Sub‐clinical orthostatic hypotension is associated with greater subjective memory impairment in older adults

O’Hare, Celia; McCrory, Cathal; O’Connell, Matthew; Kenny, Rose Anne

doi:10.1002/gps.4485

Cited by 7 publications

(11 citation statements)

References 47 publications

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“…Of note and similar to our analysis a large variability in systolic blood pressure was reported as the most significant determinant of OH [15]. The age-related prevalence of OH with up to 30% in subjects older than 70 years observed in our study is in line with the literature [2,3]. Interestingly, current concepts focus on a bidirectional interaction of OH with multimorbidity in elderly people comprising hypertension, coronary heart disease and a higher risk for strokes [6], promoting cognitive dysfunction, falls and mortality [7][8][9].…”

Section: Discussionsupporting

confidence: 93%

“…reported a higher risk of Alzheimer's disease and vascular dementia in participants with OH . The pathogenic model of the interaction between OH and cognitive decline highlights episodes of cerebral hypoperfusion during orthostatic reactions , especially in interaction with an impaired autoregulation , causing cerebral small vessel disease mainly in subcortical, frontal and prefrontal areas. Thus, it is to be expected that alertness, the ability to concentrate and executive function in particular are affected in patients with OH .…”

Section: Introductionmentioning

confidence: 99%

“…The effect of OH on cognitive function remains contradictory in the literature depending on the age group, test battery (screening tool versus comprehensive multi-domain testing), covariates and study design. Several cross-sectional studies showed either no association with global cognitive function [3,10,11] or a significant association in terms of global cognitive decline [2,4,[12][13][14]. In a long-term analysis of the Rotterdam study, Wolters et al reported a higher risk of Alzheimer's disease and vascular dementia in participants with OH [15].…”

Section: Introductionmentioning

confidence: 99%

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

Zimmermann

Wurster

Lerche

et al. 2019

Euro J of Neurology

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Background and purpose Orthostatic hypotension is frequent with aging with a prevalence of 20%–30% in people aged 65 or older and is considered to increase the risk for coronary events, strokes and dementia. Our objective was to characterize the association of orthostatic hypotension and cognitive function longitudinally over 6 years in a large cohort of the elderly aged over 50 years. Methods In all, 495 participants were assessed longitudinally with the Schellong test and comprehensive cognitive testing using the extended CERAD neuropsychological test battery at baseline and after 6 years. In a subgroup of 92 participants, cerebral magnetic resonance imaging was evaluated for white matter changes using a modified version of the Fazekas score. Results The prevalence of orthostatic hypotension increases with aging reaching up to 30% in participants aged >70 years. Participants with orthostatic hypotension presented with a higher vascular burden index (1.03 vs. 0.69, P ≤ 0.001), tended to have a higher prevalence of cerebral white matter hyperintensities (91.7% vs. 68.8%, P = 0.091) and showed a faster deterioration in executive and memory function (Trail Making Test B 95 vs. 87 s, P ≤ 0.001; word list learning sum −0.53 vs. 0.38, P = 0.002) compared to participants without orthostatic hypotension. Conclusion Orthostatic hypotension seems to be associated with cognitive decline longitudinally.

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Section: Discussionsupporting

confidence: 93%

Section: Introductionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

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

Zimmermann

Wurster

Lerche

et al. 2019

Euro J of Neurology

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“…Specifically, several studies have reported a U-shaped relationship between blood pressure and cognitive function 1,3−8 . In fact, low basal blood pressure seems to be associated with appearance of dementia 1 , mild cognitive impairment (MCI) 9 , subjective cognitive decline 10 and poor cognitive performance on the MMSE (MiniMental State Examination) 11 . These findings can be explained by the relative parieto-temporal hypoperfusion created by low blood pressure.…”

Section: Introductionmentioning

confidence: 99%

“…In contrast, individuals with high systolic blood pressure and pulse rate were found to obtain better MMSE scores 14 . On the other hand, midlife systolic hypertension induces arterial stiffness, poor compliance 15 and a progressive reduction in baroreceptor sensitivity 16 which have been associated with cerebral white matter disease 10 and elevated plasma levels of Aβ40 3 . Therefore, both hypertension, as a risk factor for cerebrovascular damage, and also low late-life diastolic blood pressure may be recognised as risk factors for the development of dementia 17 .…”

Section: Introductionmentioning

confidence: 99%

Blood pressure and risk of cognitive impairment. The role of vascular disease in neurodegeneration.

Carmona-Abellán

Trzeciak

Recio-Fernandez

et al. 2019

Preprint

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Background: Both cerebral vascular disorders and cognitive decline increase in incidence with age. The role of cerebral vascular disease and hemodynamic changes in the development of cognitive deficits is controversial. The objective of this study was to assess cardiovascular response during cardiac stress testing in neurologically asymptomatic individuals who developed cognitive impairment several years after the cardiac stress testing.Methods: This is a retrospective cohort study of patients who underwent cardiac stress testing between January 2001 and December 2010. Patients were followed up until May 2015 and we selected those who developed cognitive dysfunction including dementia, mild cognitive impairment and subjective cognitive decline, after the stress test. Heart rate and blood pressure both at rest and at peak exercise and the mean R-R interval at rest were recorded. For each patient who developed cognitive impairment, we selected one matched control who did not show cognitive decline by the end of the follow-up period.Results: From this cohort of 7224 patients, 371 developed cognitive impairment; of these, 186 (124 men) met the inclusion criteria and 186 of the other patients were selected as matched controls. During follow-up, cognitive impairment appeared 6.2 ± 4.7 years after the cardiac stress test. These patients who subsequently developed cognitive impairment had significantly lower at-rest systolic, diastolic and mean blood pressure than controls (p<0.05). Further, compared with controls, their maximum heart rate was significantly higher at peak exercise and both systolic and diastolic blood pressures increased significantly more during exercise. Conclusion: The results from this study suggest that differences in cardiovascular response to stress are present in the preclinical phase of cognitive decline, serving as a potential risk factor for cognitive impairment. These findings challenge the potential use of blood pressure and heart rate variability at rest and during cardiac stress assessment as a risk factor for cognitive impairment.

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Orthostatic hypotension and cognition in older adults: A systematic review and meta-analysis

Iseli

Nguyen

Sharmin

et al. 2019

Experimental Gerontology

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Background: Orthostatic hypotension (OH) is common in older adults with reported prevalence rates of 5-40%. A direct link between OH and cognitive performance has been proposed due to impaired vascular autoregulation. Aim: To systematically assess the literature of the association between OH and cognitive performance in older adults. Methods: Literature search of MEDLINE, Embase, Cochrane Central Register of Controlled Trials and PsycINFO from inception to May 2017. Studies were included if OH and cognition were assessed in subjects of mean or median age ≥65 years. Risk of bias was assessed with the Newcastle Ottawa Scale. Results: Of 3266 studies screened, 32 studies (22 cross-sectional; 10 longitudinal) reporting data of 28,980 individuals were included. OH prevalence ranged from 3.3% to 58%. Of the 32 studies, 18 reported an association between OH and worse cognitive performance and 14 reported no association. Mini Mental State Examination (MMSE) was the most commonly used cognitive assessment tool. Studies using more than one cognitive assessment tool were more likely to find an association between OH and worse cognition. OH was significantly associated with a lower MMSE mean score (mean difference − 0.51 (95% CI: −0.85, −0.17, p = 0.003)) and an increased risk of cognitive impairment (OR 1.19 (95% CI, 1.00-1.42, p = 0.048)). Conclusions: OH is common in older populations and is associated with worse cognition expressed as lower MMSE scores. Use of MMSE alone as a cognitive assessment tool may underestimate the association. It is yet unclear whether the association between OH and worse cognitive performance is causative.

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Sub‐clinical orthostatic hypotension is associated with greater subjective memory impairment in older adults

Cited by 7 publications

References 47 publications

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

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

Blood pressure and risk of cognitive impairment. The role of vascular disease in neurodegeneration.

Orthostatic hypotension and cognition in older adults: A systematic review and meta-analysis

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