Effects of orthostatic hypotension on cognition in Parkinson disease
Centi, Justin; Freeman, Roy; Gibbons, Christopher H.; Neargarder, Sandy; Canova, Alexander O.; Cronin-Golomb, Alice
OBJECTIVE: To investigate the relation between orthostatic hypotension (OH) and posturemediated
cognitive impairment in Parkinson disease (PD) using a cross-sectional and withingroup
design.
METHODS: Individuals without dementia with idiopathic PD included 18 with OH (PDOH) and
19 without OH; 18 control participants were also included. Neuropsychological tests were
conducted in supine and upright-tilted positions. Blood pressure was assessed in each posture.
RESULTS: The PD groups performed similarly while supine, demonstrating executive dysfunction in
sustained attention and response inhibition, and reduced semantic fluency and verbal memory
(encoding and retention). Upright posture exacerbated and broadened these deficits in the PDOH
group to include phonemic fluency, psychomotor speed, and auditory working memory. When
group-specific supine scores were used as baseline anchors, both PD groups showed cognitive
changes following tilt, with the PDOH group exhibiting a wider range of deficits in executive function
and memory as well as significant changes in visuospatial function.
CONCLUSIONS: Cognitive deficits in PD have been widely reported with assessments performed in
the supine position, as seen in both our PD groups. Here we demonstrated that those with PDOH
had transient, posture-mediated changes in excess of those found in PD without OH. These
observed changes suggest an acute, reversible effect. Understanding the effects of OH due to
autonomic failure on cognition is desirable, particularly as neuroimaging and clinical assessments
collect data only in the supine or seated positions. Identification of a distinct neuropsychological
profile in PD with OH has quality of life implications, and OH presents itself as a possible target for
intervention in cognitive disturbance.
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