Associations of Orthostatic Hypotension and Orthostatic Intolerance with Domain-Specific Cognitive Decline in Patients with Early Parkinson Disease: An 8-Year Follow-up

Seohee Choi; Ryul Kim; Nyeonju Kang; Kyeongho Byun; Kiwon Park; Jin-Sun Jun

doi:10.1016/j.jamda.2023.10.002

Associations of Orthostatic Hypotension and Orthostatic Intolerance with Domain-Specific Cognitive Decline in Patients with Early Parkinson Disease: An 8-Year Follow-up

J Am Med Dir Assoc. 2024 May;25(5):866-870. doi: 10.1016/j.jamda.2023.10.002. Epub 2023 Nov 4.

Authors

Seohee Choi¹, Ryul Kim², Nyeonju Kang³, Kyeongho Byun³, Kiwon Park⁴, Jin-Sun Jun⁵

Affiliations

¹ Department of Neurology, Inha University Hospital, Inha University College of Medicine, Incheon, South Korea.
² Department of Neurology, Inha University Hospital, Inha University College of Medicine, Incheon, South Korea. Electronic address: arkrk86@inha.ac.kr.
³ Division of Sport Science, Sport Science Institute & Health Promotion Center, Incheon National University, Incheon, South Korea.
⁴ Department of Mechatronics Engineering, Incheon National University, Incheon, South Korea.
⁵ Department of Neurology, Kangnam Sacred Heart Hospital, Hallym University College of Medicine, Seoul, South Korea. Electronic address: junjs@hallym.ac.kr.

PMID: 37935379
DOI: 10.1016/j.jamda.2023.10.002

Abstract

Objective: Although orthostatic hypotension (OH) and orthostatic intolerance (OI) are prevalent in patients with Parkinson disease (PD), it remains unclear how these conditions primarily affect the trajectory of decline in specific cognitive domains. This study aimed to explore the effects of OH and OI on longitudinal domain-specific cognitive changes in patients with PD.

Design: An 8-year follow-up of the Parkinson Progression Markers Initiative cohort study.

Setting and participants: A total of 403 patients with early, untreated PD and 195 matched healthy controls were included. They were classified into OH, OI, and normal groups. OH was defined according to the international consensus, and OI was defined as the presence of orthostatic symptoms without meeting the criteria for OH.

Methods: The patients underwent detailed neuropsychological testing annually for up to 8 years of follow-up. Linear mixed effects models were used to investigate the associations between OH, OI, and longitudinal cognitive changes.

Results: The prevalence of both OH and OI in patients with PD was significantly higher than that in controls (13.4% vs 7.2%, P = .002, for OH, and 29.3% vs 14.4%, P < .001, for OI). The OH group in patients with PD showed a faster decline in Letter-Number Sequencing (LNS) (β = -0.11, 95% CI -0.20 to -0.02, t = -2.44, P = .015) and Semantic Fluency Test (SFT) (β = -0.44, 95% CI -0.81 to -0.08, t = -2.42, P = .016) scores than the normal group. Similarly, the OI group showed a steeper decline in LNS (β = -0.08, 95% CI -0.14 to -0.01, t = -2.20, P = .028) and SFT (β = -0.36, 95% CI -0.63 to -0.08, t = -2.55, P = .011) scores compared to the normal group. There were no significant longitudinal changes in the other neuropsychological test scores between the groups.

Conclusions and implications: Both OH and OI may be associated with a faster decline in executive function among cognitive domains of patients with PD. These findings may highlight the potential importance of orthostatic blood pressure control in PD patients with OH and even those with orthostatic symptoms without OH.

Keywords: Cognition; Parkinson disease; executive function; orthostatic hypotension; orthostatic intolerance.

Publication types

Research Support, Non-U.S. Gov't

MeSH terms

Aged
Case-Control Studies
Cognitive Dysfunction* / epidemiology
Disease Progression
Female
Follow-Up Studies
Humans
Hypotension, Orthostatic* / epidemiology
Male
Middle Aged
Neuropsychological Tests
Orthostatic Intolerance*
Parkinson Disease* / complications
Parkinson Disease* / psychology