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Updated: Jun 26, 2025
Evaluation of the Cognitive Performance of Hypertensive Patients with Silent Cerebrovascular Lesions
Published on: April 23, 2021
Orthostatic hypotension, cognition and structural brain imaging in hemodynamically impaired patients
Naomi L P Starmans1, Frank J Wolters2, Anna E Leeuwis3
1Department of Neurology and Neurosurgery, University Medical Centre Utrecht, P.O. Box 85500, 3508 GA Utrecht, the Netherlands.
Insights
Severe orthostatic hypotension (OH) is linked to poorer cognitive function and brain structure changes. Clinically significant OH, not just its presence, impacts brain health, affecting cognition and brain parenchymal fraction.
Area of Science:
- Neurology
- Cardiology
- Gerontology
Background:
- Orthostatic hypotension (OH) is a known risk factor for dementia, possibly due to reduced blood flow to the brain.
- Understanding specific OH patterns is crucial for assessing cognitive and structural brain impacts.
Purpose of the Study:
- To investigate the association between specific patterns and characteristics of OH with cognitive function and brain structure.
- To compare these associations in patients with cardiovascular conditions and healthy individuals.
Main Methods:
- 337 participants (carotid occlusive disease, heart failure, or healthy controls) underwent OH measurements, neuropsychological tests, and brain MRI.
- Linear regression analyzed associations between OH, cognitive function, white matter hyperintensity (WMH) volume, and brain parenchymal fraction.
- Stratification by OH severity, duration, chronotropic incompetence, and orthostatic symptoms was performed.
Main Results:
- 113 participants (33.5%) had OH. Severe OH (≥ 30/15 mmHg) and clinically manifest OH were associated with worse cognitive functioning.
- Severe OH and clinically manifest OH correlated with a lower brain parenchymal fraction.
- Severe OH was also linked to a higher white matter hyperintensity (WMH) volume.
Conclusions:
- Severe and clinically manifest orthostatic hypotension are associated with impaired cognitive function.
- These findings highlight that specific OH characteristics, rather than just its presence, significantly impact brain health and structure.
Background:
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.
Methods:
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.
Results:
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.
Conclusions:
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.
