Orthostatic Hypotension Is Associated With Cognitive Decline in Parkinson Disease.

Katherine Longardner,Irene Litvan,Ece Bayram

doi:10.3389/fneur.2020.00897

Abstract

Introduction: Cognitive impairment and orthostatic hypotension (OH) are common, disabling Parkinson disease (PD) symptoms that are strongly correlated. Whether the relationship is causative or associative remains unknown. OH may occur without classic orthostatic symptoms of cerebral hypoperfusion (i.e., lightheadedness or dizziness). Whether longitudinal differences in cognition occur between symptomatic and asymptomatic OH patients has not been explored.Objectives: We characterized the prevalence of OH, orthostatic symptoms, and cognitive impairment among PD patients and compared cognition between patients with and without OH, and between patients with symptomatic and asymptomatic OH.Methods: Our cross-sectional, retrospective, observational study included 226 clinically diagnosed PD patients who underwent repeated standardized evaluations. Among these, 62 had longitudinal follow-up of > 3.5 years. We compared longitudinal Montreal Cognitive Assessment (MoCA) scores between patients remaining OH-free (n = 14) and those without baseline OH that developed OH (n = 28), matched for age, sex, education, and PD duration. We also compared MoCA scores between groups with asymptomatic OH (n = 13) and symptomatic OH (n = 13) matched for the same factors.Results: In the cross-sectional analysis, OH patients had worse cognition. In the longitudinal analysis (mean follow-up = 5.3 years), OH patients had worse cognitive decline (p = 0.027). Cognitive impairment was similar between asymptomatic and symptomatic OH patients in the cross-sectional and longitudinal analyses.Conclusions: OH is associated with cognitive impairment in PD. Further studies are needed in larger cohorts to expand our findings and to determine whether treating OH can prevent or delay cognitive dysfunction.

Highlights

Cognitive impairment and orthostatic hypotension (OH) are common, disabling Parkinson disease (PD) symptoms that are strongly correlated
In the model adjusted for age and disease duration, Montreal Cognitive Assessment (MoCA) was lower in OH+ compared to the OH– group, this difference remained at a trend level [OH– mean = 25.3 (0.3) vs. OH+ mean (SE) = 24.2 (0.5); F(1, 222) = 3.53, p = 0.062, η2p = 0.016]
There were no differences in demographics, clinical features, mean blood pressure (BP) change, or MoCA scores between asymptomatic OH (aOH) and symptomatic OH (sOH) patients

Summary

Introduction

Cognitive impairment and orthostatic hypotension (OH) are common, disabling Parkinson disease (PD) symptoms that are strongly correlated. OH may occur without classic orthostatic symptoms of cerebral hypoperfusion (i.e., lightheadedness or dizziness). While the manifestations of Parkinson disease (PD) affecting movement are well-recognized, PD causes myriad non-motor symptoms, including cognitive and autonomic disorders, which can be as disabling as motor symptoms [1]. Autonomic nervous system dysfunction causing neurogenic orthostatic hypotension (OH) affects up to half of PD patients [5]. OH may manifest with temporary symptoms caused by hypoperfusion to the brain and other organs when upright, including lightheadedness, fatigue, dizziness, syncope, and visual, gait, and cognitive disturbances. Orthostatic symptoms increase functional disability and fall risk and negatively affect quality of life [7, 8]. Potential contributing factors include neurodegeneration, repeated episodes of cerebral hypoperfusion, and/or noradrenergic deficits [9,10,11]

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