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Association of cognitive dysfunction with neurocirculatory abnormalities in early Parkinson disease
Joong-Seok Kim, MD, PhD, Yoon-Sang Oh, MD, PhD, Kwang-Soo Lee, MD, PhD, Yeong-In Kim, MD, PhD, Dong-Won Yang, MD, PhD and David S. Goldstein, MD, PhD

From the Department of Neurology (J.-S.K., Y.-S.O., K.-S.L., Y.-I.K., D.-W.Y.), College of Medicine, The Catholic University of Korea, Seoul, Korea; and Clinical Neurocardiology Section (D.S.G.), Clinical Neurosciences Program, Division of Intramural Research, National Institute of Neurological Disorders and Stroke, National Institutes of Health, Bethesda, MD.

ABSTRACT

Objective: Cognitive impairment and neurocirculatory abnormalities such as orthostatic hypotension (OH), supine hypertension (SH), and failure to decrease blood pressure at night (nondipping) occur relatively commonly in Parkinson disease (PD); however, whether cognitive dysfunction in early PD is related to neurocirculatory abnormalities has not been established. Cognitive dysfunction in PD is associated with white matter hyperintensities on MRI. We report results of an analysis of neuropsychological and hemodynamic parameters in patients with early PD.

Methods: Among 87 patients, 25 had normal cognition, 48 had mild cognitive impairment, and 14 had dementia, based on comprehensive neuropsychological tests. Orthostatic vital signs and ambulatory 24-hour blood pressure monitoring were recorded, and brain magnetic resonance scans were obtained for all patients.

Results: Cognitive impairment was associated with OH, SH, and white matter hyperintensities but not with nondipping. Dementia and white matter hyperintensities were common in SH. Of 13 patients with OH + SH, every one had mild cognitive impairment or dementia.

Conclusions: Cognitive dysfunction is related to neurocirculatory abnormalities, especially OH + SH, in early PD, raising the possibility that early detection and effective treatment of those abnormalities might slow the rate of cognitive decline.

The focal hypertension weakens the blood-brain barrier and leads to a cascade of ill effects.

The glymphatic system was interesting but seems to be moving the focus away from the jugulars and the CSF and the blood-brain barrier. ...

The effect of a slap is all capillaries, isn't it? But vasodilatation is good for flow, vasoconstriction is bad...