Relationship between Orthostatic Hypotension and White Matter Hyperintensity Load in Older Patients with Mild Dementia

Hogne Soennesyn,Mona K Beyer,Ketil Oppedal,Ole Jacob Greve,Dennis W Nilsen,Dag Aarsland,Antony Bayer

doi:10.1371/journal.pone.0052196

Abstract

Background/ObjectivesWhite matter hyperintensities (WMH) in magnetic resonance imaging (MRI) scans of the brain, and orthostatic hypotension (OH) are both common in older people. We tested the hypothesis that OH is associated with WMH.DesignCross-sectional study.SettingSecondary care outpatient clinics in geriatric medicine and old age psychiatry in western Norway.Participants160 older patients with mild dementia, diagnosed according to standardised criteria.MeasurementsOH was diagnosed according to the consensus definition, measuring blood pressure (BP) in the supine position and within 3 minutes in the standing position. MRI scans were performed according to a common protocol at three centres, and the volumes of WMH were quantified using an automated method (n = 82), followed by manual editing. WMH were also quantified using the visual Scheltens scale (n = 139). Multiple logistic regression analyses were applied, with highest vs. lowest WMH quartile as response.ResultsThere were no significant correlations between WMH volumes and systolic or diastolic orthostatic BP drops, and no significant correlations between Scheltens scores of WMH and systolic or diastolic BP drops. In the multivariate analyses, only APOEε4 status remained a significant predictor for WMH using the automated method (p = 0.037, OR 0.075 (0.007–0.851)), whereas only age remained a significant predictor for WMH scores (p = 0.019, OR 1.119 (1.018–1.230)).ConclusionWe found no association between OH and WMH load in a sample of older patients with mild dementia.

Highlights

White matter hyperintensities (WMH) are commonly found in cerebral T2-weighted magnetic resonance imaging (MRI) scans in older people [1,2]
Only APOEe4 status remained a significant predictor for WMH using the automated method (p = 0.037, OR 0.075 (0.007– 0.851)), whereas only age remained a significant predictor for WMH scores (p = 0.019, OR 1.119 (1.018–1.230))
We found no association between Orthostatic hypotension (OH) and WMH load in a sample of older patients with mild dementia

Summary

Introduction

White matter hyperintensities (WMH) are commonly found in cerebral T2-weighted magnetic resonance imaging (MRI) scans in older people [1,2]. WMH seem to have a common distribution regardless of underlying diagnosis [3,4], with a preference for areas of lower relative perfusion. They have been associated with depression [5] and dementia [6]. WMH have been associated, only modestly [10], with classic cardiovascular risk factors [2,11] including hypertension [12] and APOEe4 [13], and are considered a marker of cerebrovascular disease. Some studies [15,16,17,18,19] suggest that hypotension, including orthostatic hypotension, plays a role in the development of WMH

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Results

Conclusion