Orthostatic hypotension as a risk factor for longitudinal deterioration of cognitive function in the elderly

Eur J Neurol. 2020 Jan;27(1):160-167. doi: 10.1111/ene.14050. Epub 2019 Aug 26.


Background and purpose: Orthostatic hypotension is frequent with aging with a prevalence of 20%-30% in people aged 65 or older and is considered to increase the risk for coronary events, strokes and dementia. Our objective was to characterize the association of orthostatic hypotension and cognitive function longitudinally over 6 years in a large cohort of the elderly aged over 50 years.

Methods: In all, 495 participants were assessed longitudinally with the Schellong test and comprehensive cognitive testing using the extended CERAD neuropsychological test battery at baseline and after 6 years. In a subgroup of 92 participants, cerebral magnetic resonance imaging was evaluated for white matter changes using a modified version of the Fazekas score.

Results: The prevalence of orthostatic hypotension increases with aging reaching up to 30% in participants aged >70 years. Participants with orthostatic hypotension presented with a higher vascular burden index (1.03 vs. 0.69, P ≤ 0.001), tended to have a higher prevalence of cerebral white matter hyperintensities (91.7% vs. 68.8%, P = 0.091) and showed a faster deterioration in executive and memory function (Trail Making Test B 95 vs. 87 s, P ≤ 0.001; word list learning sum -0.53 vs. 0.38, P = 0.002) compared to participants without orthostatic hypotension.

Conclusion: Orthostatic hypotension seems to be associated with cognitive decline longitudinally.

Keywords: aging; cognitive function; dementia; orthostatic hypotension.

MeSH terms

  • Aged
  • Aged, 80 and over
  • Cognitive Dysfunction / diagnostic imaging
  • Cognitive Dysfunction / epidemiology*
  • Cohort Studies
  • Disease Progression
  • Female
  • Humans
  • Hypotension, Orthostatic / complications*
  • Hypotension, Orthostatic / diagnostic imaging
  • Hypotension, Orthostatic / psychology
  • Magnetic Resonance Imaging
  • Male
  • Middle Aged
  • Neuropsychological Tests
  • Prevalence
  • Risk Factors
  • Trail Making Test
  • White Matter / diagnostic imaging