Orthostatic hypotension, cognition and structural brain imaging in hemodynamically impaired patients

• Published in: Journal of the neurological sciences 2024-06, Vol.461, p.123026-123026, Article 123026
• Main Authors: Starmans, Naomi L.P., Wolters, Frank J., Leeuwis, Anna E., Bron, Esther E., de Bresser, Jeroen, Brunner-La Rocca, Hans-Peter, Staals, Julie, Muller, Majon, Biessels, Geert Jan, Kappelle, L. Jaap
• Format: Article
• Language: English
• Subjects: Aged; Atrophy; Blood pressure; Brain - diagnostic imaging; Brain - physiopathology; Cerebral small vessel disease; Cognition; Cognition - physiology; Female; Heart Failure - complications; Heart Failure - diagnostic imaging; Heart Failure - physiopathology; Hemodynamics - physiology; Humans; Hypotension, Orthostatic - diagnostic imaging; Hypotension, Orthostatic - etiology; Hypotension, Orthostatic - physiopathology; Magnetic Resonance Imaging; Male; Middle Aged; Neuropsychological Tests; Orthostatic hypotension; White Matter - diagnostic imaging; White Matter - pathology; White matter hyperintensities
• ISSN: 0022-510X; 1878-5883
• DOI: 10.1016/j.jns.2024.123026

Orthostatic hypotension (OH) is associated with an increased risk of dementia, potentially attributable to cerebral hypoperfusion. We investigated which patterns and characteristics of OH are related to cognition or to potentially underlying structural brain injury in hemodynamically impaired patients and healthy reference participants. Participants with carotid occlusive disease or heart failure, and reference participants from the Heart-Brain Connection Study underwent OH measurements, neuropsychological assessment and brain MRI. We analyzed the association between OH, global cognitive functioning, white matter hyperintensity (WMH) volume and brain parenchymal fraction with linear regression. We stratified by participant group, severity and duration of OH, chronotropic incompetence and presence of orthostatic symptoms. Of 337 participants (mean age 67.3 ± 8.8 years, 118 (35.0%) women), 113 (33.5%) had OH. Overall, presence of OH was not associated with cognitive functioning (β: −0.12 [−0.24–0.00]), but we did observe worse cognitive functioning in those with severe OH (≥ 30/15 mmHg; β: −0.18 [−0.34 to −0.02]) and clinically manifest OH (β: −0.30 [−0.52 to −0.08]). These associations did not differ significantly by OH duration or chronotropic incompetence, and were similar between patient groups and reference participants. Similarly, both severe OH and clinically manifest OH were associated with a lower brain parenchymal fraction, and severe OH also with a somewhat higher WMH volume. Severe OH and clinically manifest OH are associated with worse cognitive functioning. This supports the notion that specific patterns and characteristics of OH determine its impact on brain health. •Effects of OH on brain health may differ by OH characteristics.•OH characteristics are severity, duration, chronotropic incompetence and symptoms.•Severe OH and clinically manifest OH are related to poorer cognitive functioning.•This coincided with a significantly lower brain parenchymal fraction.•Individuals with severe OH also tended to have larger WMH volumes.