RT杂志文章SR电子T1在帕金森病和多系统萎缩患者中直立性低血压和痴呆之间的关联JF神经学JO神经学FD Lippincott Williams & Wilkins SP e998 OP e1008 DO 10.1212/WNL.0000000000201659首页VO 100 IS 10 A1 Ruiz Barrio, Iñigo A1 Miki, Yasuo A1 Jaunmuktane, Zane T. A1 Warner, Thomas A1 De Pablo-Fernandez, Eduardo YR 2023 UL http://n.首页neurology.org/content/100/10/e998.abstract AB背景和目的直立性低血压(OH)增加帕金森病(PD)患者的痴呆风险，尽管其潜在机制以及OH与认知障碍之间是否存在其他突触核病变的类似关联尚不清楚。目的是评估OH与PD患者痴呆风险、多系统萎缩(MSA)患者认知障碍风险之间的关系，并探讨相关临床和神经病理因素，了解潜在的致病机制。方法这是一项回顾性队列研究。系统地回顾了来自皇后广场脑库的连续的神经病理证实的PD和MSA患者的整个病程的医疗记录。记录oh相关症状的发病时间和严重程度，并评估其与其他临床和神经病理变量的关系。使用多变量风险回归估计PD患者的痴呆风险和MSA患者的认知障碍风险。结果纳入PD 132例，MSA 137例。MSA患者发生OH的频率更高，病程更早，症状更严重。PD患者的累积痴呆患病率较高。多变量调整回归模型显示，早期OH，而不是其症状严重程度，使PD患者的痴呆风险每年增加14%(危险比[HR] = 0.86;95% CI, 0.80-0.93)和MSA患者认知障碍风险每年降低41% (HR = 0.59; 95% CI, 0.42–0.83). Early OH was not associated with increased α-synuclein, β-amyloid, tau, Alzheimer, or cerebrovascular pathologies. No significant associations were found between severity of OH symptoms and other clinical or neuropathologic variables.Discussion Early OH, but not its symptom severity, increases the risk of cognitive impairment in patients with PD and MSA. OH is not associated with more extensive Lewy, β-amyloid, tau, Alzheimer, or cerebrovascular pathologies. It is likely that OH contributes to cognitive impairment in patients with PD and MSA by hypoxia-induced nonspecific neurodegeneration. Further research should evaluate whether improving brain perfusion by treating OH may modify the risk of dementia in these conditions.HR=hazard ratio; OH=orthostatic hypotension; PD=Parkinson disease; MSA=multiple system atrophy; SH=supine hypertension

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