ORIGINAL RESEARCH article
Front. Neurol.
Sec. Neuroepidemiology
Association of Neurogenic Orthostatic Hypotension with Cognitive Decline in Parkinson's Disease: A Longitudinal Cohort Study
Neda Bagheri 1
Katherine Longardner 2
David Coughlin 2
1. University of California, San Diego, School of Medicine, San Diego, United States
2. University of California San Diego, Department of Neuroscience, San Diego, United States
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Abstract
Neurogenic orthostatic hypotension (nOH), a common non-motor feature of Parkinson's disease (PD), is defined as a sustained drop in blood pressure (BP) upon standing due to autonomic dysfunction. Although prior studies support an association between nOH and cognitive impairment, its longitudinal impact on cognitive decline in PD remains insufficiently explored. We aimed to determine to what extent baseline nOH is associated with an accelerated decline in global and exploratory domain-specific cognitive functions. A retrospective longitudinal cohort study was conducted using clinical data from patients with PD evaluated at the University of California San Diego movement disorders clinics between 2012 and 2024. Participants were classified as having nOH (nOH+) or without nOH (nOH−) based on initial orthostatic BP measurements (≥20 mmHg systolic BP (SBP) and/or ≥10 mmHg diastolic BP reduction within 3 minutes of standing, with a blunted heart rate response (change in heart rate/change in systolic blood pressure [ΔHR/ΔSBP] < 0.5 bpm/mmHg)). Cognitive performance was assessed using the Montreal Cognitive Assessment (MoCA), including total scores and domain-specific subscores. Longitudinal changes in cognitive function were modeled using linear mixed-effects models, adjusting for time, nOH status, age, sex, and their interaction. Motor and non-motor symptom progression was evaluated using the Movement Disorder Society – Unified Parkinson's Disease Rating Scale (MDS-UPDRS) Parts I–III. Patients with nOH at the first visit showed faster decline in total MoCA scores (Interaction β = −0.57, SE = 0.15, p <0.001), reflecting declines in abstraction (Interaction β = −0.15, SE = 0.05, p <0.01), attention (Interaction β = −0.13, SE = 0.04,
Summary
Keywords
autonomic dysfunction, cognitive decline, longitudinal analysis, neurogenic orthostatic hypotension, Parkinson's disease
Received
09 January 2026
Accepted
18 February 2026
Copyright
© 2026 Bagheri, Longardner and Coughlin. This is an open-access article distributed under the terms of the Creative Commons Attribution License (CC BY). The use, distribution or reproduction in other forums is permitted, provided the original author(s) or licensor are credited and that the original publication in this journal is cited, in accordance with accepted academic practice. No use, distribution or reproduction is permitted which does not comply with these terms.
*Correspondence: Neda Bagheri
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