Objective: This study aims to investigate the relationship between OH and cognitive impairment in PD patients using gray matter volume (GMV) analysis.

Background: Orthostatic hypotension (OH) is a prevalent non-motor symptom in Parkinson’s disease (PD), associated with an increased risk of falls and cognitive decline. Despite its clinical significance, the mechanisms linking OH to cognitive impairment remain poorly understood.

Method: Data were obtained from the Parkinson’s Progression Markers Initiative (PPMI) database, comprising 351 PD patients categorized into OH (n=50) and non-OH (n=301) groups based on baseline assessments. All participants underwent comprehensive clinical evaluations, including the Montreal Cognitive Assessment (MoCA) for cognitive function (with a score <26 indicating impairment), and structural MRI scans using a 3.0T scanner. Demographic and clinical data, such as age, gender, disease duration, education, UPDRS scores, and non-motor symptom scales, were collected. GMV analysis was performed using voxel-based morphometry (VBM). Statistical analyses included independent t-tests, Mann-Whitney U tests, chi-square tests, Kaplan-Meier survival analysis, and Cox proportional hazards models to assess the association between OH and cognitive impairment.

Results: The median time to cognitive impairment onset was significantly shorter in the OH group (70.7 months) compared to the non-OH group (92.4 months; p=0.006). Cox regression analysis revealed that OH was a significant predictor of cognitive impairment (HR=2.11, p=0.008). At baseline, the OH group exhibited reduced GMV in the precentral gyrus and superior temporal gyrus. During follow-up, these patients showed further GMV reductions in the inferior frontal gyrus and inferior occipital gyrus, suggesting that OH may contribute to cognitive decline through structural changes in specific brain regions.

Conclusion: This study demonstrates that PD patients with OH are at a higher risk of developing cognitive impairment, potentially mediated by GMV reductions in key brain regions. The findings suggest that OH may influence cognitive function through mechanisms involving α-synuclein deposition, which affects both blood pressure regulation and cognitive-related brain areas. These insights provide a foundation for future research into targeted interventions aimed at delaying cognitive decline in PD patients with OH.

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MDS Abstracts - https://www.mdsabstracts.org/abstract/correlation-between-orthostatic-hypotension-and-cognitive-impairment-in-parkinsons-disease/