Relationship between cardiovascular autonomic failure and cognitive performance in the ?-synucleinopathies: preliminary cross-sectional analysis of the Natural History Study of Synucleinopathies (NHSS) registry
Bibliographic record
Abstract
Cardiovascular autonomic failure, presenting with neurogenic orthostatic hypotension (nOH) and supine hypertension (SH), is a common non-motor feature of the α-synucleinopathies. High blood pressure (BP) variability may foster end-organ damage and promote cognitive impairment. Nevertheless, the interplay between cardiovascular dysautonomia and cognitive performance in α-synucleinopathies is yet unclear. We therefore analyzed data from 76 Parkinson´s Disease (PD), 282 Multiple System Atrophy (MSA) and 133 stable pure autonomic failure (PAF) patients enrolled in the Natural History Study of Synucleinopathies (NHSS). The Montreal Cognitive Assessment (MoCA) was used to test patients’ baseline cognitive performance. Orthostatic hypotension (OH), neurogenic OH (nOH) and SH were defined based on supine-to-standing heart rate and BP measurements contemporary to cognitive testing. In PD, 36% of patients (n=26) had no OH, 15% (n=11) non-neurogenic OH, 11% (n=8) nOH and 38% (n=28) both nOH and SH. In PAF 8% of patients (n=9) showed no OH, 21% (n=24) non-neurogenic OH, 12% (n=14) nOH and 58% (n=66) both nOH and SH. In MSA, 25% of patients (n=65) had no OH, 17% (n=45) non-neurogenic OH, 16% (n=43) nOH and 42% (n=114) both nOH and SH. In our cross-sectional analysis, median MoCA scores did not differ across PD (p=0.108) and PAF (p=0.453) patients with and without baseline orthostatic BP dysregulation. In MSA, the nOH subgroup showed higher median MoCA scores (p=0.036) compared to the other groups but different clinical-demographic features may account for this observation. The longitudinal analysis of MoCA score changes according to baseline BP dysregulation will clarify the impact of cardiovascular dysautonomia on the progression of cognitive impairment in the α-synucleinopathies.
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How this classification was reachedexpand
Full frame machine prediction
Teacher imitationNot calibrated prevalence, not ground truth. Human validation pending. The Gemma side is a direct model label for every work in the frame, read from the title-only record. The Codex side is a classifier learned from the 10,348 direct Codex labels and calibrated to design-weighted sample rates; fields without enough sample support carry no Codex call. Candidate is the union of the two sides; consensus is their intersection. These outputs are machine_predicted_unvalidated and are not human labels.
Distilled classifier scores by category (both heads)
| Category | Codex | Gemma |
|---|---|---|
| Metaresearch | 0.001 | 0.002 |
| Meta-epidemiology (narrow) | 0.000 | 0.000 |
| Meta-epidemiology (broad) | 0.000 | 0.000 |
| Bibliometrics | 0.001 | 0.001 |
| Science and technology studies | 0.000 | 0.000 |
| Scholarly communication | 0.001 | 0.001 |
| Open science | 0.000 | 0.001 |
| Research integrity | 0.001 | 0.001 |
| Insufficient payload (model declined to judge) | 0.001 | 0.000 |
Machine scores (provisional)
The two teacher heads of the student model, read on this work. A score orders the frame for review; it never asserts a category, and the validation status ships verbatim with every row.
Baseline scores from an immature model (maturity gate not passed, 7 training rounds). Scores rank; they never assert a category.
score_only:v0-immature-baseline · verbatim from the scoring run: score_only means the number may rank works, and no category label ships from itClassification
machine, unvalidatedMachine predicted; a candidate call from one source (direct Gemma or distilled Codex), not a consensus.
How this classification was reached, model by model and score by score, is at the end of the page under "How this classification was reached".