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Abstract
Objective: Cognitive impairment and neurocirculatory abnormalities such as orthostatic hypotension (OH), supine hypertension (SH), and failure to decrease blood pressure at night (nondipping) occur relatively commonly in Parkinson disease (PD); however, whether cognitive dysfunction in early PD is related to neurocirculatory abnormalities has not been established. Cognitive dysfunction in PD is associated with white matter hyperintensities on MRI. We report results of an analysis of neuropsychological and hemodynamic parameters in patients with early PD.
Methods: Among 87 patients, 25 had normal cognition, 48 had mild cognitive impairment, and 14 had dementia, based on comprehensive neuropsychological tests. Orthostatic vital signs and ambulatory 24-hour blood pressure monitoring were recorded, and brain magnetic resonance scans were obtained for all patients.
Results: Cognitive impairment was associated with OH, SH, and white matter hyperintensities but not with nondipping. Dementia and white matter hyperintensities were common in SH. Of 13 patients with OH + SH, every one had mild cognitive impairment or dementia.
Conclusions: Cognitive dysfunction is related to neurocirculatory abnormalities, especially OH + SH, in early PD, raising the possibility that early detection and effective treatment of those abnormalities might slow the rate of cognitive decline.
GLOSSARY
- CHIPS=
- Cholinergic Pathways Hyperintensities Scale;
- MBP=
- mean arterial blood pressure;
- OH=
- orthostatic hypotension;
- PD=
- Parkinson disease;
- SH=
- supine hypertension;
- UPDRS=
- Unified Parkinson's Disease Rating Scale
Footnotes
Study funding: Supported by the Catholic Medical Center Research Foundation. Dr. Goldstein is supported by the Division of Intramural Research of the National Institute of Neurological Disorders and Stroke.
Supplemental data at www.neurology.org
- Received December 7, 2011.
- Accepted May 16, 2012.
- Copyright © 2012 by AAN Enterprises, Inc.
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