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

IF 4.6 2区医学 Q1 CLINICAL NEUROLOGY Journal of Neurology Pub Date : 2025-02-11 DOI:10.1007/s00415-025-12936-1

Wanlin Li, Yan Ding, Zhenbo Zhao, Xiaoyu Zhang, Ai Guan, Liufeng Tang, Ruoyang Hao, Xiaoyun Liu, Shengdi Chen, Hualong Wang

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Abstract

Background: Orthostatic hypotension (OH) is a common symptom of multiple system atrophy (MSA), however, its role in cognitive impairment and the mechanism in these patients remains unclear. This study aims to assess the role of OH on cognitive impairment in MSA patients, as well as to explore the potential association of cerebral autoregulation (CA) and white matter hyperintensities (WMHs) on cognitive impairment.

Methods: This observational study was conducted in three general hospitals in China from January 2018 to October 2023, with patients at one center followed up for 6 months after enrollment. The primary outcomes included cognitive function assessed using the Mini-Mental State Examination (MMSE) and Montreal cognitive assessment (MoCA). Secondary outcomes included the results of the Head-up tilt test, scores for CA and the extent of WMHs.

Results: The 132 MSA patients included 72 men (54.54%) with a mean age of 61.16 (7.80) years. Among them, 80 patients (60.61%) had orthostatic hypotension, and 48 patients (36.36%) had cognitive impairment. OH plays an important role in cognitive impairment in MSA patients (OR = 0.328,95% CI 0.135-0.797, P = 0.014). Cognitive impairment was associated with impaired CA (OR = 0.088,95% CI 0.012-0.657, P = 0.018) and severe WMHs (OR = 0.030,95% CI 0.002-0.423, P = 0.009), particularly in the presence of OH.

Conclusion: OH is associated with cognitive impairment in MSA patients, and cognitive decline is linked to impaired CA and increased WMHs. Future studies are needed to explore the mechanisms underlying cognitive impairment in MSA patients.

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直立性低血压与多系统萎缩患者的认知障碍有关：中国一项多中心队列研究。

背景：直立性低血压（OH）是多系统萎缩（MSA）的常见症状，但其在这些患者的认知功能障碍中的作用及其机制尚不清楚。本研究旨在评估OH在MSA患者认知功能障碍中的作用，并探讨脑自动调节（CA）和白质高强度（WMHs）在认知功能障碍中的潜在关联。方法：本观察性研究于2018年1月至2023年10月在中国三家综合医院进行，其中一个中心的患者入组后随访6个月。主要结果包括使用简易精神状态检查（MMSE）和蒙特利尔认知评估（MoCA）评估认知功能。次要结果包括平视倾斜测试结果、CA评分和wmh程度。结果：132例MSA患者中，男性72例（54.54%），平均年龄61.16岁（7.80）岁。其中体位性低血压80例（60.61%），认知功能障碍48例（36.36%）。OH在MSA患者认知功能障碍中起重要作用（OR = 0.328,95% CI 0.135 ~ 0.797, P = 0.014）。认知障碍与CA受损（OR = 0.088,95% CI 0.012-0.657, P = 0.018）和严重wmh （OR = 0.030,95% CI 0.002-0.423, P = 0.009）相关，特别是OH存在时。结论：OH与MSA患者的认知障碍有关，认知能力下降与CA受损和wmh增加有关。未来的研究需要探索MSA患者认知功能障碍的机制。

本文章由计算机程序翻译，如有差异，请以英文原文为准。

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来源期刊

Journal of Neurology 医学-临床神经学

CiteScore

10.00

自引率

5.00%

发文量

558

审稿时长

1 months

期刊介绍： The Journal of Neurology is an international peer-reviewed journal which provides a source for publishing original communications and reviews on clinical neurology covering the whole field. In addition, Letters to the Editors serve as a forum for clinical cases and the exchange of ideas which highlight important new findings. A section on Neurological progress serves to summarise the major findings in certain fields of neurology. Commentaries on new developments in clinical neuroscience, which may be commissioned or submitted, are published as editorials. Every neurologist interested in the current diagnosis and treatment of neurological disorders needs access to the information contained in this valuable journal.