Orthostatic intolerance predicts mild cognitive impairment: incidence of mild cognitive impairment and dementia from the Swedish general population cohort Good Aging in Skåne

Figures & data

Table 1 Baseline descriptive statistics of mean values and proportions of OH test parameters and background factors for controls and participants with MCI, dementia, and objective and subjective memory loss at 6-year follow-up of the general elderly Swedish population of GÅS-SNAC (n=1,480)

	Controls	Objective memory loss	Subjective memory loss	MCI	Dementia	All participants
Participants (n/%)	697/47	381/26	158/11	123/8	121/8	1,480/100
Valid OH test	686	375	156	123	119	1,459
Men/women (%)	44/56	53/47	32/68	52/48	42/58	46/54
Age (years)	65.6	67.6	70.1	71.7	76.2	68.0
High school/university (%)	32/29	27/18	17/24	24/15	27/12	29/23
Hypertensive (>140/90) or antihypertensive treatment (%)	60	67	65	67	73	64
Hypertensive at baseline (mean of 3 BP) (%)	55	61	56	59	68	59
Antihypertensive treatment (%)	21	24	27	25	33	23
Diabetes type 1/2 (%)	0.3/4.6	0.5/5.8	0/4.4	0.8/4.9	1.7/10.7	0.5/5.4
Treatment for hyperlipidemia (%)	13	18	16	15	15	15
Physical inactivity (%)	11	12	11	17	25	13
Present smoker (%)	13	17	11	8	15	13
Past or present smoker (%)	62	57	60	50	49	58
Born abroad (%)	9	7	9	9	10	9
Single or living alone (%)	28	35	50	30	45	30
SBP resting (mmHg) (mean; SD)	142; 19	146; 21	144; 21	149; 21	149; 20	146; 22
DBP resting (mmHg) (mean; SD)	82; 9.2	82; 9.7	80; 10.5	81; 9.8	79; 10.0	83; 10.6
Heart rate resting (mean; SD)	67; 11	66; 10	68; 10	66; 13	68; 11	67; 11
Max difference SBP supine – upright 10 minutes (mean; SD)	10; 11	11; 10	11; 12	12; 11	15; 15	11; 11
Max difference DBP supine – upright 10 minutes (mean; SD)	2; 6	2; 6	3; 6	3; 6	4; 7	2; 6
Max heart rate during OH test (mean; SD)	78; 13	77; 12	78; 11	77; 13	79; 13	78; 13
Change in heart rate during OH test (mean; SD)	12; 8	12; 7	12; 11	12; 10	12; 7	12; 8
OH (SBP falls >20 mmHg/DBP >10 mmHg) (%)	17	17	8	24	34	19
Systolic OH falls >20 mmHg (%)	9	10	12	15	23	11
Diastolic OH falls >10 mmHg (%)	5	6	8	8	10	6
Previous or present orthostatic intolerance (%)	25	28	35	41	25	28
Previous orthostatic intolerance (%)	22	27	31	40	23	26
Present orthostatic intolerance (%)	6	5	8	9	8	7
Subjective memory loss at baseline (%)	1.6	2.4	15.8	6.5	5.0	11
Objective memory loss at baseline (%)	19.1	44.6	24.1	47.2	53.7	25.7

Abbreviations: DBP, diastolic blood pressure; GÅS-SNAC, Good Aging in Skåne; max, maximum; MCI, mild cognitive impairment; OH, orthostatic hypotension; SBP, systolic blood pressure; SD, standard deviation.

Table 2 Six-year incidence of MCI and dementia at follow-up and prevalence of OH at baseline in the general elderly Swedish population of GÅS-SNAC (n=1,480)

	Number of persons (%)	Mean py	Total py	6-year incidence/1,000 py	OH at baseline (%)	All persons (%)
Total study sample	1,480a	5.86	8,681		18	100
Controls (all)	697	5.87	4,092	–	16	47
Men (%)/women (%)	309 (44)/388 (56)	5.87/5.87	1,814/2,278	–
60–69 years (%)	253 (47)/290 (53)	5.86/5.86	1,484/1,699	–
70–79 years (%)	40 (42)/56 (58)	5.90/5.90	236/330	–
80+ years (%)	16 (28)/42 (72)	5.91/5.93	95/249	–
Objective memory loss (all)	381	5.85	2,229	43.9	16	26
Men (%)/women (%)	201 (53)/180 (47)	5.83/5.86	1,172/1,055	50.9/31.4
60–69 years (%)	145 (57)/108 (43)	5.83/5.86	845/633	51.7/37.4
70–79 years (%)	37 (47)/41 (53)	5.83/5.84	216/239	52.8/42.9
80+ years (%)	19 (38)/31 (62)	5.86/5.90	111/183	42.7/35.1
Subjective memory loss (all)	158	5.87	928	18.2	19	11
Men (%)/women (%)	51 (32)/107 (68)	5.83/5.89	297/630	12.9/18.7
60–69 years (%)	32 (36)/57 (64)	5.83/5.82	187/332	11.4/19.7
70–79 years (%)	13 (32)/28 (68)	5.93/6.00	77/168	18.6/29.3
80+ years (%)	6 (21)/22 (79)	5.62/5.95	34/131	13.5/24.9
MCI (all)	123	5.82	716	14.2	24	8
Men (%)/women (%)	64 (52)/59 (48)	5.74/5.90	367/348	16.2/10.3
60–69 years (%)	34 (63)/20 (37)	5.80/5.92	197/118	12.1/6.9
70–79 years (%)	12 (33)/24 (67)	5.62/5.80	67/139	17.1/25.1
80+ years (%)	18 (55)/15 (45)	5.71/6.03	103/91	40.5/16.9
Dementia (all)	121	5.94	719	13.9	31	8
Men (%)/women (%)	51 (42)/70 (58)	5.92/5.96	302/417	12.9/12.2
60–69 years (%)	16 (47)/18 (53)	5.94/5.98	95/108	5.7/6.2
70–79 years (%)	18 (58)/13 (42)	5.80/6.06	104/79	25.7/13.6
80+ years (%)	17 (30)/39 (70)	6.02/5.91	102.3/230.5	38.2/46.2
Any form of cognitive impairment (all)	783	5.86	4,588	90.2	20	53
Men (%)/women (%)	367 (47)/416 (53)	5.82/5.89	2,136/2,450	92.8/72.6
60–69 years (%)	227 (53)/203 (47)	5.83/5.87	1,323/1,192	80.9/70.3
70–79 years (%)	80 (43)/106 (57)	5.81/5.90	465/625	114.2/111.0
80+ years (%)	60 (36)/107 (64)	5.83/5.93	350/634	135.0/121.0

Note:

a In the total sample, OH tests were missing in 21 persons.

Abbreviations: GÅS-SNAC, Good Aging in Skåne; MCI, mild cognitive impairment; OH, orthostatic hypotension; py, person-years.

Table 3 Comparisons of baseline mean values, proportions of OH test parameters, and crude and age-adjusted ORs for groups with MCI, dementia, and objective and subjective memory loss at 6-year follow-up of the general elderly Swedish population of GÅS-SNAC (n=1,480)

	Controls versus objective memory loss	Controls versus subjective memory loss	Controls versus MCI	Controls versus dementia
SBP, resting (P)	0.037	0.811	0.064	0.435
DBP, resting (P)	0.715	0.175	0.948	0.316
Quotient SBP supine/5 minutes after uprising (P)	0.208	0.205	0.327	0.598
SBP orthostatic diff max (P)	0.280	0.777	0.217	0.004
DBP orthostatic diff max (P)	0.446	0.600	0.182	0.036
Pulse maximum (P)	0.493	0.625	0.107	0.843
Pulse difference (P)	0.537	0.365	0.963	0.958
OH, systolic or diastolic
OR (95% CI)	1.03 (0.74–1.44)	1.27 (0.82–1.96)	1.59 (1.00–2.50)	2.49 (1.62–3.82)
OR, age-adjusted (95% CI)	0.95 (0.68–1.33)	1.07 (0.68–1.69)	1.23 (0.75–2.00)	1.93 (1.19–3.14)
Systolic OH
OR (95% CI)	1.05 (0.69–1.60)	1.33 (0.78–2.30)	1.74 (1.00–3.03)	2.83 (1.72–4.67)
OR, age-adjusted (95% CI)	0.99 (0.64–1.51)	1.12 (0.64–1.96)	1.41 (0.79–2.53)	2.18 (1.24–3.84)
Diastolic OH
OR (95% CI)	1.18 (0.69–2.03)	1.64 (0.85–3.18)	1.6 (0.77–3.32)	2.03 (1.02–4.02)
OR, age-adjusted (95% CI)	1.61 (0.61–1.83)	1.32 (0.67–2.60)	1.19 (0.55–2.55)	1.35 (0.62–2.93)
Previous or present OI
OR (95% CI)	1.11 (0.84–1.47)	1.55 (1.07–2.25)	2.07 (1.39–3.08)	0.98 (0.62–1.53)
OR, age-adjusted (95% CI)	1.10 (0.83–1.47)	1.55 (1.06–2.27)	2.01 (1.33–3.05)	0.90 (0.55–1.50)
Previous symptoms of OI
OR (95% CI)	1.26 (0.94–1.68)	1.58 (1.08–2.32)	2.31 (1.54–3.45)	1.01 (0.64–1.61)
OR, age-adjusted (95% CI)	1.26 (0.94–1.68)	1.62 (1.10–2.40)	2.34 (1.53–3.58)	0.99 (0.59–1.66)
Present symptoms of OI
OR (95% CI)	0.80 (0.46–1.39)	1.36 (0.72–2.60)	1.47 (0.74–2.94)	1.36 (0.67–2.79)
OR, age-adjusted (95% CI)	0.76 (0.43–1.33)	1.22 (0.63–2.36)	1.26 (0.61–2.61)	0.98 (0.44–2.22)

Abbreviations: CI, confidence interval; DBP, diastolic blood pressure; GÅS-SNAC, Good Aging in Skåne; MCI, mild cognitive impairment; OH, orthostatic hypotension; OI, orthostatic intolerance; OR, odds ratio; orthostatic diff max, maximum difference during OH testing; SBP, systolic blood pressure.