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Background <p>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.</p> Methods <p>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&#xa0;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.</p> Results <p>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, <i>P</i> = 0.014). Cognitive impairment was associated with impaired CA (OR = 0.088,95% CI 0.012–0.657, <i>P</i> = 0.018) and severe WMHs (OR = 0.030,95% CI 0.002–0.423, <i>P</i> = 0.009), particularly in the presence of OH.</p> Conclusion <p>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.</p>

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

  • 期刊论文

  • 发表日期：

    2025年2月11日

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

摘要

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.