Department of Neurology, Juntendo University, 2-1-1, Hongo, Bunkyo Ward, Tokyo, 113-0033, Japan.
Department of Neurology, Juntendo University, 2-1-1, Hongo, Bunkyo Ward, Tokyo, 113-0033, Japan.
Parkinsonism Relat Disord. 2018 Jan;46:24-29. doi: 10.1016/j.parkreldis.2017.10.014. Epub 2017 Oct 20.
Circadian blood pressure alterations are frequently observed in Parkinson's disease, but the association between these changes and dementia in the condition remains unclear. Here, we assess the relationship between abnormal nocturnal blood pressure profiles and dementia in Parkinson's disease.
We enrolled 137 patients with Parkinson's disease, who underwent 24 h ambulatory blood pressure monitoring, following cognitive and clinical assessment.
Twenty-seven patients (19.7%) were diagnosed with dementia in this cohort. We observed significant associations of dementia with age, male gender, Hoehn-Yahr (H-Y) stage, diabetes mellitus, history of stroke, presence of cerebrovascular lesions on MRI, and orthostatic hypotension. Univariate logistic regression analysis showed that among the patterns of nocturnal blood pressure profiles, the riser pattern was significantly associated with dementia (OR 11.6, 95%CI: 2.14-215.0, P < 0.01), and this trend was observed after adjusting for all confounding factors except orthostatic hypotension (OR 19.2, 95%CI: 1.12-1960.3, P = 0.04). However, coexistence of a riser pattern and orthostatic hypotension was related to a higher prevalence of dementia (45.2%) than was a riser pattern alone (9.5%). Furthermore, coexistence of a riser pattern and orthostatic hypotension was significantly more associated with dementia than was a riser pattern alone, even after adjusting for confounders (OR 1625.1, 95%CI: 21.9-1343909.5, P < 0.01).
Our results suggest a relationship between a riser pattern coexisting with orthostatic hypotension and dementia in Parkinson's disease. Further prospective studies are warranted to investigate whether abnormal nocturnal blood pressure profiles predict dementia in Parkinson's disease.
在帕金森病中经常观察到昼夜血压变化，但这些变化与该疾病中的痴呆之间的关联尚不清楚。在这里，我们评估了帕金森病中异常夜间血压谱与痴呆之间的关系。
我们招募了 137 名帕金森病患者，他们在认知和临床评估后接受了 24 小时动态血压监测。
在该队列中，27 名患者（19.7%）被诊断为痴呆。我们观察到痴呆与年龄、男性、Hoehn-Yahr （H-Y）分期、糖尿病、中风史、MRI 上存在脑血管病变以及直立性低血压显著相关。单变量逻辑回归分析显示，在夜间血压谱模式中，上升模式与痴呆显著相关（OR 11.6，95%CI：2.14-215.0，P<0.01），并且这种趋势在排除直立性低血压以外的所有混杂因素后仍然存在（OR 19.2，95%CI：1.12-1960.3，P=0.04）。然而，上升模式和直立性低血压共存与更高的痴呆患病率（45.2%）相关，而上升模式单独存在时的痴呆患病率为 9.5%。此外，即使在调整混杂因素后，上升模式和直立性低血压共存与痴呆的相关性也明显高于上升模式单独存在（OR 1625.1，95%CI：21.9-1343909.5，P<0.01）。
我们的结果表明，帕金森病中上升模式与直立性低血压共存与痴呆之间存在关系。需要进一步的前瞻性研究来研究异常夜间血压谱是否可以预测帕金森病中的痴呆。
