Department of Medicine and Aged Care, @AgeMelbourne, The Royal Melbourne Hospital, The University of Melbourne, Parkville, Victoria, Australia.
Department of Medicine and Aged Care, @AgeMelbourne, The Royal Melbourne Hospital, The University of Melbourne, Parkville, Victoria, Australia.
Exp Gerontol. 2019 Jun;120:40-49. doi: 10.1016/j.exger.2019.02.017. Epub 2019 Feb 28.
Orthostatic hypotension (OH) is common in older adults with reported prevalence rates of 5-40%. A direct link between OH and cognitive performance has been proposed due to impaired vascular autoregulation.
To systematically assess the literature of the association between OH and cognitive performance in older adults.
Literature search of MEDLINE, Embase, Cochrane Central Register of Controlled Trials and PsycINFO from inception to May 2017. Studies were included if OH and cognition were assessed in subjects of mean or median age ≥65 years. Risk of bias was assessed with the Newcastle Ottawa Scale.
Of 3266 studies screened, 32 studies (22 cross-sectional; 10 longitudinal) reporting data of 28,980 individuals were included. OH prevalence ranged from 3.3% to 58%. Of the 32 studies, 18 reported an association between OH and worse cognitive performance and 14 reported no association. Mini Mental State Examination (MMSE) was the most commonly used cognitive assessment tool. Studies using more than one cognitive assessment tool were more likely to find an association between OH and worse cognition. OH was significantly associated with a lower MMSE mean score (mean difference - 0.51 (95% CI: -0.85, -0.17, p = 0.003)) and an increased risk of cognitive impairment (OR 1.19 (95% CI, 1.00-1.42, p = 0.048)).
OH is common in older populations and is associated with worse cognition expressed as lower MMSE scores. Use of MMSE alone as a cognitive assessment tool may underestimate the association. It is yet unclear whether the association between OH and worse cognitive performance is causative.
体位性低血压（OH）在老年人中很常见，其报告发病率为 5-40%。由于血管自动调节受损，OH 与认知表现之间存在直接联系。
系统评估 OH 与老年人认知表现之间关联的文献。
对 MEDLINE、Embase、Cochrane 对照试验中心注册库和 PsycINFO 从创建到 2017 年 5 月的文献进行检索。如果 OH 和认知在平均或中位年龄≥65 岁的受试者中进行评估，则纳入研究。使用纽卡斯尔-渥太华量表评估偏倚风险。
在筛选的 3266 项研究中，纳入了 32 项研究（22 项横断面研究；10 项纵向研究），共报告了 28980 名个体的数据。OH 的患病率从 3.3%到 58%不等。在这 32 项研究中，有 18 项研究报告 OH 与认知功能下降之间存在关联，有 14 项研究报告两者之间无关联。简易精神状态检查（MMSE）是最常用的认知评估工具。使用多种认知评估工具的研究更有可能发现 OH 与认知障碍之间的关联。OH 与 MMSE 平均得分较低显著相关（平均差异 -0.51（95%CI：-0.85，-0.17，p=0.003））和认知障碍风险增加（OR 1.19（95%CI，1.00-1.42，p=0.048））。
OH 在老年人群中很常见，与认知功能下降有关，表现为 MMSE 得分较低。单独使用 MMSE 作为认知评估工具可能会低估这种关联。OH 与认知功能下降之间的关联是否具有因果关系尚不清楚。
