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Neurocardiovascular Instability, Hypotensive Episodes, and MRI Lesions in Neurodegenerative Dementia
Author(s) -
BALLARD CLIVE,
O'BRIEN JOHN,
BARBER BOB,
SCHELTENS PHILIP,
SHAW FIONA,
MCKEITH IAN,
KENNY ROSE ANNE
Publication year - 2000
Publication title -
annals of the new york academy of sciences
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 1.712
H-Index - 248
eISSN - 1749-6632
pISSN - 0077-8923
DOI - 10.1111/j.1749-6632.2000.tb06396.x
Subject(s) - hyperintensity , dementia , medicine , cardiology , magnetic resonance imaging , orthostatic vital signs , cognitive decline , blood pressure , disease , radiology
A bstract : We investigated whether carotid sinus hypersensitivity (CSH) and orthostatic hypotension (OH) were associated with a greater severity of hyperintensities on MRI scan in 30 patients with neurodegenerative dementia (17 dementia with Lewy bodies, 13 Alzheimer's disease), who had a detailed evaluation of OH and CSH during active standing and head‐up tilt. Patients also underwent a 1.0 Tesla MRI scan, from which hyperintensities were rated on a standardized scale. A blood pressure (BP) drop >30 mm Hg during carotid sinus massage or active standing was significantly associated with the severity of MRI hyperintensities in the deep white matter (OR 10.0, 95%; CI 1.8–55.7) and in the basal ganglia (OR 11.0, 95%; CI 1.2–99.5) but not in periventricular areas (OR 1.4, 95%; CI 0.3–1.8). Patients with the cardio‐inhibitory form of CSH with the largest BP drops were the most at risk. Further longitudinal studies need to investigate the direction of causality to determine whether CSH or OH predispose to MRI hyperintensities and accelerate cognitive decline.