Orthostatic hypotension and cognition in older adults: A systematic review and meta-analysis

Rebecca Iseli*, Vi Truc Vo Nguyen, Sifat Sharmin, Esmee M. Reijnierse, Wen Kwang Lim, Andrea B. Maier

*Corresponding author for this work

Research output: Contribution to JournalReview articleAcademicpeer-review

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Background: Orthostatic hypotension (OH) is common in older adults with reported prevalence rates of 5–40%. A direct link between OH and cognitive performance has been proposed due to impaired vascular autoregulation. Aim: To systematically assess the literature of the association between OH and cognitive performance in older adults. Methods: Literature search of MEDLINE, Embase, Cochrane Central Register of Controlled Trials and PsycINFO from inception to May 2017. Studies were included if OH and cognition were assessed in subjects of mean or median age ≥65 years. Risk of bias was assessed with the Newcastle Ottawa Scale. Results: Of 3266 studies screened, 32 studies (22 cross-sectional; 10 longitudinal) reporting data of 28,980 individuals were included. OH prevalence ranged from 3.3% to 58%. Of the 32 studies, 18 reported an association between OH and worse cognitive performance and 14 reported no association. Mini Mental State Examination (MMSE) was the most commonly used cognitive assessment tool. Studies using more than one cognitive assessment tool were more likely to find an association between OH and worse cognition. OH was significantly associated with a lower MMSE mean score (mean difference − 0.51 (95% CI: −0.85, −0.17, p = 0.003)) and an increased risk of cognitive impairment (OR 1.19 (95% CI, 1.00–1.42, p = 0.048)). Conclusions: OH is common in older populations and is associated with worse cognition expressed as lower MMSE scores. Use of MMSE alone as a cognitive assessment tool may underestimate the association. It is yet unclear whether the association between OH and worse cognitive performance is causative.

Original languageEnglish
Pages (from-to)40-49
Number of pages10
JournalExperimental Gerontology
Early online date28 Feb 2019
Publication statusPublished - Jun 2019


This study has received funding from the perspective grant (NeuroCIMT) of the Applied and Engineering Sciences, which is part of the Netherlands Organisation for Scientific Research (Utrecht, the Netherlands) and which is partly funded by the Ministry of Economic Affairs . Furthermore, this study received funding from the European Union's Horizon 2020 research and innovation programme: PreventIT (No. 689238 ) and PANINI (No. 675003 ). The funders had no role in the study design, data collection and analysis, decision to publish, or preparation of the manuscript.

FundersFunder number
European Commission
Ministerie van Economische Zaken
Nederlandse Organisatie voor Wetenschappelijk Onderzoek
Ministry of Economic Affairs
Horizon 2020689238


    • Aged
    • Blood pressure
    • Cognition
    • Orthostatic hypotension


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