Jonathan Silver, MD reviewing Centi J et al. Neurology 2016 Nov 30. Boylan LS and Messinis L. Neurology 2016 Nov 30.

Cognition worsens in these patients when they are sitting up. Is this also true for other patients with cognitive impairment?

Parkinson disease (PD) and other synucleinopathies have been associated with orthostatic hypotension (OH), which can be both asymptomatic and linked to cognitive impairment. In a systematic review, the relationship between OH and cognitive impairment in these disorders was potentially explained by the deposition of alpha-synuclein in both the brain and the peripheral nervous system, by the direct effect of OH on brain function, or by a synergistic effect (J Neurol Neurosurg Psychiatry 2016 Sep 9; [e-pub]). Now, researchers have directly examined the relationship in 37 patients with mild-to-moderate PD and no dementia (18 with OH and 19 without) and 18 non-PD controls.

Exclusions were severe dizziness or lightheadedness, tachycardia (>150 beats per minute), or systolic blood pressure consistent with syncope or presyncope. Orthostatic changes and cognition were assessed after 5 minutes supine and after 15 minutes in a 60-degree tilted position. Baseline pulse and blood pressure did not differ between groups. Unlike the other groups, cognitive deficits broadened in the OH patient group when upright relative to supine on nearly all measures.

CITATION(S):

Centi J et al. Effects of orthostatic hypotension on cognition in Parkinson disease. Neurology 2016 Nov 30; [e-pub].

Boylan LS and Messinis L.Orthostatic hypotension, cognition, and Parkinson disease: Dumbing down by standing up. Neurology 2016 Nov 30; [e-pub]. 

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