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Blood pressure and heart rate responses to orthostatic challenge and Valsalva manoeuvre in mild cognitive impairment with Lewy bodies

Lookup NU author(s): Dr Calum Hamilton, Dr James FrithORCiD, Dr Paul Donaghy, Sally Barker, Dr Rory Durcan, Dr Sarah Lawley, Nicola Barnett, Dr Michael FirbankORCiD, Dr Gemma RobertsORCiD, Professor John-Paul TaylorORCiD, Dr Louise Allan, Professor John O'Brien, Professor Alison Yarnall, Professor Alan ThomasORCiD



This work is licensed under a Creative Commons Attribution 4.0 International License (CC BY 4.0).


Objectives Orthostatic hypotension is a common feature of normal ageing, and age-related neurodegenerative diseases, in particular the synucleinopathies including dementia with Lewy bodies. Orthostatic hypotension and other abnormal cardiovascular responses may be early markers of Lewy body disease We aimed to assess whether abnormal blood pressure and heart rate responses to orthostatic challenge and Valsalva manoeuvre would be more common in mild cognitive impairment with Lewy bodies (MCI-LB) than MCI due to Alzheimer’s disease (MCI-AD). Methods MCI patients (n = 89) underwent longitudinal clinical assessment with differential classification of probable MCI-LB, possible MCI-LB, or MCI-AD, with objective autonomic function testing at baseline. Blood pressure and heart rate responses to active stand and Valsalva manoeuvre were calculated from beat-to-beat cardiovascular data, with abnormalities defined by current criteria, and age-adjusted group differences estimated with logistic models. Results Orthostatic hypotension and abnormal heart rate response to orthostatic challenge were not more common in probable MCI-LB than MCI-AD. Heart rate abnormalities were likewise not more common in response to Valsalva manoeuvre in probable MCI-LB. An abnormal blood pressure response to Valsalva (delayed return to baseline/absence of overshoot after release of strain) was more common in probable MCI-LB than MCI-AD. In secondary analyses, magnitude of blood pressure drop after active stand and 10-seconds after release of Valsalva strain were moderately correlated with cardiac sympathetic denervation. Conclusions Probable MCI-LB may feature abnormal blood pressure response to Valsalva, but orthostatic hypotension is not a clear distinguishing feature from MCI-AD.

Publication metadata

Author(s): Hamilton CA, Frith J, Donaghy PC, Barker SAH, Durcan R, Lawley S, Barnett NA, Firbank M, Roberts G, Taylor JP, Allan LM, O'Brien J, Yarnall AJ, Thomas AJ

Publication type: Article

Publication status: Published

Journal: International Journal of Geriatric Psychiatry

Year: 2022

Volume: 37

Issue: 5

Print publication date: 01/05/2022

Online publication date: 02/04/2022

Acceptance date: 30/03/2022

Date deposited: 31/03/2022

ISSN (print): 0885-6230

ISSN (electronic): 1099-1166

Publisher: John Wiley & Sons Ltd


DOI: 10.1002/gps.5709


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Funder referenceFunder name
Alzheimer’s Research UK
GE Healthcare
National Institute for Health Research Applied Research Collaboration South West Peninsula
NIHR Newcastle Biomedical Research Centre