Hamilton Calum A, Frith James, Donaghy Paul C, Barker Sally A H, Durcan Rory, Lawley Sarah, Barnett Nicola, Firbank Michael, Roberts Gemma, Taylor John-Paul, Allan Louise M, O'Brien John, Yarnall Alison J, Thomas Alan J
Translational and Clinical Research Institute, Biomedical Research Building, Campus for Ageing and Vitality, Newcastle University, Newcastle upon Tyne, UK.
Population Health Sciences Institute, Newcastle University, Newcastle upon Tyne, UK.
Int J Geriatr Psychiatry. 2022 May;37(5). doi: 10.1002/gps.5709.
Orthostatic hypotension is a common feature of normal ageing, and age-related neurodegenerative diseases, in particular the synucleinopathies including dementia with Lewy bodies. Orthostatic hypotension and other abnormal cardiovascular responses may be early markers of Lewy body disease. We aimed to assess whether abnormal blood pressure and heart rate responses to orthostatic challenge and Valsalva manoeuvre would be more common in mild cognitive impairment with Lewy bodies (MCI-LB) than MCI due to Alzheimer's disease (MCI-AD).
MCI patients (n = 89) underwent longitudinal clinical assessment with differential classification of probable MCI-LB, possible MCI-LB, or MCI-AD, with objective autonomic function testing at baseline. Blood pressure and heart rate responses to active stand and Valsalva manoeuvre were calculated from beat-to-beat cardiovascular data, with abnormalities defined by current criteria, and age-adjusted group differences estimated with logistic models.
Orthostatic hypotension and abnormal heart rate response to orthostatic challenge were not more common in probable MCI-LB than MCI-AD. Heart rate abnormalities were likewise not more common in response to Valsalva manoeuvre in probable MCI-LB. An abnormal blood pressure response to Valsalva (delayed return to baseline/absence of overshoot after release of strain) was more common in probable MCI-LB than MCI-AD. In secondary analyses, magnitude of blood pressure drop after active stand and 10-s after release of Valsalva strain were weakly correlated with cardiac sympathetic denervation.
Probable MCI-LB may feature abnormal blood pressure response to Valsalva, but orthostatic hypotension is not a clear distinguishing feature from MCI-AD.
体位性低血压是正常衰老以及与年龄相关的神经退行性疾病的常见特征，尤其是包括路易体痴呆在内的突触核蛋白病。体位性低血压和其他异常心血管反应可能是路易体病的早期标志物。我们旨在评估与阿尔茨海默病所致轻度认知障碍（MCI-AD）相比，路易体轻度认知障碍（MCI-LB）患者在体位性挑战和瓦尔萨尔瓦动作时出现异常血压和心率反应是否更为常见。
89例MCI患者接受了纵向临床评估，对可能的MCI-LB、可能的MCI-LB或MCI-AD进行鉴别分类，并在基线时进行客观自主神经功能测试。根据逐搏心血管数据计算主动站立和瓦尔萨尔瓦动作时的血压和心率反应，按照当前标准定义异常情况，并使用逻辑模型估计年龄调整后的组间差异。
与MCI-AD相比，可能的MCI-LB患者中体位性低血压和体位性挑战时的异常心率反应并不更常见。在可能的MCI-LB患者中，对瓦尔萨尔瓦动作的心率异常反应同样不更常见。可能的MCI-LB患者中，对瓦尔萨尔瓦动作的异常血压反应（应变释放后延迟恢复到基线/无过冲）比MCI-AD更常见。在二次分析中，主动站立后和瓦尔萨尔瓦应变释放10秒后的血压下降幅度与心脏交感神经去神经支配呈弱相关。
可能的MCI-LB可能表现为对瓦尔萨尔瓦动作的异常血压反应，但体位性低血压并非与MCI-AD区分的明确特征。
