Case 39 - Cognitive Impairment and Blood Pressure Fluctuations

Summary

This 86-year-old right-handed man with a 4-year history of Parkinson disease dementia (PDD) presented for follow-up with his wife, who reported a substantial decline. He was diagnosed with Parkinson disease (PD) five years prior and progressive cognitive impairment emerged three years later. At the visit, she described increasingly frequent episodes of unresponsiveness. These episodes would begin with the patient feeling tired, followed by a period of immobile unresponsiveness associated with glazed eyes lasting up to 10 minutes. The episodes occurred most commonly after eating breakfast. He was admitted to the hospital after one such event and his systolic blood pressure (BP) was reported to be as high as 250 mmHg, and was discharged on three new antihypertensive medications (lisinopril, hydralazine, and metoprolol). After this admission his episodes became more frequent. His wife noticed that having him lie down allowed him to recover promptly from episodes of unresponsiveness. No changes had been made to his levodopa regimen, which continued to be 200 mg three times a day.