Mid-life orthostatic hypotension related to dementia

Orthostatic hypotension at mid-life was linked to an increased risk of dementia later in life, according to prospective cohort badysis.

People who had orthostatic hypotension at an average age of 54 demonstrated a higher risk of dementia. Andreea Rawlings, Ph.D., of the Johns Hopkins Bloomberg School of Public Health in Baltimore, and colleagues at Neurology .

Although the relationship between them and people who have not had orthostatic hypotension between postural blood pressure changes and stroke has been known for some time, " Previous studies had not shown that orthostatic hypotension was badociated with an increased risk of dementia, probably because they had mostly looked at orthostatic hypotension at a later age, "he said. co-author Rebecca Gottesman, MD, Ph.D., also of Johns Hopkins.

"It is much more common in the elderly, and it is possible that you have to start being exposed to hypotension. orthostatic at a younger age to have an impact on your cognitive health, "she said MedPage Today .

data from 11,709 participants in the study on the risk of atherosclerosis in communities (ARIC), u cohort that has been followed for more than 25 years. Between 1987 and 1989, men and women were recruited from ARIC in four communities in the United States. The average age of the participants was 54 years initially; those who had a history of coronary heart disease or stroke, or who self-reported Parkinson's disease, were excluded

Participants had baseline badessments and met with researchers until they were diagnosed with Parkinson's disease. at five times during the course of the study. Cases of dementia were determined from reviews of study visits, contacts with participants or agents, or monitoring of medical records. Ischemic stroke was confirmed by monitoring of hospitalization, follow-up and links to the registers. Cognitive tests were performed on three visits after the start of the study.

Postural changes in blood pressure were evaluated initially only. The researchers defined orthostatic hypotension as a drop in systolic blood pressure of at least 20 mm Hg or a decrease in diastolic blood pressure of at least 10 mm Hg at rest

. 552 participants (4.7%) had orthostatic hypotension. During the study, 1,068 people developed dementia and 842 had ischemic stroke.

Compared with people without postural hypotension at baseline, people with orthostatic hypotension had a higher risk of dementia (RR 1.54, 95% CI 1.20-1.97) and stroke. ischemic (HR 2.08, 95% CI 1.65-2.62). People with orthostatic hypotension also experienced cognitive decline over 20 years (SD 0.09, 95% CI: 0.02 to 0.21), which was insignificant.

Ischemic stroke in the orthostatic hypotension and dementia badociation accounted for a small portion of the risk "The measurement of orthostatic hypotension at middle age may be a new way of thinking. identify people who need to be closely monitored for dementia or stroke, "Rawlings said in a statement. "More studies are needed to clarify what can cause these links as well as to study possible prevention strategies."

Jose-Alberto Palma, MD, PhD, of New York University Langone Health, who was not involved in the study, commented that "in our clinical experience, he It is not uncommon for patients with orthostatic hypotension to eventually develop a cognitive impairment, usually caused by Parkinson's disease or dementia with Lewy bodies. "

: "We found that patients with isolated or pure autonomic insufficiency, a disorder characterized by severe orthostatic hypotension, had a significantly elevated risk of developing a neurodegenerative disease, including Lewy body dementia. In this case, orthostatic hypotension was an early sign of a neurodegenerative disorder, and not the cause of it. "

" It could be argued that many of the patients with Orthostatic hypotension studied by Rawlings and colleagues may have had a purely autonomic failure and that some eventually developed Parkinson's disease or dementia with Lewy bodies, "perhaps indicating that orthostatic hypotension could be the first neurodegenerative sign "

The limitations of the study included the fact that orthostatic hypotension was measured e only initially and did not necessarily represent changes in blood pressure over time. Although participants with cardiovascular disease and Parkinson's disease initially were excluded and the data were adjusted for a number of variables, residual confusion may have occurred. The researchers also had no data on cerebrospinal fluid or imaging biomarkers, so they could not determine whether participants had vascular or mixed dementia rather than disease. Alzheimer.

• Reviewed by
  F. Perry Wilson, MD, MSCE Assistant Professor, Nephrology Section, Yale Medical School and Dorothy Caputo, MA, BSN, Nurse, Nurse Planner

2018-07-25T16: 30: 00-0400