Orthostatic hypotension and cognitive decline in older people

OBJECTIVES: To establish the role of orthostatic hypotension (OH) as a risk factor for cognitive decline among home-dwelling and institutionalized old er people and to describe other predictors of cognitive decline. DESIGN: Follow-up study with two clinical examinations. SETTING: A community-based setting in northern Finland. PARTICIPANTS: All of the 1159 people aged 70 or more living in five rural m unicipalities around the town of Oulu in Northern Finland in 1991. At the t ime of the follow-up examination, 2.5 years later, 884 of the original part icipants were alive and 651 were re-examined. MEASUREMENTS: In 1991, 907 people (78.3 % of the total population) were tes ted for orthostatic hypotension, and their cognitive capacity was assessed with the Mini-Mental State Examination (MMSE). The calculation/spelling tas ks were excluded from the final version used in the statistical analysis. T he re-assessment of cognitive capacity was made on 651 subjects (73.6% of t hose alive) who had participated in the first examination. The data were an alyzed using polychotomous and linear regression analysis models. RESULTS: The prevalence of OH was 28.7%, with no age or sex differences. Th e mean sum score for the shortened MMSE in 1991 was 21.6 (+/-3.98) for pers ons with OH and 21.1 (+/-4.08) for non-OH persons. During the follow-up, th e sum score declined in the OH group by .44 (+/-2.81) points and in the non -OH group by .83 (+/-3.61) points. No type of OH (systolic or diastolic 1- or 3-minute values or their combination) predicted cognitive decline; the o nly predictors were old age and low level of formal education. CONCLUSIONS: Orthostatic hypotension is a common clinical condition that af fects every fourth person aged 70 years or older. By temporarily inducing c erebral hypoperfusion, it may cause or exacerbate cognitive dysfunction. In an unselected population, OH was not associated with cognitive deteriorati on, nor did it predict cognitive decline during a 2-year follow-up.