Association of orthostatic blood pressure with the symptoms of orthostatic hypotension and cognitive impairment in patients with multiple system atrophy

Introduction: The aim of this study is to investigate the impact of orthostatic hypotension (OH) on cognitive functions in patients with multiple system atrophy (MSA) followed over time.Methods: Thirty-two MSA patients were enrolled and underwent a comprehensive neuropsychological battery; at baseline (T0) 15 out of 32 patients presented OH, assessed by means of orthostatic standing test. All patients underwent a follow-up (T1) evaluation 12 months after baseline. Thirteen out of 32 patients also underwent a second follow-up (T2) evaluation at 24 months. Changes over time on different neuropsychological tasks were compared between patients with and without OH by means of Mann-Whitney's U-test. Moreover, clinical categories of normal cognition, mild cognitive impairment, and dementia were determined, and changes at T1 and T2 in global cognitive status were compared between patients with and without OH.Results: At T0, patients with OH had better performance on words/non-words repetition task (p = 0.02) compared to patients without OH. Compared to patients without OH, patients with OH performed worse on semantic association task (p < 0.01) at T1 and on Stroop test-error effect (p = 0.04) at T2. The percentage of patients with worsened cognitive status at T1 was higher among patients with OH than among patients without OH (93 vs. 59%, p = 0.03). OH (β = −4.67, p = 0.01), education (β = 0.45, p = 0.02), age (β = 0.19, p = 0.03), and Montreal Cognitive Assessment battery (MOCA) score at T0 (β = −0.26, p = 0.04) were significant predictors of global cognitive status worsening at T1.Discussion: We found that global cognitive status worsened at 1-year follow-up in 93% of patients with OH, and OH, along with age, education, and MOCA score, predicted cognitive worsening over time. To clarify the relationship between OH and cognitive dysfunction in MSA, we suggest the use of clinical categories of normal cognition, mild cognitive impairment, and dementia in further longitudinal studies on MSA patients with and without OH.

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Ambulatory blood pressure and drug treatment for orthostatic hypotension as predictors of mortality in patients with Multiple System Atrophy

European Journal of Neurology ◽

10.1111/ene.15232 ◽

2021 ◽

Author(s):

Anne Pavy‐Le Traon ◽

Alexandra Foubert‐Samier ◽

Fabienne Ory‐Magne ◽

Margherita Fabbri ◽

Jean‐Michel Senard ◽

...

Keyword(s):

Blood Pressure ◽

Drug Treatment ◽

Multiple System Atrophy ◽

Orthostatic Hypotension ◽

Ambulatory Blood Pressure ◽

Predictors Of Mortality

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Patterns of Orthostatic Blood Pressure Changes in Patients with Orthostatic Hypotension

Journal of Clinical Neurology ◽

10.3988/jcn.2018.14.3.283 ◽

2018 ◽

Vol 14 (3) ◽

pp. 283 ◽

Cited By ~ 3

Author(s):

Hung Youl Seok ◽

Yoo Hwan Kim ◽

Hayom Kim ◽

Byung-Jo Kim

Keyword(s):

Blood Pressure ◽

Orthostatic Hypotension ◽

Orthostatic Blood Pressure ◽

Pressure Changes

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Potential contribution of diabetes mellitus to orthostatic blood pressure fall and conversion of mild cognitive impairment to dementia

Clinical Interventions in Aging ◽

10.2147/cia.s103638 ◽

2016 ◽

pp. 83

Author(s):

Fatih Tufan ◽

Sevilay Muratli ◽

Ozlem SOYLUK ◽

Gulistan BAHAT ◽

Mehmet Akif KARAN

Keyword(s):

Diabetes Mellitus ◽

Blood Pressure ◽

Cognitive Impairment ◽

Mild Cognitive Impairment ◽

Potential Contribution ◽

Blood Pressure Fall ◽

Orthostatic Blood Pressure ◽

Pressure Fall

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Schwindel und Blutdruck

DMW - Deutsche Medizinische Wochenschrift ◽

10.1055/a-0873-2423 ◽

2019 ◽

Vol 144 (12) ◽

pp. 795-798

Author(s):

Martin Middeke

Keyword(s):

Blood Pressure ◽

Multiple System Atrophy ◽

Neurodegenerative Diseases ◽

Orthostatic Hypotension ◽

Autonomic Dysfunction ◽

Broad Spectrum

AbstractDizziness is most frequently caused by blood pressure dysregulation comprising a broad spectrum from constitutional and orthostatic hypotension to severe conditions like endocrinopathies and neurodegenerative diseases with autonomic dysfunction like in multiple system atrophy.

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Orthostatic Hypotension and Novel Blood Pressure Associated Gene Variants in Older Adults: Data From the TILDA Study

The Journals of Gerontology Series A ◽

10.1093/gerona/glz286 ◽

2019 ◽

Vol 75 (11) ◽

pp. 2074-2080

Author(s):

Eamon Laird ◽

Aisling M O’halloran ◽

Artur Fedorowski ◽

Olle Melander ◽

Ann Hever ◽

...

Keyword(s):

Blood Pressure ◽

Older Adults ◽

Logistic Regression ◽

Orthostatic Hypotension ◽

Genetic Variants ◽

Incidence Rate Ratio ◽

Nucleotide Polymorphism ◽

Single Nucleotide ◽

Increased Risk ◽

Orthostatic Blood Pressure

Abstract Orthostatic hypotension (OH) is associated with increased risk of trauma and cardiovascular events. Recent studies have identified new genetic variants that influence orthostatic blood pressure (BP). The aim of this study was to investigate the associations of candidate gene loci with orthostatic BP responses in older adults. A total of 3,430 participants aged ≥50 years from The Irish Longitudinal Study on Ageing (TILDA) with BP measures and genetic data from 12 single-nucleotide polymorphism (SNP) linked to BP responses were analyzed. Orthostatic BP responses were recorded at each 10 s interval and were defined as OH (SBP drop ≥20 mmHg or DBP drop ≥10 mmHg) at the time-points 40, 90, and 110 s. We defined sustained OH (SOH) as a drop that exceeded consensus BP thresholds for OH at 40, 90, and 110 s after standing. Logistic regression analyses modeled associations between the candidate SNP alleles and OH. We report no significant associations between OH and measured SNPs after correction for multiple comparisons apart from the SNP rs5068 where proportion of the minor allele was significantly different between cases and controls for SOH 40 (p = .002). After adjustment for covariates in a logistic regression, those with the minor G allele (compared to the A allele) had a decreased incidence rate ratio (IRR) for SOH 40 (IRR 0.45, p = .001, 95% CI 0.29–0.72). Only one SNP linked with increased natriuretic peptide concentrations was associated with OH. These results suggest that genetic variants may have a weak impact on OH but needs verification in other population studies.

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