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

Abstract

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.

Orthostatic hypotension in older people: considerations, diagnosis and management

“…41,42 Cognitive impairment OH is associated with cognitive decline and dementia. [43][44][45][46][47] One meta-analysis estimates an increased dementia risk of 21%. 43 In a memory clinic cohort, OH correlated with the severity of cognitive deficits, particularly executive function.…”

Orthostatic hypotension and health outcomes: an umbrella review of observational studies

“…We initially identified 975 papers. Of these, 22 full texts were screened and finally 7 meta-analyses [34][35][36][37][38][39][40], which included 12 different outcomes, were included as reported in Figure 1. Table 1 summarises the main findings of our umbrella review.…”

Multimodal Monitoring of Cardiovascular Responses to Postural Changes

“…Orthostatic hypotension (OH), defined as a blood pressure (BP) drop of at least 20 mm Hg systolic and/or >10 mm Hg diastolic after postural change (Freeman et al, 2011), is highly prevalent in older adults (Cooke et al, 2013;Frewen et al, 2014;Timmermans et al, 2018), whereas the effectiveness of non-pharmacological interventions are limited (De Bruïne et al, 2017). OH may be accompanied by clinical symptoms, e.g., lightheadedness and dizziness (Juraschek et al, 2017(Juraschek et al, , 2018, and is associated with poor clinical outcome such as impaired physical performance (Pasma et al, 2014;de Bruïne et al, 2018;Mol et al, 2018b), falls (Saedon et al, 2016;Mol et al, 2018a), cognition (Iseli et al, 2019), cardiovascular diseases (Verwoert et al, 2008;Ricci et al, 2015) and mortality (Verwoert et al, 2008;Lagro et al, 2012;Rockwood et al, 2012;Ricci et al, 2015;Frith et al, 2016). Sensitivity for the diagnosis of OH is higher for continuous BP measurement than for intermittent BP measurements after standing up, and continuous BP measurement has shown to be stronger associated with physical performance (Pasma et al, 2014;de Bruïne et al, 2018).…”