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Interactive effect of orthostatic hypotension on gray matter atrophy associated with hyposmia and RBD in de novo Parkinson’s disease

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Abstract

Background

Orthostatic hypotension (OH) is a potential modifiable risk factor for cognitive impairment in patients with Parkinson’s disease (PD). Although other risk factors for dementia, hyposmia and REM sleep behavior disorder (RBD), are closely associated with autonomic dysfunction in PD, little is known about how these risk factors influence cognitive function and cerebral pathology.

Objective

We investigated how these three factors contribute to gray matter atrophy by considering the interaction of OH with hyposmia and RBD.

Methods

We analyzed cortical thickness, subcortical gray matter volume, and cognitive measures from 78 patients with de novo PD who underwent the head-up tilt test for the diagnosis of OH.

Results

Whole-brain analyses with Monte Carlo corrections revealed that hyposmia was associated with decreased cortical thickness in a marginal branch of the cingulate sulcus among patients with OH, and cortical thickness in this area correlated with cognitive functioning only in patients with OH. Subcortical gray matter volume analysis indicated that severe RBD was associated with decreased volume in the left hippocampus and bilateral amygdala among patients with OH.

Conclusion

Even in early PD, OH exerts effects on gray matter atrophy and cognitive dysfunction by interacting with RBD and hyposmia. OH might exacerbate cerebral pathology induced by hyposmia or RBD.

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Data availability

The data sets of the current study are available from the corresponding author upon reasonable request.

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Acknowledgements

We are grateful to our hospital's ward doctors. This work was supported by the Jikei University Research Fund and a Grant-in-Aid for JSPS Research Fellows (202212840) to T. Shiraishi.

Author information

Authors and Affiliations

  1. Department of Neurology, The Jikei University School of Medicine, 3-25-8 Nishi-Shinbashi, Minato-ku, Tokyo, 105-8461, Japan

    Tomotaka Shiraishi, Tadashi Umehara, Motohiro Okumura, Tatsushi Kokubu, Junichiro Takahashi, Takeo Sato, Asako Onda, Teppei Komatsu, Kenichiro Sakai, Hidetaka Mitsumura & Yasuyuki Iguchi

  2. Division of Regenerative Medicine, The Jikei University School of Medicine, Tokyo, Japan

    Tomotaka Shiraishi, Daisuke Yoshimaru & Hirotaka James Okano

  3. Department of Neurology, Daisan Hospital, The Jikei University School of Medicine, Tokyo, Japan

    Masakazu Ozawa

  4. Department of Neurology, The Jikei University Katsushika Medical Center, Tokyo, Japan

    Shusaku Omoto

  5. Department of Neurology, Showa University East Hospital, Tokyo, Japan

    Hidetomo Murakami

Authors
  1. Tomotaka Shiraishi
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  2. Daisuke Yoshimaru
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Corresponding author

Correspondence to Tomotaka Shiraishi.

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All authors declare no financial or non-financial competing interests.

Ethical approval

Approval was received from the Regional Ethics and Hospital Management Committee of Jikei University School of Medicine. Written informed consent was obtained from all subjects prior to study participation according to the Declaration of Helsinki.

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Shiraishi, T., Yoshimaru, D., Umehara, T. et al. Interactive effect of orthostatic hypotension on gray matter atrophy associated with hyposmia and RBD in de novo Parkinson’s disease. J Neurol 270, 5924–5934 (2023). https://doi.org/10.1007/s00415-023-11934-5

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  • DOI: https://doi.org/10.1007/s00415-023-11934-5

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