Advertisement

Journal of Neurology

, Volume 260, Issue 1, pp 253–259 | Cite as

Cognitive and MRI correlates of orthostatic hypotension in Parkinson’s disease

  • Manuela Pilleri
  • Silvia Facchini
  • Elisabetta Gasparoli
  • Roberta Biundo
  • Laura Bernardi
  • Mauro Marchetti
  • Patrizia Formento
  • Angelo Antonini
Original Communication

Abstract

Orthostatic hypotension (OH) is a frequent nonmotor feature of Parkinson’s disease (PD), and its occurrence has been associated with cognitive impairment. The underlying mechanism could be mediated by development of cerebrovascular disease induced by chronic or episodic hypoperfusion, but the extent of brain vascular load in PD patients with OH has never been investigated. This study aimed to assess the relationship between OH and cognitive function in PD patients and to investigate the contribution of brain vascular lesions. Forty-eight PD patients underwent a tilt table test (TT) to assess supine and orthostatic blood pressure as well as an extensive neuropsychological evaluation to evaluate cognitive function. Brain magnetic resonance imaging was acquired in 44/48 patients and analyzed by a visual semiquantitative scale. Twenty-three patients presented OH at TT (13/23 were symptomatic), and 25 did not. There were no differences in motor severity or disease duration between patients with and without OH. In patients with OH we found significantly worse cognitive performance in specific tasks, such as sustained attention, visuospatial and verbal memory, compared with patients without OH. However, there were no differences in vascular burden between the two groups. Our study confirms that there is an association between OH and selective cognitive deficits in PD, but rebuts the hypothesis that this is underlined by the development of cerebrovascular disease.

Keywords

Parkinson disease Orthostatic hypotension Cognition Magnetic resonance Vascular load 

Notes

Conflicts of interest

All authors have no financial or other conflicts of interest that might bias their work.

Ethical standard

This study has been approved by local ethic committee of IRCCS San Camillo and has been performed in agreement with the ethical standards laid down in the 1964 declaration of Helsinki.

References

  1. 1.
    Ha AD, Brown CH, York MK, Jankovic J (2011) The prevalence of symptomatic orthostatic hypotension in patients with Parkinson’s disease and atypical Parkinsonism. Parkinsonism Rel Disord 17:625–628CrossRefGoogle Scholar
  2. 2.
    Senard JM, Rai S, Lapeyre-Mestre M et al (1997) Prevalence of orthostatic hypotension in Parkinson’s disease. J Neurol Neurosurg Psychiatry 63:584–589PubMedCrossRefGoogle Scholar
  3. 3.
    Peralta C, Stampfer M, Karner E, Benke T, Poewe W, Wenning GK (2004) Orthostatic hypotension and attention in Lewy body disorders. Mov Disord 19:S331–S332CrossRefGoogle Scholar
  4. 4.
    Poewe W (2007) Dysautonomia and cognitive dysfunction in Parkinson’s disease. Mov Disord 22(Suppl 17):S374–S378PubMedCrossRefGoogle Scholar
  5. 5.
    Idiaquez J, Benarroch EE, Rosales H, Milla P, Ríos L (2007) Autonomic and cognitive dysfunction in Parkinson’s disease. Clin Auton Res 17(2):93–98PubMedCrossRefGoogle Scholar
  6. 6.
    Allcock LM, Kenny RA, Mosimann UP, Tordoff S, Wesnes KA, Hildreth AJ, Burn DJ (2006) Orthostatic hypotension in Parkinson’s disease: association with cognitive decline? Int J Geriatr Psychiatry 21:778–783PubMedCrossRefGoogle Scholar
  7. 7.
    Hohler AD, Zuzuárregui JR, Katz DI, Depiero TJ, Hehl CL, Leonard A, Allen V, Dentino J, Gardner M, Phenix H, Saint-Hilaire M, Ellis T (2011) Differences in motor and cognitive function in patients with Parkinson’s disease with and without orthostatic hypotension. Int J Neurosci. [Epub ahead of print]Google Scholar
  8. 8.
    Hughes AJ, Daniel SE, Kilford L, Lees AJ (1992) Accuracy of clinical diagnosis of idiopathic Parkinson's disease: a clinico-pathological study of 100 cases. J Neurol Neurosurg Psychiatry 55(3):181–184Google Scholar
  9. 9.
    Tomlinson CL, Stowe R, Patel S, Rick C, Gray R, Clarke CE (2010) Systematic review of levodopa dose equivalency reporting in Parkinson’s disease. Mov Disord 25(15):2649–2653PubMedCrossRefGoogle Scholar
  10. 10.
    Antonini A, Abbruzzese G, Ferini-Strambi L, Tilley B, Huang J, Stebbins GT, Goetz CG, Barone P; MDS-UPDRS Italian Validation Study Group (2012) Validation of the Italian version of the movement disorder society-unified Parkinson’s disease rating scale. Neurol Sci. [Epub ahead of print]Google Scholar
  11. 11.
    The Consensus Committee of the American Autonomic Society and the American Academy of Neurology (1996) Consensus statement on the definition of orthostatic hypotension, pure autonomic failure, and multiple system atrophy. Neurology 46(5):147CrossRefGoogle Scholar
  12. 12.
    Chaudhuri KR, Martinez-Martin P, Brown RG, Sethi K, Stocchi F, Odin P, Ondo W et al (2007) The metric properties of a novel non-motor symptoms scale for Parkinson’s disease: results from an international pilot study. Mov Disord 22:1901–1911PubMedCrossRefGoogle Scholar
  13. 13.
    Biundo R, Formento-Dojot P, Facchini S, Vallelunga A, Ghezzo L, Foscolo L, Meneghello F, Antonini A (2011) Brain volume changes in Parkinson’s disease and their relationship with cognitive and behavioural abnormalities. J Neurol Sci 310(1–2):64–69PubMedCrossRefGoogle Scholar
  14. 14.
    Scheltens P, Barkhof F, Leys D, Pruvo JP, Nauta JJ, Vermersch P, Steinling M, Valk J (1993) A semiquantative rating scale for the assessment of signal hyperintensities on magnetic resonance imaging. J Neurol Sci 114(1):7–12PubMedCrossRefGoogle Scholar
  15. 15.
    Santangelo G, Viatle C, Trojano L, De Gaspari D, Bilo L, Antonini A, Barone P (2010) Differential neuropsychological profiles in Parkinsonian patients with or without vascular lesions. Mov Disord 25(1):50–56PubMedGoogle Scholar
  16. 16.
    Jordan J, Biaggioni I (2002) Diagnosis and treatment of supine hypertension in autonomic failure patients with orthostatic hypotension. J Clin Hypertens 4(2):139–145CrossRefGoogle Scholar
  17. 17.
    Allcock LM, Kenny RA, Burn DJ (2006) Clinical phenotype of subjects with Parkinson’s disease and orthostatic hypotension: autonomic symptom and demographic comparison. Mov Disord 21(11):1851–1855PubMedCrossRefGoogle Scholar
  18. 18.
    Wenning GK, Scherfler C, Granata R et al (1999) Time course of symptomatic orthostatic hypotension and urinary incontinence in patients with postmortem confirmed parkinsonian syndromes: a clinicopathological study. J Neurol Neurosurg Psychiatry 67:620–623PubMedCrossRefGoogle Scholar
  19. 19.
    Rose KM, Couper D, Eigenbrodt ML, Mosley TH, Sharrett AR, Gottesman RF (2010) Orthostatic hypotension and cognitive function: the Atherosclerosis risk in Communities study. Neuroepidemiology 34(1):1–7PubMedCrossRefGoogle Scholar
  20. 20.
    Duschek S, Matthias E, Schandry R (2005) Essential hypotension is accompanied by deficits in attention and working memory. Behav Med 30:149–158PubMedCrossRefGoogle Scholar
  21. 21.
    Weisz N, Schandry R, Jacobs A, Mialet J, Duschek S (2002) Early contingent negative variation of the EEG and attentional flexibility are reduced in hypotension. Int J Psychophysiol 45:253–260PubMedCrossRefGoogle Scholar
  22. 22.
    Mehrabian S, Duron E, Labouree F, Rollot F, Bune A, Traykov L, Hanon O (2010) Relationship between orthostatic hypotension and cognitive impairment in the elderly. J Neurol Sci 299:45–48PubMedCrossRefGoogle Scholar
  23. 23.
    Viramo P, Luukinen H, Koski K, Laippala P, Sulkava R, Kivela SL (1999) Orthostatic hypotension and cognitive decline in older people. J Am Geriatr Soc 47:600–604PubMedGoogle Scholar
  24. 24.
    Heims H, Critchley H, Martin N, Jager R, Mathias CJ, Copolotti L (2006) Cognitive functioning in orthostatic hypotension due to pure autonomic failure. Clin Auton Res 16:113–120PubMedCrossRefGoogle Scholar
  25. 25.
    Elmstahl S, Rosen I (1997) Postural hypotension and EEG variables predict cognitive decline: results from a 5-year follow-up of healthy elderly women. Dement Geriatr Cogn Disord 8:180–187PubMedCrossRefGoogle Scholar
  26. 26.
    Freitag MH, Peila R, Masaki K, Petrovitch H, Ross GW, White LR, Launer LJ (2006) Midlife pulse pressure and incidence of dementia: the Honolulu-Asia Aging Study. Stroke 37:33–37PubMedCrossRefGoogle Scholar
  27. 27.
    Van Dijk EJ, Breteler MM, Schmidt R, Berger K, Nilsson LG, Oudkerk M, Pajak A, Sans S, de Ridder M, Dufouil C, Fuhrer R, Giampaoli S, Launer LJ, Hofman A (2004) The association between blood pressure, hypertension, and cerebral white matter lesions: cardiovascular determinants of dementia study. Hypertension 44:625–630PubMedCrossRefGoogle Scholar
  28. 28.
    Vokatch N, Grötzsch H, Mermillod B, Burkhard PR, Sztajzel R (2007) Is cerebral autoregulation impaired in Parkinson’s disease? A transcranial Doppler study. Neurol Sci 254(1–2):49–53Google Scholar
  29. 29.
    Tsai SJ, Chen SC, Leu TM, Chen CM, Chou HH, Peng HY, Liao JM, Lin TB (2009) Impairment of cerebral hemodynamic response to the cold pressor test in patients with Parkinson’s disease. Parkinsonism Relat Disord 15(2):94–100 Epub 2008 Apr 28PubMedCrossRefGoogle Scholar
  30. 30.
    Bohnen NI, Albin RL (2011) White matter lesions in Parkinson disease. Nat Rev Neurol 7(4):229–236PubMedCrossRefGoogle Scholar
  31. 31.
    Antonini A, Vitale C, Barone P, Cilia R, Righini A, Bonuccelli U, Abbruzzese G, Ramat S, Petrone A, Quatrale R, Marconi R, Ceravolo R, Stefani A, Lopiano L, Zappia M, Capus L, Morgante L, Tamma F, Tinazzi M, Colosimo C, Guerra UP (2012) The relationship between cerebral vascular disease and parkinsonism: The VADO study. Parkinsonism Relat Disord. [Epub ahead of print]Google Scholar
  32. 32.
    Miklossy J (2003) Cerebral hypoperfusion induces cortical watershed microinfarcts which may further aggravate cognitive decline in Alzheimer’s disease. Neurol Res 25:605–610PubMedCrossRefGoogle Scholar
  33. 33.
    Fernández-Seara MA, Mengual E, Vidorreta M, Aznárez-Sanado M, Loayza FR, Villagra F, Irigoyen J, Pastor MA (2012) Cortical hypoperfusion in Parkinson’s disease assessed using arterial spin labeled perfusion MRI. Neuroimage 59(3):2743–2750PubMedCrossRefGoogle Scholar
  34. 34.
    Borghammer P, Chakravarty M, Jonsdottir KY, Sato N, Matsuda H, Ito K, Arahata Y, Kato T, Gjedde A (2010) Cortical hypometabolism and hypoperfusion in Parkinson’s disease is extensive: probably even at early disease stages. Brain Struct Funct 214(4):303–317PubMedCrossRefGoogle Scholar
  35. 35.
    Nobili F, Abruzzese G, Morbelli S, Marchese R, Girtler N, Dessi B et al (2009) Amnestic mild cognitive impairment in Parkinson’s disease: a brain perfusion SPECT study. Mov Disord 24:414–421PubMedCrossRefGoogle Scholar
  36. 36.
    Aliev G, Smith MA, de la Torre JC, Perry G (2004) Mitochondria as a primary target for vascular hypoperfusion and oxidative stress in Alzheimer’s disease. Mitochondrion 4(5–6):649–663PubMedCrossRefGoogle Scholar
  37. 37.
    Hai J, Lin Q, Su SH, Zhang L, Wan JF, Lu Y (2011) Chronic cerebral hypoperfusion in rats causes proteasome dysfunction and aggregation of ubiquitinated proteins. Brain Res 1374:73–81PubMedCrossRefGoogle Scholar

Copyright information

© Springer-Verlag 2012

Authors and Affiliations

  • Manuela Pilleri
    • 1
  • Silvia Facchini
    • 1
  • Elisabetta Gasparoli
    • 1
  • Roberta Biundo
    • 1
  • Laura Bernardi
    • 1
  • Mauro Marchetti
    • 2
  • Patrizia Formento
    • 1
  • Angelo Antonini
    • 1
  1. 1.Department of Parkinson Disease and Movement DisordersIRCCS San CamilloVeniceItaly
  2. 2.Department of PsychologyUniversity of PaduaPaduaItaly

Personalised recommendations