‘Under pressure’: is there a link between orthostatic hypotension and cognitive impairment in α-synucleinopathies?

Udow, Sean; Robertson, Andrew D.; MacIntosh, Bradley J.; Espay, Alberto J.; Rowe, James B.; Lang, Anthony E.; Masellis, Mario

doi:10.1136/jnnp-2016-314123

Cited by 83 publications

(100 citation statements)

References 60 publications

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“…Interestingly, autonomic dysfunction is associated with reduced amygdala grey matter volume,30 an area that has been proposed as part of the anatomical substrate of ICB 24. However, the lower SCOPA-AUT scores in patients with ICBs might be explained by loss of peripheral sympathetic or parasympathetic nerve terminals 31.…”

Section: Discussionmentioning

confidence: 99%

Can we predict development of impulsive–compulsive behaviours in Parkinson’s disease?

Ricciardi

Lambert

Morgante³

et al. 2017

J Neurol Neurosurg Psychiatry

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Section: Discussionmentioning

confidence: 99%

Can we predict development of impulsive–compulsive behaviours in Parkinson’s disease?

Ricciardi

Lambert

Morgante³

et al. 2017

J Neurol Neurosurg Psychiatry

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“…It is well established that anxiety and depression are both frequently found in MSA patients and possibly influence cognitive function. Additionally, orthostatic hypotension (OH) may also be associated with cognitive impairment in MSA, although the underlying mechanisms have not been established yet …”

Section: Introductionmentioning

confidence: 99%

Cognition in multiple system atrophy: a single‐center cohort study

Eschlböck

Delazer

Krismer

et al. 2020

Ann Clin Transl Neurol

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Objective Cognitive impairment in multiple system atrophy (MSA) is common, but remain poorly characterized. We evaluated cognitive and behavioral features in MSA patients and assessed between‐group differences for MSA subtypes and the effect of orthostatic hypotension (OH) on cognition. Methods This retrospective study included 54 patients with clinical diagnosis of possible and probable MSA referred to the Department of Neurology at Medical University of Innsbruck between 2000 and 2018. Neurological work‐up included comprehensive neuropsychological testing including Consortium to Establish a Registry for Alzheimer's Disease (CERAD‐plus) test battery, Frontal Assessment Battery (FAB), digit span test (DST), clock drawing task (CLOX1), and Hospital Anxiety and Depression Scale (HADS‐D). Results The mean MMSE score was 27.6 points. Overall, slight to moderate cognitive impairment was noted in up to 40% of patients, with predominant impairment of executive function and verbal memory. Patients with the cerebellar variant performed significantly worse than patients with the parkinsonian type (P < 0.05) in a screening of executive functions (FAB) and in phonemic verbal fluency. Depression and anxiety scores were elevated in 28% and 22% of MSA patients, respectively. Cognitive profile, depression, and anxiety levels were comparable between patients with and without OH. Interpretation Cognitive deficits are relatively frequent in MSA and primarily affect executive functions and verbal memory. Future comparative studies including Parkinson dementia, Lewy body disease, and MSA cases with and without OH are required to elucidate disease‐specific cognitive profiles in these synucleinopathies and to examine the influence of cardiovascular autonomic dysfunction on cognitive function in MSA.

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“…We also aimed to explore the mediating role of known magnetic resonance imaging (MRI) markers of brain health namely cerebral small vessel disease and gray matter atrophy. Examining the central nervous system pathways linking OBP to CS is important because accumulating evidence suggests that higher brain centers may be involved in cardiovascular autonomic regulation [13] and OBP levels [14]. Additionally, it has been postulated that lower OBP may relate to CS via cerebral hypoperfusion [14], to which watershed areas of the cortex may be particularly vulnerable [15].…”

Section: Introductionmentioning

confidence: 99%

Cognitive Status, Gray Matter Atrophy, and Lower Orthostatic Blood Pressure in Older Adults

O’Hare

Kenny

Aizenstein

et al. 2017

JAD

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Background Associations between orthostatic blood pressure and cognitive status (CS) have been described with conflicting results. Objective We hypothesize that long-term exposure to lower orthostatic blood pressure is related to having worse CS later in life and that atrophy of regions involved in central regulation of autonomic function mediate these associations. Methods Three-to-four measures of orthostatic blood pressure were obtained from 1997–2003 in a longitudinal cohort of aging, and average systolic orthostatic blood pressure response (ASOBPR) was computed as % change in systolic blood pressure from sit-to-stand measured at one minute post stand. CS was determined in 2010–2012 by clinician-adjudication (n = 240; age = 87.1±2.6; 59% women; 37% black) with a subsample also undergoing concurrent structural neuroimaging (n = 129). Gray matter volume of regions related to autonomic function was measured. Multinomial regression was used to compare ASOBPR in those who were cognitively intact versus those with a diagnosis of mild cognitive impairment or dementia, controlling for demographics, trajectories of seated blood pressure, incident cardiovascular risk/events and medications measured from 1997 to 2012. Models were repeated in the subsample with neuroimaging, before and after adjustment for regional gray matter volume. Results There was an inverse association between ASOBPR and probability of dementia diagnosis (9% lower probability for each % point higher ASOBPR: OR 0.91, CI95% = 0.85–0.98; p = 0.01). Associations were similar in the subgroup with neuroimaging before and after adjustment for regional gray matter volume. Conclusion ASOBPR may be an early marker of risk of dementia in older adults living in the community.

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‘Under pressure’: is there a link between orthostatic hypotension and cognitive impairment in α-synucleinopathies?

Cited by 83 publications

References 60 publications

Can we predict development of impulsive–compulsive behaviours in Parkinson’s disease?

Can we predict development of impulsive–compulsive behaviours in Parkinson’s disease?

Cognition in multiple system atrophy: a single‐center cohort study

Cognitive Status, Gray Matter Atrophy, and Lower Orthostatic Blood Pressure in Older Adults

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