Association of cognitive dysfunction with neurocirculatory abnormalities in early Parkinson disease

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.

Figure 1. Cognitive status as a function of neurocirculatory abnormalities in Parkinson disease

(A) Orthostatic hypotension (OH) (p = 0.003). (B) Supine hypertension (SH) (p < 0.001). (C) OH + SH (p < 0.001). (D) Nondipping phenomenon (p = 0.172). (E) Arterial hypertension (HBP) (p = 0.297).

Figure 2. Cholinergic Pathways Hyperintensities Scale (CHIPS) mean (±SEM) scores as a function of neurocirculatory abnormalities in Parkinson disease

(A) Orthostatic hypotension (OH). (B) Supine hypertension (SH). (C) OH + SH. (D) Dementia. (E) Nondipping. (F) Arterial hypertension (HBP). Statistical tests were analyses of covariance, controlling for age, the presence of hypertension or diabetes, low-density lipoprotein cholesterol, and serum homocysteine level. *p < 0.05; **p < 0.001.