Agnetic resonance imaging (MRI) scans in older people [1,2]. WMH seem to have a common distribution regardless of underlying diagnosis [3?], with a preference for areas of lower relative perfusion. They have been associated with depression [5] and dementia [6]. WMH predict functional decline in voiding, mobility and cognition, and depression [7?]. WMH have been associated, although only modestly [10], with classic cardiovascular risk factors [2,11] including hypertension [12] and APOEe4 [13], and are considered a marker ofcerebrovascular disease. Alternatively, WMH may, at least in Alzheimer’s disease (AD), primarily be associated with neurodegenerative disease [14]. However, some studies [15?9] suggest that hypotension, including orthostatic hypotension, plays a role in the development of WMH. Orthostatic hypotension (OH) [20] is common in older people [21], and particularly in older people with dementia [22,23]. OH is associated with falls [24], coronary heart disease and Benzocaine site increased mortality [25]. Furthermore, one older study using CT scans found seated systolic blood pressure (BP) below 130 to be predictive of having white matter low attenuation (equivalent to WMH in MRI) of theOH and WMH in Mild Dementiabrain [26], suggesting that the absolute BP level might be of importance. In this study we wanted to explore the association between OH and WMH in older people with mild dementia. We hypothesized that systolic and/or diastolic BP drop at baseline are positively correlated with total WMH volumes and Scheltens deep WMH scores, and that having OH, or standing systolic BP at or below 110 mm Hg at baseline is independently associated with having more severe WMH on imaging. Since OH appears to be particularly common in Lewy body dementias [27], we tested this association separately.[20]. The diagnosis of OH was based solely on the baseline BP measurements. By contrast, a diagnosis of hypertension was based on the medical history and the medical Tunicamycin web records only, and not on the baseline BP measurements. The assessments took place during normal office hours (i.e. 8 a.m. to 4 p.m.).APOEApolipoprotein E (APOE) genotypes were determined in a subgroup. First, genomic DNA was extracted from 200 ml EDTA-blood using the QIAamp 96 DNA Blood Kit (Qiagen, Hilden, Germany). For detection of the APOE e2, e3 and e4 genotypes, which are determined by the combination of two SNP’s (rs7412 and rs429358), we employed the LightCycler APOE Mutation Detection Kit (Roche Diagnostics, Mannheim, Germany), using the assay according to the instructions of the manufacturer.Methods SubjectsConsecutive referrals to dementia clinics in the counties of Rogaland and Hordaland in western Norway from March 2005 to March 2007 were screened, and patients with a first time diagnosis of mild dementia, i.e. a minimum Mini-Mental State Examination (MMSE) score of 20 were included. From April 2007 we selectively recruited patients with dementia with Lewy bodies (DLB) and Parkinson’s disease with dementia (PDD) fulfilling the aforementioned criteria of mild dementia. A total of 246 patients have completed baseline assessments, the last of whom was included in May 2011. In the current study, we included those who had both OH measurements and available MRI scans with adequate scan quality.Assessment of Physical ComorbidityWe 18325633 employed the “Cumulative Illness Rating Scale” (CIRS) for assessment of physical comorbidity. This instrument measures the chronic medical illness burden, while als.Agnetic resonance imaging (MRI) scans in older people [1,2]. WMH seem to have a common distribution regardless of underlying diagnosis [3?], with a preference for areas of lower relative perfusion. They have been associated with depression [5] and dementia [6]. WMH predict functional decline in voiding, mobility and cognition, and depression [7?]. WMH have been associated, although only modestly [10], with classic cardiovascular risk factors [2,11] including hypertension [12] and APOEe4 [13], and are considered a marker ofcerebrovascular disease. Alternatively, WMH may, at least in Alzheimer’s disease (AD), primarily be associated with neurodegenerative disease [14]. However, some studies [15?9] suggest that hypotension, including orthostatic hypotension, plays a role in the development of WMH. Orthostatic hypotension (OH) [20] is common in older people [21], and particularly in older people with dementia [22,23]. OH is associated with falls [24], coronary heart disease and increased mortality [25]. Furthermore, one older study using CT scans found seated systolic blood pressure (BP) below 130 to be predictive of having white matter low attenuation (equivalent to WMH in MRI) of theOH and WMH in Mild Dementiabrain [26], suggesting that the absolute BP level might be of importance. In this study we wanted to explore the association between OH and WMH in older people with mild dementia. We hypothesized that systolic and/or diastolic BP drop at baseline are positively correlated with total WMH volumes and Scheltens deep WMH scores, and that having OH, or standing systolic BP at or below 110 mm Hg at baseline is independently associated with having more severe WMH on imaging. Since OH appears to be particularly common in Lewy body dementias [27], we tested this association separately.[20]. The diagnosis of OH was based solely on the baseline BP measurements. By contrast, a diagnosis of hypertension was based on the medical history and the medical records only, and not on the baseline BP measurements. The assessments took place during normal office hours (i.e. 8 a.m. to 4 p.m.).APOEApolipoprotein E (APOE) genotypes were determined in a subgroup. First, genomic DNA was extracted from 200 ml EDTA-blood using the QIAamp 96 DNA Blood Kit (Qiagen, Hilden, Germany). For detection of the APOE e2, e3 and e4 genotypes, which are determined by the combination of two SNP’s (rs7412 and rs429358), we employed the LightCycler APOE Mutation Detection Kit (Roche Diagnostics, Mannheim, Germany), using the assay according to the instructions of the manufacturer.Methods SubjectsConsecutive referrals to dementia clinics in the counties of Rogaland and Hordaland in western Norway from March 2005 to March 2007 were screened, and patients with a first time diagnosis of mild dementia, i.e. a minimum Mini-Mental State Examination (MMSE) score of 20 were included. From April 2007 we selectively recruited patients with dementia with Lewy bodies (DLB) and Parkinson’s disease with dementia (PDD) fulfilling the aforementioned criteria of mild dementia. A total of 246 patients have completed baseline assessments, the last of whom was included in May 2011. In the current study, we included those who had both OH measurements and available MRI scans with adequate scan quality.Assessment of Physical ComorbidityWe 18325633 employed the “Cumulative Illness Rating Scale” (CIRS) for assessment of physical comorbidity. This instrument measures the chronic medical illness burden, while als.
