Clinical Autonomic Research

, Volume 6, Issue 1, pp 29–36 | Cite as

Orthostatic hypotension in organic dementia: Relationship between blood pressure, cortical blood flow and symptoms

  • U. Passant
  • S. Warkentin
  • S. Karlson
  • K. Nilsson
  • L. Edvinsson
  • L. Gustafson
Research Paper

Abstract

Regional cerebral blood flow was measured in 35 patients with organic dementia (Alzheimer's disease, n=13, vascular dementia, n=17, frontotemporal dementia, n=5) and orthostatic hypotension. Measurements were performed during supine rest and during head-up tilt (60°). Despite marked blood pressure falls, few patients had symptoms of orthostatic hypotension. All three dementia groups had a decrease in regional cerebral blood flow in the frontal lobes during head-up tilt, but no change in mean hemispheric flow. All patients had a consistent drop in their systolic blood pressure upon head-up tilt, with a wide variation over time. The findings suggest that orthostatic hypotension needs to be considered, and actively sought for, in organic dementia as many patients may lack the typical symptoms of orthostatic hypotension, despite a marked fall in blood pressure.

Keywords

regional cerebral blood flow orthostatic hypotension organic dementia blood pressure 

Preview

Unable to display preview. Download preview PDF.

Unable to display preview. Download preview PDF.

References

  1. 1.
    Jorm AF, Korten AE, Henderson AS. The prevalence of dementia: a quantitative integration of the literature.Acta Psychiatr Scand 1987;76:465–479.Google Scholar
  2. 2.
    Brun A. Frontal lobe degeneration of non-Alzheimer type. I: Neuropathology.Arch Gerontol Geriatr 1987;6:193–208.Google Scholar
  3. 3.
    Gustafson L. Frontal lobe degeneration of non-Alzheimer type. II: Clinical picture and differential diagnosis.Arch Gerontol Geriatr 1987;6:209–233.Google Scholar
  4. 4.
    Brun A, Englund B, Gustafson L et al. Consensus statement—clinical and neuropathological criteria for frontotemporal dementia.J Neurol Neurosurg Psychiatr 1994;57:416–418.Google Scholar
  5. 5.
    Caird FJ, Andrews GR, Kennedy RD. Effects of posture on blood pressure in the elderly.Br Heart J 1973;35:527–530.Google Scholar
  6. 6.
    Palmer KT. Studies into postural hypotension in elderly patients.N Z Med J 1983:43–45.Google Scholar
  7. 7.
    Patel A, Maloney A, Damato AN. On the frequency and reproducibility of orthostatic blood pressure changes in healthy community—dwelling elderly during 60-degree head-up tilt.Am Heart J 1993;126:184–188.Google Scholar
  8. 8.
    Mader SL. Orthostatic hypotension.Med Clin North Am 1989;73:6:1337–1349.Google Scholar
  9. 9.
    Mayers MG, Kearns PM, Kennedy K et al. Postural hypotension and direct therapy in the elderly.Can Med Assoc J 1978;119:581–585.Google Scholar
  10. 10.
    Passant U, Warkentin S, Karison S et al. Cortical blood flow changes related to orthostatic hypotension.J Cerebral Blood Flow Metabol 1993;13:388.Google Scholar
  11. 11.
    Englund E, Brun A, Gustafson L. A white matter disease in dementia of Alzheimer type—clinical and neuropathological correlates.Int J Geriatr Psychiatr 1989;4:87–102.Google Scholar
  12. 12.
    Brun A, Englund E. Brain changes in dementia of Alzheimer type relevant to new imaging diagnostic methods.Proc Neuro-Psychopharm Biol Psychiatr 1986;10:297–308.Google Scholar
  13. 13.
    Englund E, Brun A, Alling C. White matter changes in dementia of Alzheimer type—biochemical and neuropathological correlates.Brain 1988;III:1425–1439.Google Scholar
  14. 14.
    Räihä I, Tarvonen S, Kurki T, Rajala T, Sourander L. Relationship between vascular factors and white matter low attenuation of the brain.Acta Neurol Scand 1993;97:286–289.Google Scholar
  15. 15.
    American Psychiatric Association.Diagnostic and Statistical Manual of Mental Disorders. Washington, DC: APA, 1987.Google Scholar
  16. 16.
    McKhann G, Drachman D, Folstein M, Katzman R, Price D, Stadlan EM. Clinical diagnosis of Alzheimer's disease: report of the NINCDS-ADRDA Work Group under the auspices of Department of Health and Human Services Task Force on Alzheimer's disease.Neurology 1984;34:939–944.Google Scholar
  17. 17.
    Roman GC, Tatemichi TK, Erkinjuntti T, Cummings JL, Masdeu JC. Vascular dementia: diagnostic criteria for research studies. Report of the NINDS-AIREN international workshop.Neurology 1993;43: 250–260.Google Scholar
  18. 18.
    White WB, Reik L, Cutlip DE. Pernicious anaemia seen initially as orthostatic hypotension.Arch Intern Med 1981;141:1543–1544.Google Scholar
  19. 19.
    Eisenhofer G, Lamoire DG, Johnson RH, Tan E, Whiteside EA. Deficient catecholamine release as the basis of orthostatic hypotension in pernicious anaemia.J Neurol Neurosurg Psychiatr 1982;45: 1053–1055.Google Scholar
  20. 20.
    McLeod JG. Autonomic dysfunction in peripheral nerve disease. In: Bannister R, Mathias CJ (eds).Autonomic Failure. A Textbook of Clinical Disorders of the Autonomic Nervous System. Oxford: Oxford Univ Press 1992:650–681.Google Scholar
  21. 21.
    Obrist WD, Thompson HK, Wang HS, Wilkinson WE. Regional cerebral blood flow estimated by 133-Xenon inhalation.Stroke 1975;6:245–256.Google Scholar
  22. 22.
    Risberg J, Ali Z, Wilson EM, Willis EL, Halsey JH. Regional cerebral blood flow by 133-Xenon inhalation.Stroke 1975;6:142–148.Google Scholar
  23. 23.
    Risberg J. Regional cerebral blood flow measurements by 133-Xenon inhalation: Methodology and applications in neuropsychology and psychiatry.Brain Lang 1980;9:9–34.Google Scholar
  24. 24.
    Mathias CJ, Bannister R. Investigation of autonomic disorders. In: Bannister R, Mathias CJ, eds.Autonomic Failure. A Textbook of Clinical Disorders of the Autonomic Nervous System, 3rd edn. Oxford: Oxford University Press, 1992:489–509.Google Scholar
  25. 25.
    Lipsitz LA, Nyqvist RP, Wei JY, Rowe JW. Postprandial reduction in blood pressure in the elderly.N Engl J Med 1983;309:81–86.Google Scholar
  26. 26.
    Maximiliam VA, Prohovnik I, Risberg J. Cerebral hemodynamic response to mental activation in normo and hypercapnia.Stroke 1980;11:342–347.Google Scholar
  27. 27.
    Elmståhl S, Petersson M, Lilja B, Samuelsson SM, Rosén J, Bjurö L. Autonomic cardiovascular response to tilting in patients with Alzheimer's disease and in healthy elderly women.Age Ageing 1992;21:301–307.Google Scholar
  28. 28.
    Bannister R, Mathias CJ. Introduction and classification. In: Bannister R, Mathias CJ, eds.Autonomic Failure. A Textbook of Clinical Disorders of the Autonomic Nervous System, 3rd edn. Oxford: Oxford University Press, 1992:1–12.Google Scholar
  29. 29.
    Bannister R, Mathias CJ. Clinical features and investigation of the primary autonomic failure syndromes. In: Bannister R, Mathias CJ, eds.Autonomic Failure. A Textbook of Clinical Disorders of the Autonomic Nervous System, 3rd edn. Oxford: Oxford University Press, 1992:531–547.Google Scholar
  30. 30.
    Johnson RH. Ageing and the autonomic nervous system. In: Bannister R, Mathias CJ, eds.Autonomic Failure. A Textbook of Clinical Disorders of the Autonomic Nervous System, 3rd edn. Oxford: Oxford University Press, 1992:882–903.Google Scholar
  31. 31.
    Mathias CJ. Orthostatic hypotension: causes, mechanisms and influencing factors.Neurology 1995;45:suppl. 5, s6-s11Google Scholar
  32. 32.
    Gustafson L, Brun A, Passant U. Frontal lobe degeneration of non-Alzheimer type. In Rosser MN, ed.Clinical Neurology International Practice and Research Unusual Dementia Bailliere Tindal vol 1. 1992;3:559–582.Google Scholar
  33. 33.
    Robinson BJ, Johnson RH, Lanibie DG, Palmer KT. Do elderly patients with an excessive fall in blood pressure on standing have evidence of autonomic failure?Clin Sci 1983;64:587–591.Google Scholar
  34. 34.
    Macrae AD, Bulpitt CJ. Assessment of postural hypotension in elderly patients.Age Ageing 1989;18:110–112.Google Scholar
  35. 35.
    Warkentin S, Passant U, Minthon L et al. Redistribution of blood flow in the crebral cortex of normal subjects during head-up postural change.Clin Auton Res 1992;2:119–124.Google Scholar
  36. 36.
    Passant U, Warkentin S, Minthon L, Fäldt R, Edvinsson L. Cortical blood flow during head-up postural change in subjects with orthostatic hypotension.Clin Auton Res 1993;3:311–318.Google Scholar
  37. 37.
    Bacon SJ, Smith AD. A monosynaptic pathway from an identified vasomotor centre in the medial prefrontal cortex to an autonomic area in the thoracic spinal cord.Neurol Sci 1993;3:719–728.Google Scholar

Copyright information

© Rapid Science Publishers 1996

Authors and Affiliations

  • U. Passant
    • 1
  • S. Warkentin
    • 1
  • S. Karlson
    • 1
  • K. Nilsson
    • 1
  • L. Edvinsson
    • 2
  • L. Gustafson
    • 1
  1. 1.Department of PsychogeriatricsUniversity HospitalLundSweden
  2. 2.Department of Internal MedicineUniversity HospitalLundSweden

Personalised recommendations