Riley David E, Espay Alberto J
Department of Medical Education, InMotion, Warrensville Heights, OH USA.
2UC Gardner Neuroscience Institute and Gardner Family Center for Parkinson's Disease and Movement Disorders, Department of Neurology, University of Cincinnati, 260 Stetson St, Ste 2300, Cincinnati, OH 45267-0525 USA.
J Clin Mov Disord. 2018 Feb 13;5:1. doi: 10.1186/s40734-018-0068-4. eCollection 2018.
Cognitive fluctuations refer to alterations in cognition, attention, or arousal occurring over minutes to hours, most commonly in patients with dementias associated with advanced Lewy body pathology. Their pathophysiologic underpinning remains undetermined.
We documented serial blood pressure (BP) measurements in an 86-year-old man with Parkinson's disease dementia experiencing cognitive fluctuations during an office visit. This patient's associated dysautonomia included labile BP with orthostatic hypotension and nocturnal hypertension. A spontaneous episode of unresponsiveness occurred while his BP was 72/48. His mental status began to recover immediately as his BP increased to 84/56 when he was placed in a recumbent position; it fully returned to baseline when it reached 124/66 within 1 min. His heart rate remained in the mid-to-high 60s throughout. Subsequent treatment with midodrine markedly reduced the frequency of cognitive fluctuations.
Paroxysmal hypotension may represent an explanatory mechanism for cognitive fluctuations, a common clinical feature in patients with Parkinson's disease dementia and dementia with Lewy bodies.
认知波动是指在数分钟至数小时内发生的认知、注意力或觉醒状态的改变，最常见于与晚期路易体病理相关的痴呆患者。其病理生理基础尚不清楚。
我们记录了一名86岁帕金森病痴呆男性患者在门诊就诊期间出现认知波动时的连续血压测量值。该患者相关的自主神经功能障碍包括血压不稳定、体位性低血压和夜间高血压。当他的血压为72/48时，发生了一次自发的无反应发作。当他被置于卧位时，随着血压升至84/56，他的精神状态立即开始恢复；当血压在1分钟内达到124/66时，精神状态完全恢复到基线水平。他的心率始终保持在60多次/分钟的中高水平。随后使用米多君治疗显著降低了认知波动的频率。
阵发性低血压可能是认知波动的一种解释机制，认知波动是帕金森病痴呆和路易体痴呆患者的常见临床特征。
