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Hypotensive Episodes Precede Cognitive Fluctuations in Parkinson's Disease Dementia

Year: 2026

Type: article

Abstract: BACKGROUND: Cognitive fluctuations (CFs) are a disabling feature in Parkinson's disease dementia (PDD) and contribute to caregiver burden. The relationship between CFs and neurogenic orthostatic hypotension (nOH), a common autonomic complication in PDD, has not been adequately examined. CASES: We describe four patients with PDD and nOH with caregiver-reported CFs manifesting as impaired attention, comprehension, language, and visuospatial skills. Each patient underwent bedside assessment for orthostatic vital signs and 24-hour ambulatory blood pressure monitoring (ABPM). CFs were consistently time-locked to periods of hypotension, independent of carbidopa/levodopa dosing. CONCLUSIONS: Hypotensive episodes may be under-recognized contributors to CFs in PDD. Interventions targeting hypotension warrant further investigation as potential strategies to mitigate CFs. Incorporation of ABPM into routine clinical evaluation may help guide their management.

Source: Movement Disorders Clinical Practice

DOI: 10.1002/mdc3.70590