Department of Neurology and Neurosurgery, University Medical Centre Utrecht, P.O. Box 85500, 3508 GA Utrecht, the Netherlands.
Department of Epidemiology, Erasmus MC, P.O. Box 2040, 3000 CA Rotterdam, the Netherlands; Department of Radiology & Nuclear Medicine and Alzheimer Centre Erasmus MC, Erasmus MC, P.O. Box 2040, 3000 CA Rotterdam, the Netherlands.
J Neurol Sci. 2024 Jun 15;461:123026. doi: 10.1016/j.jns.2024.123026. Epub 2024 May 4.
Orthostatic hypotension (OH) is associated with an increased risk of dementia, potentially attributable to cerebral hypoperfusion. We investigated which patterns and characteristics of OH are related to cognition or to potentially underlying structural brain injury in hemodynamically impaired patients and healthy reference participants.
Participants with carotid occlusive disease or heart failure, and reference participants from the Heart-Brain Connection Study underwent OH measurements, neuropsychological assessment and brain MRI. We analyzed the association between OH, global cognitive functioning, white matter hyperintensity (WMH) volume and brain parenchymal fraction with linear regression. We stratified by participant group, severity and duration of OH, chronotropic incompetence and presence of orthostatic symptoms.
Of 337 participants (mean age 67.3 ± 8.8 years, 118 (35.0%) women), 113 (33.5%) had OH. Overall, presence of OH was not associated with cognitive functioning (β: -0.12 [-0.24-0.00]), but we did observe worse cognitive functioning in those with severe OH (≥ 30/15 mmHg; β: -0.18 [-0.34 to -0.02]) and clinically manifest OH (β: -0.30 [-0.52 to -0.08]). These associations did not differ significantly by OH duration or chronotropic incompetence, and were similar between patient groups and reference participants. Similarly, both severe OH and clinically manifest OH were associated with a lower brain parenchymal fraction, and severe OH also with a somewhat higher WMH volume.
Severe OH and clinically manifest OH are associated with worse cognitive functioning. This supports the notion that specific patterns and characteristics of OH determine its impact on brain health.
直立性低血压（OH）与痴呆风险增加相关，这可能与脑灌注不足有关。我们研究了哪些 OH 模式和特征与认知功能或血流动力学受损患者和健康参考参与者潜在的结构性脑损伤有关。
患有颈动脉闭塞性疾病或心力衰竭的参与者和来自“心脏-大脑连接研究”的参考参与者接受了 OH 测量、神经心理学评估和脑 MRI。我们使用线性回归分析了 OH 与整体认知功能、脑白质高信号（WMH）体积和脑实质分数之间的关系。我们按参与者组、OH 的严重程度和持续时间、变时性功能不全和直立症状的存在进行了分层。
在 337 名参与者（平均年龄 67.3±8.8 岁，118 名[35.0%]女性）中，有 113 名（33.5%）患有 OH。总体而言，OH 的存在与认知功能无关（β：-0.12[-0.24-0.00]），但我们确实观察到严重 OH（≥30/15mmHg；β：-0.18[-0.34 至-0.02]）和临床表现 OH（β：-0.30[-0.52 至-0.08]）患者的认知功能更差。这些关联在 OH 持续时间或变时性功能不全方面没有显著差异，并且在患者组和参考参与者之间相似。同样，严重 OH 和临床表现 OH 均与脑实质分数较低相关，严重 OH 还与稍高的 WMH 体积相关。
严重 OH 和临床表现 OH 与认知功能下降相关。这支持了这样一种观点，即 OH 的特定模式和特征决定了其对大脑健康的影响。
