to clarify whether cardiovascular dysautonomia had an influence on cognitive function in Lewy body disease or not. Parkinson’s disease (PD) is commonly accepted to be associated with motor symptoms and various non-motor symptoms, including behavioral changes such as depression, sleep disturbance, fatigue and autonomic dysfunction. Autonomic impairment associated with PD is characterized by clinical features of constipation, sweating, orthostatic hypotension (OH) and postprandial hypotension (PPH), even in the early phase [1]. OH occurs through sympathetic noradrenergic dysfunction and is clinically important in 20–50% of patients with PD [1]. Patients with PD with OH have significantly worse sustained attention and visual episodic memory [5] and significantly lower scores on the MiniMental State Examination (MMSE) [6, 7]
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