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Vol 55, No 6 (2021)
Review Article
Submitted: 2021-01-24
Accepted: 2021-04-01
Published online: 2021-05-26
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Cardiovascular dysautonomia and cognition in Parkinson’s Disease — a possible relationship

Magdalena Kwaśniak-Butowska12, Jarosław Dulski12, Anna Pierzchlińska3, Monika Białecka3, Dariusz Wieczorek4, Jarosław Sławek12
DOI: 10.5603/PJNNS.a2021.0040
·
Pubmed: 34037978
·
Neurol Neurochir Pol 2021;55(6):525-535.
Affiliations
  1. Division of Neurological and Psychiatric Nursing, Faculty of Health Sciences, Medical University of Gdansk, Poland
  2. Department of Neurology, St Adalbert Hospital, Gdansk, Poland, Poland
  3. Department of Pharmacokinetics and Therapeutic Drug Monitoring, Pomeranian Medical University, Szczecin, Poland
  4. Division of Rehabilitation, Faculty of Health Sciences, Medical University of Gdansk, Poland

open access

Vol 55, No 6 (2021)
REVIEW ARTICLES — LEADING TOPIC
Submitted: 2021-01-24
Accepted: 2021-04-01
Published online: 2021-05-26

Abstract

Dementia in advanced Parkinson’s Disease (PD) is a fatal milestone resulting in reduced life expectancy and nursing home placement. Cognitive impairment and cardiovascular dysautonomia are common and debilitating non-motor symptoms that frequently coexist in PD since the early stages and progress in subsequent years. In particular, blood pressure (BP) abnormalities, including orthostatic hypotension (OH), supine hypertension (SH) and the loss of nocturnal BP fall (non-dipping) in PD have been associated with cognitive deterioration. They usually have multifactorial aetiology, including neuronal (central and peripheral) mechanisms and concomitant intake of medications. BP abnormalities can influence cognition in many ways, including repeated cerebral hypoperfusion leading to cerebral ischaemic lesions, higher burden of white matter hyperintensities, and possible impact on neurodegenerative process in PD. They are often asymptomatic and remain unrecognised, hence 24-hour ambulatory BP monitoring is recommended in patients with clinical symptoms of dysautonomia. Management is challenging and should address the multifactorial nature of BP disturbances. The aim of this review was to present the state of current knowledge regarding the possible relationship between cardiovascular dysautonomia and cognition in PD, its diagnosis and treatment.

Abstract

Dementia in advanced Parkinson’s Disease (PD) is a fatal milestone resulting in reduced life expectancy and nursing home placement. Cognitive impairment and cardiovascular dysautonomia are common and debilitating non-motor symptoms that frequently coexist in PD since the early stages and progress in subsequent years. In particular, blood pressure (BP) abnormalities, including orthostatic hypotension (OH), supine hypertension (SH) and the loss of nocturnal BP fall (non-dipping) in PD have been associated with cognitive deterioration. They usually have multifactorial aetiology, including neuronal (central and peripheral) mechanisms and concomitant intake of medications. BP abnormalities can influence cognition in many ways, including repeated cerebral hypoperfusion leading to cerebral ischaemic lesions, higher burden of white matter hyperintensities, and possible impact on neurodegenerative process in PD. They are often asymptomatic and remain unrecognised, hence 24-hour ambulatory BP monitoring is recommended in patients with clinical symptoms of dysautonomia. Management is challenging and should address the multifactorial nature of BP disturbances. The aim of this review was to present the state of current knowledge regarding the possible relationship between cardiovascular dysautonomia and cognition in PD, its diagnosis and treatment.

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Keywords

cognitive impairment, dementia, orthostatic hypotension, Parkinson’s Disease, supine hypertension

About this article
Title

Cardiovascular dysautonomia and cognition in Parkinson’s Disease — a possible relationship

Journal

Neurologia i Neurochirurgia Polska

Issue

Vol 55, No 6 (2021)

Article type

Review Article

Pages

525-535

Published online

2021-05-26

Page views

7378

Article views/downloads

1274

DOI

10.5603/PJNNS.a2021.0040

Pubmed

34037978

Bibliographic record

Neurol Neurochir Pol 2021;55(6):525-535.

Keywords

cognitive impairment
dementia
orthostatic hypotension
Parkinson’s Disease
supine hypertension

Authors

Magdalena Kwaśniak-Butowska
Jarosław Dulski
Anna Pierzchlińska
Monika Białecka
Dariusz Wieczorek
Jarosław Sławek

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