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Orthostatic hypotension and acute cognitive dysfunction in Parkinson’s disease: insights from functional near-infrared spectroscopy
Journal article   Open access   Peer reviewed

Orthostatic hypotension and acute cognitive dysfunction in Parkinson’s disease: insights from functional near-infrared spectroscopy

Katherine Longardner, Pratusha Reddy, Danielle Shoshany, Michael Skipworth, Dawn M. Schiehser, David P. Salmon, Roy Freeman, Patricia A. Shewokis, Irene Litvan and Kurtulus Izzetoglu
Clinical neurophysiology, v 191, 2112351
Nov 2026
DOI: https://doi.org/10.1016/j.clinph.2026.2112351
PMID: 42556274
Featured in Collection :   Drexel's Newest Publications
url
https://doi.org/10.1016/j.clinph.2026.2112351View
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Abstract

Bloodpressure Cognitiveimpairment Functionalnear-infraredspectroscopy Orthostatichypotension Parkinson’sdisease Verbalfluency
•Participants with orthostatic hypotension (OH) had reduced letter fluency in the upright position compared to those without OH.•Participants with OH had impaired cerebral hemodynamic regulation in the upright position compared to supine.•Positional impairments in cognitive performance and cerebral hemodynamics occurred in the OH group without accompanying symptoms. To examine short-term associations among position-dependent executive performance and cerebral hemodynamic changes using functional near-infrared spectroscopy (fNIRS) in participants with Parkinson’s disease (PD) with and without orthostatic hypotension (OH). Twenty-nine nondemented participants with PD (19 without OH (OH–), 10 with OH (OH + )) completed a verbal fluency test (VFT) in supine and upright positions on a tilt table, while their cerebral oxygenation was continuously monitored using a full-head fNIRS system. Age-adjusted ANCOVA examined the interaction effects of OH status and position on VFT scores, while linear mixed-effects models assessed changes in oxygenated (HbO) and deoxygenated hemoglobin (HbR) within the dorsolateral prefrontal cortex (DLPFC). A significant interaction between OH status and position emerged for letter fluency (p = 0.044, ηp2 = 0.148), with the OH + group demonstrating poorer performance and more errors while upright. fNIRS analyses revealed that OH + participants exhibited reduced HbR in both left (p = 0.010, d = 0.73, 95% CI: [0.19, 1.27]) and right DLPFC (p = 0.011, d = 0.73, 95% CI: [0.19, 1.27]) when upright, suggesting increased utilization of cognitive resources. No participants reported orthostatic symptoms during the cognitive task. Despite lack of OH symptomatology, PD OH + individuals demonstrated impaired cerebral hemodynamic regulation when upright, which was associated with poorer cognitive performance. fNIRS-derived measures for monitoring cerebral hemodynamics in patients with autonomic failure may provide a clinically relevant indicator of postural changes in brain dysfunction.

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