Orthostatic hypotension and dementia incidence: links and implications
| Autor: | Andrew D. Robertson, Alberto J. Espay, Aristide Merola, Sean J. Udow, Anthony E. Lang, Mario Masellis, Richard Camicioli |
|---|---|
| Rok vydání: | 2019 |
| Předmět: |
education.field_of_study
Pediatrics medicine.medical_specialty Activities of daily living business.industry Population Disease medicine.disease Hyperintensity 030227 psychiatry 3. Good health 03 medical and health sciences Orthostatic vital signs 0302 clinical medicine Quality of life Medicine Dementia business education 030217 neurology & neurosurgery Cohort study |
| Zdroj: | Neuropsychiatric Disease and Treatment. 15:2181-2194 |
| ISSN: | 1178-2021 |
| Popis: | Orthostatic hypotension (OH) is a common condition, particularly in patients with α-synucleinopathies such as Parkinson’s disease, and has a significant impact on activities of daily living and quality of life. Recent data suggest an association with cognitive impairment. Herein, we review the evidence that OH increases the odds of incident mild cognitive impairment and dementia. Potential mechanisms underlying the putative relationship are discussed, including cerebral hypoperfusion, supine hypertension, white matter hyperintensities, and neurodegeneration. Finally, we highlight the challenges with respect to treatment and the negative impact on the quality of life and long-term prognosis presented by the coexistence of OH and dementia. Large population-based studies have reported that OH is associated with about a 20% increased risk of dementia in the general population, while smaller cohort studies suggest an even greater effect in patients with α-synucleinopathies (3- to 7-fold higher than controls). Ultimately, OH exposure is difficult to quantify, predominantly limited to pressure regulation during a one-time orthostatic challenge, and the causative association with dementia may turn out to be bidirectional, especially in α-synucleinopathies. Early diagnosis and treatment of OH may improve long-term prognosis. |
| Databáze: | OpenAIRE |
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