1. Author response: Effects of orthostatic hypotension on cognition in Parkinson disease
- Author
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Justin Centi, Alexander O. Canova, Alice Cronin-Golomb, Christopher H. Gibbons, Roy Freeman, and Sandy Neargarder
- Subjects
medicine.medical_specialty ,business.industry ,Cognition ,Parkinson Disease ,Autoimmune autonomic ganglionopathy ,Disease ,Autonomic disorder ,medicine.disease ,03 medical and health sciences ,Orthostatic vital signs ,Hypotension, Orthostatic ,0302 clinical medicine ,Physical medicine and rehabilitation ,Anesthesia ,Cognitive Changes ,medicine ,Humans ,In patient ,Cognitive Dysfunction ,030212 general & internal medicine ,Neurology (clinical) ,Pure autonomic failure ,business ,030217 neurology & neurosurgery - Abstract
We thank Guaraldi et al. for their comment on our article,1 and for drawing our attention to their work assessing cognitive function in patients with peripheral autonomic disorders, pure autonomic failure (PAF), and autoimmune autonomic neuropathy.2 The results in their study are similar to our results in Parkinson disease (PD),2 and to data we reported earlier on reversible cognitive impairment in individuals with orthostatic hypotension (OH) due to the peripheral disorder autoimmune autonomicganglionopathy.3 Cognitive changes in all of these studies are most significant in the domains of attention and executive functioning; while disease-specific decrements vary across each participant group regardless of posture, the totality of these data strongly suggest an independent effect of OH that may go unnoticed during standard clinical assessment. This is perhaps most relevant for PD, where the management focus tends to be on motor features and OH may be unrecognized whereas dysautonomic signs are prioritized in autoimmune autonomic ganglionopathy, autonomic neuropathies, and PAF. All these studies highlight the need for clinical awareness of cognitive impairment in association with OH, and for additional work to delineate the pathophysiologic mechanisms underlying OH-induced cognitive impairment.1–3
- Published
- 2017