Feeney Joanne, O'Leary Neil, Kenny Rose Anne
Centre for Public Health, Institute of Clinical Sciences, Block B, Queens University Belfast, Royal Victoria Hospital, Grosvenor Road, Belfast, BT12 6BA, UK.
The Irish Longitudinal Study on Ageing, Trinity College Dublin, Dublin 2, Ireland.
Clin Auton Res. 2016 Apr;26(2):127-33. doi: 10.1007/s10286-016-0340-3. Epub 2016 Mar 11.
Prospective investigations of the association between impaired orthostatic blood pressure (BP) regulation and cognitive decline in older adults are limited, and findings to-date have been mixed. The aim of this study was to determine whether impaired recovery of orthostatic BP was associated with change in cognitive function over a 2-year period, in a population based sample of community dwelling older adults.
Data from the first two waves of the Irish Longitudinal Study on Ageing were analysed. Orthostatic BP was measured during a lying to standing orthostatic stress protocol at wave 1 using beat-to-beat digital plethysmography, and impaired recovery of BP at 40 s post stand was investigated. Cognitive function was assessed at wave 1 and wave 2 (2 years later) using the Mini-Mental State Exam (MMSE), verbal fluency and word recall tasks.
After adjustment for measured, potential confounders, and multiple imputation for missing data, the change in the number of errors between waves on the MMSE was 10 % higher [IRR (95 % CI) = 1.10 (0.96, 1.26)] in those with impaired recovery at 40 s. However, this was not statistically significant (p = 0.17). Impaired BP recovery was not associated with change in performance on any of the other cognitive measures.
There was no clear evidence for an association between impaired recovery of orthostatic BP and change in cognition over a 2-year period in this nationally representative cohort of older adults. Longer follow-up and more detailed cognitive testing would be advantageous to further investigate the relationship between orthostatic BP and cognitive decline.
关于老年人直立性血压（BP）调节受损与认知功能下降之间关联的前瞻性研究有限，且迄今为止的研究结果不一。本研究的目的是在一个基于社区居住老年人的人群样本中，确定直立性BP恢复受损是否与2年内认知功能的变化有关。
分析了爱尔兰纵向老龄化研究前两波的数据。在第1波时，使用逐搏数字体积描记法在从卧位到站立的直立应激方案中测量直立性BP，并研究站立后40秒时BP的恢复受损情况。在第1波和第2波（2年后）使用简易精神状态检查表（MMSE）、语言流畅性和单词回忆任务评估认知功能。
在对测量的潜在混杂因素进行调整以及对缺失数据进行多重插补后，40秒时恢复受损的人群中，MMSE各波间错误数量的变化高出10%[IRR（95%CI）=1.10（0.96，1.26）]。然而，这在统计学上并不显著（p=0.17）。BP恢复受损与任何其他认知指标的表现变化均无关联。
在这个具有全国代表性的老年人群队列中，没有明确证据表明直立性BP恢复受损与2年内认知变化之间存在关联。更长时间的随访和更详细的认知测试将有助于进一步研究直立性BP与认知下降之间的关系。
