Researchers of a recent study examined whether abnormal blood pressure fluctuations in Parkinson’s disease are associated with hallucinations, cognitive impairment, and brain white matter hyperintensities. Compared with hospital controls, patients with Parkinson’s disease had greater systolic blood pressure variability over 24-hour ambulatory monitoring and a much higher prevalence of neurogenic orthostatic hypotension, even though average systolic blood pressure was similar between groups. Within the Parkinson’s disease cohort, larger systolic blood pressure variability and neurogenic orthostatic hypotension were both independently associated with hallucinations and psychosis. Larger systolic blood pressure variability was also independently associated with cognitive impairment. These findings suggest that autonomic blood pressure instability may be clinically relevant in Parkinson’s disease, including in earlier stages.
The study also explored whether white matter hyperintensities help explain these associations, but the results did not support that idea. Periventricular white matter hyperintensities were independently associated with cognitive impairment, and deep white matter hyperintensities showed a weaker association. But neither type of white matter lesion was linked to hallucinations or psychosis, and they did not mediate the relationship between blood pressure variability and cognitive impairment. The authors conclude that large blood pressure fluctuations may represent an independent risk factor for hallucinations and cognitive decline in Parkinson’s disease through mechanisms other than white matter damage. However, they note that the cross-sectional design limits causal conclusions and that larger longitudinal studies are needed.
Reference: Nomoto S, Oeda T, Tomii Y, et al. Hallucinations and cognitive impairment are associated with blood pressure fluctuations in Parkinson’s disease. BMJ Neurol Open. 2026 Mar 11;8(1):e001497. doi: 10.1136/bmjno-2025-001497.
