Relationship between orthostatic hypotension and cognitive impairment in the elderly

Mehrabian, Shima; Duron, Emmanuelle; Labourée, F.; Rollot, Florence; Bune, Alexandra J.; Traykov, Latchezar; Hanon, Olivier

doi:10.1016/j.jns.2010.08.056

Cited by 118 publications

(86 citation statements)

References 32 publications

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“…Other possible frailty‐related symptoms, such as orthostatic hypotension, are also associated with cognitive dysfunction and dementia 26. We previously showed that decreased one‐leg standing time was significantly related to cognitive dysfunction 22.…”

Section: Discussionmentioning

confidence: 99%

Muscle mass decline, arterial stiffness, white matter hyperintensity, and cognitive impairment: Japan Shimanami Health Promoting Program study

Kohara

Okada

Ochi

et al. 2017

J cachexia sarcopenia muscle

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BackgroundThere is a close association between frailty and cognitive impairment. However, the underlying contribution of sarcopenia to the development of cognitive impairment is unclear. We investigated the possible association between muscle mass decline and cognitive impairment in a cross‐sectional study of 1518 subjects aged 55 years or above. We also evaluated arterial stiffness and white matter hyperintensities (WMHs) as possible underlying mechanisms for this association.MethodsTwo sarcopenic indices were measured: thigh muscle cross‐sectional area (CSA; calculated by computed tomography) and skeletal muscle mass (bioelectric impedance). Muscle mass decline was defined as either the bottom 10% or 20% of participants for each sex. Cognitive function was assessed using the Touch Panel‐type Dementia Assessment Scale, and brachial–ankle pulse wave velocity was measured as an index of arterial stiffness.ResultsBoth sarcopenic indices were modestly but significantly associated with brachial–ankle pulse wave velocity in male and female subjects. The presence of WMHs was significantly associated with low thigh muscle CSA in men and with low skeletal muscle mass in women. The Touch Panel‐type Dementia Assessment Scale score was modestly but significantly and positively associated with thigh muscle CSA in men and skeletal muscle mass in women. Muscle mass decline in the bottom 10% of participants on both sarcopenic indices was significantly and independently related to cognitive impairment in women.ConclusionsLower sarcopenic indices are significantly related to lower cognitive scores. Arterial stiffness and WMHs could account, at least in part, for this association.

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Section: Discussionmentioning

confidence: 99%

Muscle mass decline, arterial stiffness, white matter hyperintensity, and cognitive impairment: Japan Shimanami Health Promoting Program study

Kohara

Okada

Ochi

et al. 2017

J cachexia sarcopenia muscle

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“…41,74 Although the relation between orthostatic hypotension and fall risk has been shown in several studies, [74][75][76][77] studies on the relation between orthostatic hypotension and cognitive impairment are less consistent and causality is unclear. 41,78 Also, whether there are differences between symptomatic and asymptomatic orthostatic hypotension with respect to risk of functional impairment is unknown and warrants further research. 41 Furthermore, no studies of orthostatic hypotension have been done in a population selected for having hypertension.…”

Section: Risk Of Functional Disabilitiesmentioning

confidence: 99%

Treatment of Hypertension in the Oldest Old

et al. 2014

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A n 88-year-old woman with chronic hypertension was seen in the internal/geriatric medicine outpatient clinic. She had been treated for high blood pressure (BP) for ≈20 years with a low-dose thiazide, to which an angiotensin-converting enzyme-inhibitor had been added 5 years ago. In addition, after a possible transient ischemic attack 10 years ago, aspirin, omeprazole, and simvastatin had been added. She is known with mild cognitive impairment, which is stable with a mini-mental state examination score of 25, and a mild depression for which fluoxetine has been prescribed. In addition, she experienced 2 falls in the past 2 years; calcium/vitamin D and alendronate were started for the management of osteoporosis. On physical examination, she appears vital with a normal fluent gait and no signs of hemiparesis. Her BP is 165/75 mm Hg in the sitting position. Immediately after standing up from her chair, she feels dizzy for ≈10 seconds, but after 1 and 3 minutes, no orthostatic hypotension is found. Estimated glomerular filtration rate is 50 mL/min per 1.73 m 2 . Should antihypertensive treatment be intensified, left unaltered, or reduced?The oldest old, that is, persons aged ≥80 years, will be the fastest growing segment of the population for the next 40 years. By 2050, more than one quarter of all men and women aged ≥65 years in the Western world will be in the oldest old group. 1Despite longer life expectancy, the prevalence of various chronic diseases and functional impairment increases with age. As a result, populations of older individuals are often highly heterogeneous and individuals with same chronological age vary widely in health and functional ability. In other words, there is substantial heterogeneity in their biological age, and those at the higher end of biological age are often referred to as vulnerable or frail.BP rises with age, and ≈80% of people in Western societies aged ≥80 years have hypertension.2 Their hypertension is commonly characterized by elevated systolic BP, with often normal or even low diastolic BP. The widened pulse pressure (PP) is a reflection of increased arterial stiffness. Despite the large body of evidence in middle-aged populations, the predictive value of high BP in this rapidly growing older population is still debated, as is the question of whether hypertension should be treated, and if so, how intensively. Importantly, the current paradigm of lower is better may not apply to (untreated or treated) BP in the oldest old.In this concise narrative review, we summarize evidence from observational studies and randomized clinical trials. We conclude that biological age/frailty is becoming an important criterion for treatment decisions. Finally, we address what we think are the most pressing research questions for the coming years. Pathophysiology of BP Regulation in the Oldest OldAlthough hypertension in the oldest old may reflect a longstanding condition, often it manifests itself as a de novo abnormality. Data from the Framingham Heart Study indicate that the majority of patient...

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“…[11][12][13][14] Among elderly individuals, cognitive decline and other neurobehavioral signs are associated with low blood pressure, pressure fluctuations, and nondipping. [15][16][17][18][19] The hypothesis tested in this study was that neurocirculatory abnormalities may contribute to cognitive abnormalities accompanying early PD. We assessed whether cognitive abnormalities or white matter intensities on MRI were related to OH, SH, or nondipping by investigating associations among cognitive data from a variety of rating scales, neurocirculatory data from head-up tilt testing and 24-hour ambulatory blood pressure monitoring, and neuroimaging data from a quantitative measure of white matter hyperintensities seen on MRI in Korean patients with early PD.…”

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confidence: 99%

Association of cognitive dysfunction with neurocirculatory abnormalities in early Parkinson disease

et al. 2012

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Objective: Cognitive impairment and neurocirculatory abnormalities such as orthostatic hypotension (OH), supine hypertension (SH), and failure to decrease blood pressure at night (nondipping) occur relatively commonly in Parkinson disease (PD); however, whether cognitive dysfunction in early PD is related to neurocirculatory abnormalities has not been established. Cognitive dysfunction in PD is associated with white matter hyperintensities on MRI. We report results of an analysis of neuropsychological and hemodynamic parameters in patients with early PD.Methods: Among 87 patients, 25 had normal cognition, 48 had mild cognitive impairment, and 14 had dementia, based on comprehensive neuropsychological tests. Orthostatic vital signs and ambulatory 24-hour blood pressure monitoring were recorded, and brain magnetic resonance scans were obtained for all patients. Results:Cognitive impairment was associated with OH, SH, and white matter hyperintensities but not with nondipping. Dementia and white matter hyperintensities were common in SH. Of 13 patients with OH ϩ SH, every one had mild cognitive impairment or dementia. Conclusions:Cognitive dysfunction is related to neurocirculatory abnormalities, especially OH ϩ SH, in early PD, raising the possibility that early detection and effective treatment of those abnormalities might slow the rate of cognitive decline. Neurology It is increasingly being recognized that Parkinson disease (PD) involves prominent nonmotor manifestations such as dementia and autonomic failure.A variety of neurocirculatory abnormalities have been noted in PD, including orthostatic hypotension (OH), 1-4 supine hypertension (SH), 5-7 labile blood pressure, and the absence of a decrease in pressure during the night, a phenomenon called nondipping. 8 These abnormalities are related to each other. SH is found in a substantial proportion of patients with PD with OH.

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Relationship between orthostatic hypotension and cognitive impairment in the elderly

Cited by 118 publications

References 32 publications

Muscle mass decline, arterial stiffness, white matter hyperintensity, and cognitive impairment: Japan Shimanami Health Promoting Program study

Muscle mass decline, arterial stiffness, white matter hyperintensity, and cognitive impairment: Japan Shimanami Health Promoting Program study

Treatment of Hypertension in the Oldest Old

Association of cognitive dysfunction with neurocirculatory abnormalities in early Parkinson disease

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