Orthostatic hypotension and dementia incidence: links and implications

Andrew D Robertson,1,2 Sean J Udow,3 Alberto J Espay,4 Aristide Merola,4 Richard Camicioli,5 Anthony E Lang,6–8 Mario Masellis2,6,91Schlegel-UW Research Institute for Aging, University of Waterloo, Waterloo, ON, Canada; 2Hurvitz Brain Sciences Program, Sunnybrook Research Institute, Univer...

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Autores principales:	Robertson AD, Udow SJ, Espay AJ, Merola A, Camicioli R, Lang AE, Masellis M
Formato:	article
Lenguaje:	EN
Publicado:	Dove Medical Press 2019
Materias:	α-synucleinopathies cognitive impairment dementia orthostatic hypotension review Neurosciences. Biological psychiatry. Neuropsychiatry RC321-571 Neurology. Diseases of the nervous system RC346-429
Acceso en línea:	https://doaj.org/article/da1af30030524961a9826ed823f9c9a7
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spelling	oai:doaj.org-article:da1af30030524961a9826ed823f9c9a72021-12-02T03:15:21ZOrthostatic hypotension and dementia incidence: links and implications1178-2021https://doaj.org/article/da1af30030524961a9826ed823f9c9a72019-08-01T00:00:00Zhttps://www.dovepress.com/orthostatic-hypotension-and-dementia-incidence-links-and-implications-peer-reviewed-article-NDThttps://doaj.org/toc/1178-2021Andrew D Robertson,1,2 Sean J Udow,3 Alberto J Espay,4 Aristide Merola,4 Richard Camicioli,5 Anthony E Lang,6–8 Mario Masellis2,6,91Schlegel-UW Research Institute for Aging, University of Waterloo, Waterloo, ON, Canada; 2Hurvitz Brain Sciences Program, Sunnybrook Research Institute, University of Toronto, Toronto, ON, Canada; 3Division of Internal Medicine, Rady Faculty of Health Sciences, University of Manitoba, Winnipeg, MB, Canada; 4Department of Neurology, James and Joan Gardner Family Center for Parkinson’s Disease and Movement Disorders, University of Cincinnati, Cincinnati, OH, USA; 5Department of Medicine (Neurology), University of Alberta, Edmonton, AB, Canada; 6Division of Neurology, Department of Medicine, University of Toronto, Toronto, ON, Canada; 7Edmond J. Safra Program in Parkinson’s Disease, Toronto Western Hospital, University Health Network, Toronto, ON, Canada; 8Morton and Gloria Shulman Movement Disorders Clinic, Toronto Western Hospital, University Health Network, Toronto, ON, Canada; 9Cognitive and Movement Disorders Clinic, Sunnybrook Health Sciences Centre, Toronto, ON, CanadaAbstract: 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.Keywords: α-synucleinopathies, cognitive impairment, dementia, orthostatic hypotension, reviewRobertson ADUdow SJEspay AJMerola ACamicioli RLang AEMasellis MDove Medical Pressarticleα-synucleinopathiescognitive impairmentdementiaorthostatic hypotensionreviewNeurosciences. Biological psychiatry. NeuropsychiatryRC321-571Neurology. Diseases of the nervous systemRC346-429ENNeuropsychiatric Disease and Treatment, Vol Volume 15, Pp 2181-2194 (2019)
institution	DOAJ
collection	DOAJ
language	EN
topic	α-synucleinopathies cognitive impairment dementia orthostatic hypotension review Neurosciences. Biological psychiatry. Neuropsychiatry RC321-571 Neurology. Diseases of the nervous system RC346-429
spellingShingle	α-synucleinopathies cognitive impairment dementia orthostatic hypotension review Neurosciences. Biological psychiatry. Neuropsychiatry RC321-571 Neurology. Diseases of the nervous system RC346-429 Robertson AD Udow SJ Espay AJ Merola A Camicioli R Lang AE Masellis M Orthostatic hypotension and dementia incidence: links and implications
description	Andrew D Robertson,1,2 Sean J Udow,3 Alberto J Espay,4 Aristide Merola,4 Richard Camicioli,5 Anthony E Lang,6–8 Mario Masellis2,6,91Schlegel-UW Research Institute for Aging, University of Waterloo, Waterloo, ON, Canada; 2Hurvitz Brain Sciences Program, Sunnybrook Research Institute, University of Toronto, Toronto, ON, Canada; 3Division of Internal Medicine, Rady Faculty of Health Sciences, University of Manitoba, Winnipeg, MB, Canada; 4Department of Neurology, James and Joan Gardner Family Center for Parkinson’s Disease and Movement Disorders, University of Cincinnati, Cincinnati, OH, USA; 5Department of Medicine (Neurology), University of Alberta, Edmonton, AB, Canada; 6Division of Neurology, Department of Medicine, University of Toronto, Toronto, ON, Canada; 7Edmond J. Safra Program in Parkinson’s Disease, Toronto Western Hospital, University Health Network, Toronto, ON, Canada; 8Morton and Gloria Shulman Movement Disorders Clinic, Toronto Western Hospital, University Health Network, Toronto, ON, Canada; 9Cognitive and Movement Disorders Clinic, Sunnybrook Health Sciences Centre, Toronto, ON, CanadaAbstract: 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.Keywords: α-synucleinopathies, cognitive impairment, dementia, orthostatic hypotension, review
format	article
author	Robertson AD Udow SJ Espay AJ Merola A Camicioli R Lang AE Masellis M
author_facet	Robertson AD Udow SJ Espay AJ Merola A Camicioli R Lang AE Masellis M
author_sort	Robertson AD
title	Orthostatic hypotension and dementia incidence: links and implications
title_short	Orthostatic hypotension and dementia incidence: links and implications
title_full	Orthostatic hypotension and dementia incidence: links and implications
title_fullStr	Orthostatic hypotension and dementia incidence: links and implications
title_full_unstemmed	Orthostatic hypotension and dementia incidence: links and implications
title_sort	orthostatic hypotension and dementia incidence: links and implications
publisher	Dove Medical Press
publishDate	2019
url	https://doaj.org/article/da1af30030524961a9826ed823f9c9a7
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Orthostatic hypotension and dementia incidence: links and implications

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