Orthostatic hypotension is involved in cognitive impairment in patients with multiple system atrophy: a multi-center...

Area of Science:

• Neurology
• Neuroscience
• Clinical Medicine

Background:

• Orthostatic hypotension (OH) is a frequent symptom in multiple system atrophy (MSA).
• The precise role of OH in cognitive impairment and its underlying mechanisms in MSA patients remain incompletely understood.
• This study investigates the relationship between OH, cognitive function, cerebral autoregulation (CA), and white matter hyperintensities (WMHs) in MSA.

Purpose of the Study:

• To evaluate the association between orthostatic hypotension (OH) and cognitive impairment in patients with multiple system atrophy (MSA).
• To explore the potential roles of cerebral autoregulation (CA) and white matter hyperintensities (WMHs) in the cognitive decline observed in MSA patients, particularly in the context of OH.

Main Methods:

• An observational study conducted across three Chinese hospitals from January 2018 to October 2023.
• Cognitive function was assessed using the Mini-Mental State Examination (MMSE) and Montreal Cognitive Assessment (MoCA).
• Secondary outcomes included Head-up tilt test results, CA scores, and the extent of white matter hyperintensities (WMHs).

Main Results:

• Out of 132 MSA patients, 80 (60.61%) had OH and 48 (36.36%) exhibited cognitive impairment.
• OH was significantly associated with cognitive impairment in MSA patients (OR = 0.328, P = 0.014).
• Impaired CA (OR = 0.088, P = 0.018) and severe WMHs (OR = 0.030, P = 0.009) were linked to cognitive impairment, especially in patients with OH.

Conclusions:

• Orthostatic hypotension (OH) is a significant factor associated with cognitive impairment in multiple system atrophy (MSA) patients.
• Cognitive decline in MSA is further linked to impaired cerebral autoregulation (CA) and increased white matter hyperintensities (WMHs).
• Further research is warranted to elucidate the specific mechanisms driving cognitive impairment in MSA.