title: Effects of orthostatic hypotension on cognition in Parkinson disease.
abstract: OBJECTIVE
  To investigate the relation between orthostatic hypotension (OH) and posture-mediated cognitive impairment in Parkinson disease (PD) using a cross-sectional and within-group design.
  
  
  METHODS
  Individuals without dementia with idiopathic PD included 18 with OH (PDOH) and 19 without OH; 18 control participants were also included. Neuropsychological tests were conducted in supine and upright-tilted positions. Blood pressure was assessed in each posture.
  
  
  RESULTS
  The PD groups performed similarly while supine, demonstrating executive dysfunction in sustained attention and response inhibition, and reduced semantic fluency and verbal memory (encoding and retention). Upright posture exacerbated and broadened these deficits in the PDOH group to include phonemic fluency, psychomotor speed, and auditory working memory. When group-specific supine scores were used as baseline anchors, both PD groups showed cognitive changes following tilt, with the PDOH group exhibiting a wider range of deficits in executive function and memory as well as significant changes in visuospatial function.
  
  
  CONCLUSIONS
  Cognitive deficits in PD have been widely reported with assessments performed in the supine position, as seen in both our PD groups. Here we demonstrated that those with PDOH had transient, posture-mediated changes in excess of those found in PD without OH. These observed changes suggest an acute, reversible effect. Understanding the effects of OH due to autonomic failure on cognition is desirable, particularly as neuroimaging and clinical assessments collect data only in the supine or seated positions. Identification of a distinct neuropsychological profile in PD with OH has quality of life implications, and OH presents itself as a possible target for intervention in cognitive disturbance.
authors.affiliation: From the Department of Psychological and Brain Sciences (J.C., S.N., A.O.C., A.C.-G.), Boston University, Boston; Department of Neurology (J.C., R.F., C.H.G.), Beth Israel Deaconess Medical Center, Harvard Medical School, Boston; and Department of Psychology (S.N.), Bridgewater State University, Bridgewater, MA.
authors.forename: Justin
authors.initials: J
authors.lastname: Centi
authors.affiliation: From the Department of Psychological and Brain Sciences (J.C., S.N., A.O.C., A.C.-G.), Boston University, Boston; Department of Neurology (J.C., R.F., C.H.G.), Beth Israel Deaconess Medical Center, Harvard Medical School, Boston; and Department of Psychology (S.N.), Bridgewater State University, Bridgewater, MA.
authors.forename: Roy
authors.initials: R
authors.lastname: Freeman
authors.affiliation: From the Department of Psychological and Brain Sciences (J.C., S.N., A.O.C., A.C.-G.), Boston University, Boston; Department of Neurology (J.C., R.F., C.H.G.), Beth Israel Deaconess Medical Center, Harvard Medical School, Boston; and Department of Psychology (S.N.), Bridgewater State University, Bridgewater, MA.
authors.forename: Christopher H
authors.initials: CH
authors.lastname: Gibbons
authors.affiliation: From the Department of Psychological and Brain Sciences (J.C., S.N., A.O.C., A.C.-G.), Boston University, Boston; Department of Neurology (J.C., R.F., C.H.G.), Beth Israel Deaconess Medical Center, Harvard Medical School, Boston; and Department of Psychology (S.N.), Bridgewater State University, Bridgewater, MA.
authors.forename: Sandy
authors.initials: S
authors.lastname: Neargarder
authors.affiliation: From the Department of Psychological and Brain Sciences (J.C., S.N., A.O.C., A.C.-G.), Boston University, Boston; Department of Neurology (J.C., R.F., C.H.G.), Beth Israel Deaconess Medical Center, Harvard Medical School, Boston; and Department of Psychology (S.N.), Bridgewater State University, Bridgewater, MA.
authors.forename: Alexander O
authors.initials: AO
authors.lastname: Canova
authors.affiliation: From the Department of Psychological and Brain Sciences (J.C., S.N., A.O.C., A.C.-G.), Boston University, Boston; Department of Neurology (J.C., R.F., C.H.G.), Beth Israel Deaconess Medical Center, Harvard Medical School, Boston; and Department of Psychology (S.N.), Bridgewater State University, Bridgewater, MA. alicecg@bu.edu.
authors.forename: Alice
authors.initials: A
authors.lastname: Cronin-Golomb
mesh_terms: D000368:Aged; D001288:Attention / Q000502:physiology; D001794:Blood Pressure / Q000502:physiology; D003072:Cognition Disorders / Q000175:diagnosis / Q000209:etiology*; D003430:Cross-Sectional Studies; D056344:Executive Function / Q000502:physiology; D005260:Female; D006339:Heart Rate / Q000502:physiology; D006801:Humans; D007024:Hypotension, Orthostatic / Q000150:complications*; D008297:Male; D008568:Memory / Q000502:physiology; D008875:Middle Aged; D009483:Neuropsychological Tests; D010300:Parkinson Disease / Q000150:complications*; D011187:Posture; D011569:Psychiatric Status Rating Scales; D018709:Statistics, Nonparametric