Supine hypertension is longitudinally associated with verbal memory decline in Parkinson disease

Excerpt

Parkinson disease (PD) is associated with cognitive decline, for which there are no preventative therapeutics [1]. While multifactorial [1], cognitive decline in PD is associated with cardiovascular autonomic dysfunction, including orthostatic hypotension (OH) and supine hypertension (SH). This association may reflect a particular phenotype with more diffuse Lewy body pathology [2]. Alternatively, cardiovascular autonomic dysfunction may contribute to cognitive decline via hypoxia-associated atrophy or white matter disease [3‐5]. If the latter, treatment of OH and/or SH may reduce cognitive decline. However, no studies have evaluated the contributions of OH and SH to cognitive decline longitudinally. Clarifying whether OH, SH, or both drive cognitive decline is critical for determining which should be treated, even if asymptomatic, since either may be a confounder and the treatment of one may worsen the other. Here, we have evaluated whether OH and/or SH is independently associated with cognitive decline in PD across different cognitive domains for up to 9 years to inform potential interventional studies evaluating whether cardiovascular autonomic dysfunction treatment reduces cognitive decline. …