Department of Neuroscience, Division of Geriatric Medicine and Memory Clinic, UPRES EA 4638, UNAM, Angers University Hospital, Angers, France.
Department of Neuroscience, Division of Geriatric Medicine and Memory Clinic, UPRES EA 4638, UNAM, Angers University Hospital, Angers, France.
Maturitas. 2024 Jul;185:107866. doi: 10.1016/j.maturitas.2023.107866. Epub 2023 Nov 2.
The association between cognitive disorders and orthostatic hypotension (OH) has been empirically explored, but the results have been divergent, casting doubt on the presence and direction of the association. The objective of this meta-analysis was to systematically review and quantitatively synthesize the association of OH and cognitive function, specifically mean score on the Mini-Mental State Examination (MMSE), cognitive impairment and incident dementia. A Medline search was conducted in May 2022 with no date limit, using the MeSH terms "orthostatic hypotension" OR "orthostatic intolerance" OR "hypotension" combined with the Mesh terms "cognitive dysfunction" OR "Alzheimer disease" OR "dementia" OR "cognition disorder" OR "neurocognitive disorder" OR "cognition" OR "neuropsychological test". Of the 746 selected studies, 15 longitudinal studies met the selection criteria, of which i) 5 studies were eligible for meta-analysis of mean MMSE score comparison, ii) 5 studies for the association of OH and cognitive impairment, and iii) 6 studies for the association between OH and incident dementia. The pooled effect size in fixed-effects meta-analysis was: i) -0.25 (-0.42; -0.07) for the mean MMSE score, which indicates that the MMSE score was lower for those with OH; ii) OR (95 % CI) = 1.278 (1.162; 1.405), P < 0.0001, indicating a 28 % greater risk of cognitive impairment for those with OH at baseline; and iii) HR (95 % CI) = 1.267 (1.156; 1.388), P < 0.0001, indicating a 27 % greater risk of incident dementia for those with OH at baseline. Patients with OH had a lower MMSE score and higher risk of cognitive impairment and incident dementia in this meta-analysis of longitudinal studies. This study confirmed the presence of an association between OH and cognitive disorders in older adults.
认知障碍与直立性低血压（OH）之间的关联已通过实证研究进行了探索，但结果存在分歧，这使人对这种关联的存在和方向产生了怀疑。本荟萃分析的目的是系统地回顾和定量综合 OH 与认知功能（特别是简易精神状态检查（MMSE）的平均得分）、认知障碍和痴呆症发病之间的关联。2022 年 5 月，我们使用了“直立性低血压”或“直立不耐受”或“低血压”加上“认知功能障碍”或“阿尔茨海默病”或“痴呆症”或“认知障碍”或“神经认知障碍”或“认知”或“神经心理学测试”的 MeSH 术语进行了无日期限制的 Medline 搜索。在 746 项选定的研究中，有 15 项纵向研究符合选择标准，其中：i）有 5 项研究符合 MMSE 平均评分比较的荟萃分析条件；ii）有 5 项研究符合 OH 和认知障碍的关联；iii）有 6 项研究符合 OH 和痴呆症发病之间的关联。固定效应荟萃分析的合并效应大小为：i）OH 组的 MMSE 评分平均值低-0.25（-0.42；-0.07），表明 OH 组的 MMSE 评分较低；ii）OR（95%CI）=1.278（1.162；1.405），P<0.0001，表明基线时 OH 患者认知障碍的风险增加 28%；iii）HR（95%CI）=1.267（1.156；1.388），P<0.0001，表明基线时 OH 患者发生痴呆症的风险增加 27%。在本项对纵向研究的荟萃分析中，OH 患者的 MMSE 评分较低，且认知障碍和痴呆症发病的风险较高。这项研究证实了老年人 OH 与认知障碍之间存在关联。
