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Duval GT, Raud E, Gohier H, Dramé M, Tabue-Teguo M, Annweiler C. Orthostatic hypotension and cognitive impairment: Systematic review and meta-analysis of longitudinal studies. Maturitas 2024; 185:107866. [PMID: 38604094 DOI: 10.1016/j.maturitas.2023.107866] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/13/2023] [Revised: 07/31/2023] [Accepted: 09/22/2023] [Indexed: 04/13/2024]
Abstract
The association between cognitive disorders and orthostatic hypotension (OH) has been empirically explored, but the results have been divergent, casting doubt on the presence and direction of the association. The objective of this meta-analysis was to systematically review and quantitatively synthesize the association of OH and cognitive function, specifically mean score on the Mini-Mental State Examination (MMSE), cognitive impairment and incident dementia. A Medline search was conducted in May 2022 with no date limit, using the MeSH terms "orthostatic hypotension" OR "orthostatic intolerance" OR "hypotension" combined with the Mesh terms "cognitive dysfunction" OR "Alzheimer disease" OR "dementia" OR "cognition disorder" OR "neurocognitive disorder" OR "cognition" OR "neuropsychological test". Of the 746 selected studies, 15 longitudinal studies met the selection criteria, of which i) 5 studies were eligible for meta-analysis of mean MMSE score comparison, ii) 5 studies for the association of OH and cognitive impairment, and iii) 6 studies for the association between OH and incident dementia. The pooled effect size in fixed-effects meta-analysis was: i) -0.25 (-0.42; -0.07) for the mean MMSE score, which indicates that the MMSE score was lower for those with OH; ii) OR (95 % CI) = 1.278 (1.162; 1.405), P < 0.0001, indicating a 28 % greater risk of cognitive impairment for those with OH at baseline; and iii) HR (95 % CI) = 1.267 (1.156; 1.388), P < 0.0001, indicating a 27 % greater risk of incident dementia for those with OH at baseline. Patients with OH had a lower MMSE score and higher risk of cognitive impairment and incident dementia in this meta-analysis of longitudinal studies. This study confirmed the presence of an association between OH and cognitive disorders in older adults.
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Affiliation(s)
- Guillaume T Duval
- Department of Neuroscience, Division of Geriatric Medicine and Memory Clinic, UPRES EA 4638, UNAM, Angers University Hospital, Angers, France.
| | - Eve Raud
- Department of Neuroscience, Division of Geriatric Medicine and Memory Clinic, UPRES EA 4638, UNAM, Angers University Hospital, Angers, France
| | - Hugo Gohier
- Department of Neuroscience, Division of Geriatric Medicine and Memory Clinic, UPRES EA 4638, UNAM, Angers University Hospital, Angers, France
| | - Moustapha Dramé
- University of the French West Indies, EpiCliV Research Unit, Fort-de-France, Martinique; University Hospitals of Martinique, Department of Clinical Research and Innovation, Fort-de-France, Martinique
| | - Maturin Tabue-Teguo
- Department of Geriatrics, University Hospital of Martinique, Fort-de-France, Martinique
| | - Cédric Annweiler
- Department of Neuroscience, Division of Geriatric Medicine and Memory Clinic, UPRES EA 4638, UNAM, Angers University Hospital, Angers, France; Department of Medicine, Division of Geriatric Medicine, Parkwood Hospital, St. Joseph's Health Care London, Gait and Brain Lab, Lawson Health Research Institute, the University of Western Ontario, London, ON, Canada; Robarts Research Institute, Department of Medical Biophysics, Schulich School of Medicine and Dentistry, The University of Western Ontario, London, ON, Canada
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2
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Vidal-Petiot E, Pathak A, Azulay JP, Pavy-Le Traon A, Hanon O. Orthostatic hypotension: Review and expert position statement. Rev Neurol (Paris) 2024; 180:53-64. [PMID: 38123372 DOI: 10.1016/j.neurol.2023.11.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/26/2023] [Revised: 11/19/2023] [Accepted: 11/21/2023] [Indexed: 12/23/2023]
Abstract
Orthostatic hypotension is defined as a drop in systolic blood pressure of at least 20mmHg or a drop in diastolic blood pressure of at least 10mmHg within 3minutes of standing. It is a common disorder, especially in high-risk populations such as elderly subjects and patients with neurological diseases, and is associated with markedly increased morbidity and mortality. Its management can be challenging, particularly in cases where supine hypertension is associated with severe orthostatic hypotension. Education of the patient, non-pharmacological measures, and drug adaptation are the cornerstones of treatment. Pharmacological treatment should be individualized according to the severity, underlying cause, 24-hour blood pressure profile, and associated coexisting conditions. First-line therapies are midodrine and fludrocortisone, which may need to be combined for optimal care of severe cases.
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Affiliation(s)
- E Vidal-Petiot
- Service de physiologie, ESH Excellence Center, hôpital Bichat, Assistance Publique-Hôpitaux de Paris, 75018 Paris, France; INSERM U1148, Université Paris-Cité and Université Sorbonne Paris Nord, LVTS, 75018 Paris, France.
| | - A Pathak
- Service de cardiologie, ESH Excellence Center, centre hospitalier Princesse Grace, 1, avenue Pasteur, 98000 Monaco, France
| | - J-P Azulay
- Service de neurologie et pathologie du mouvement, hôpital de la Timone, 13385 Marseille cedex 05, France
| | - A Pavy-Le Traon
- Service de neurologie, CHU de Toulouse, 31059 Toulouse cedex, France; UMR 1297, institut des maladies métaboliques et cardiovasculaires, Toulouse, France
| | - O Hanon
- Service de gériatrie, université Paris-Cité, EA4468, hôpital Broca, AP-HP, 75013 Paris, France
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Zhu X, Luo Z, Tian G, Hu Z, Li S, Wang QM, Luo X, Chen L. Hypotension and cognitive impairment among the elderly: Evidence from the CLHLS. PLoS One 2023; 18:e0291775. [PMID: 37725634 PMCID: PMC10508618 DOI: 10.1371/journal.pone.0291775] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/17/2023] [Accepted: 08/25/2023] [Indexed: 09/21/2023] Open
Abstract
BACKGROUND While high blood pressure has been linked to cognitive impairment, the relationship between low blood pressure, especially hypotension, and cognitive impairment has not been well studied. Therefore, this study aimed to assess the prevalence of hypotension and cognitive impairment in the seniors of China, and the association between hypotension and cognitive function impairment. METHODS The data was derived from the 2018 wave of the Chinese Longitudinal Healthy Longevity Survey (CLHLS). Systolic blood pressures (SBP) and diastolic blood pressures (DBP) were measured by objective examination. The Chinese version of the Mini-Mental State Examination (CMMSE) was used to evaluate the cognitive impairment of the elderly. Generalized linear models were conducted to evaluate the association of hypotension with cognitive impairment. RESULTS The prevalence of hypotension and cognitive impairment in the Chinese elderly were 0.76% and 22.06%, respectively. Participants with hypotension, lower SBP, and lower DBP, had odds ratios of 1.62, 1.38, and 1.48 for cognitive impairment, respectively. Besides, the CMMSE scores decreased by 2.08, 0.86, and 1.08 in the elderly with hypotension, lower SBP, and DBP, compared with those with non-hypotension, higher SBP, and DBP, respectively. Subgroup analyses showed that the association of cognitive impairment with hypotension was stronger in Chinese elderly who had decreased activity of daily living. Moreover, there was statistical evidence of a nonlinear dose-response relationship of SBP and DBP with cognitive impairment (Pnonlinear < 0.05). CONCLUSION Hypotension was a potential risk factor for cognitive impairment of the Chinese elderly, especially for those having decreased activity of daily living. Blood pressure management should be conducted to prevent them from cognitive impairment.
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Affiliation(s)
- Xidi Zhu
- Department of Epidemiology and Health Statistics, Xiangya School of Public Health, Central South University, Changsha, China
- Stroke Biological Recovery Laboratory, Spaulding Rehabilitation Hospital, the Teaching Affiliate of Harvard Medical School, Boston, Massachusetts, United States of America
| | - Zhicheng Luo
- Department of Epidemiology and Health Statistics, Xiangya School of Public Health, Central South University, Changsha, China
| | - Gang Tian
- Department of Epidemiology and Health Statistics, Xiangya School of Public Health, Central South University, Changsha, China
| | - Zhao Hu
- Department of Social Medicine and Health Management, Xiangya School of Public Health, Central South University, Changsha, China
| | - Shaojie Li
- School of Public Health, Peking University, Beijing, China
| | - Qing Mei Wang
- Stroke Biological Recovery Laboratory, Spaulding Rehabilitation Hospital, the Teaching Affiliate of Harvard Medical School, Boston, Massachusetts, United States of America
| | - Xun Luo
- Kerry Rehabilitation Medicine Research Institute, Shenzhen, China
- School of Medicine, Shenzhen University, Shenzhen, China
| | - Lizhang Chen
- Department of Epidemiology and Health Statistics, Xiangya School of Public Health, Central South University, Changsha, China
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Duval GT, Asfar M, Gautier J, Annweiler C. Orthostatic hypotension and executive function in older people from the French MERE cohort attending a memory clinic. Maturitas 2023; 173:16-19. [PMID: 37182386 DOI: 10.1016/j.maturitas.2023.04.007] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/24/2022] [Revised: 04/06/2023] [Accepted: 04/15/2023] [Indexed: 05/16/2023]
Abstract
Orthostatic hypotension (OH) seems to be implicated in cognitive impairment. Nevertheless, not all the cognitive functions affected by OH have been identified. Participants from the MERE cohort were evaluated for OH (i.e. drop in blood pressure ≥20 mmHg for systolic and ≥10 mmHg for diastolic between lying and standing) and executive functions, implicated in brain motor control, and evaluated with the Frontal Assessment Battery (FAB) and its sub-scores. Of the 1573 patients selected, 338 had OH (21.5 %). We found an inverse cross-sectional association between OH and linear FAB score and an association with the sub-score for the motor sequence of Luria. In the MERE cohort, OH was associated with executive function disorder and with a pathological motor sequence of Luria as a melo-kinetic praxis disorder.
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Affiliation(s)
- Guillaume T Duval
- Department of Geriatric Medicine, University Memory Center, Research Center on Autonomy and Longevity (CeRAL), Angers University Hospital, Angers, France; School of Medicine and UPRES EA 4638, University of Angers, Angers, France.
| | - Marine Asfar
- Department of Geriatric Medicine, University Memory Center, Research Center on Autonomy and Longevity (CeRAL), Angers University Hospital, Angers, France; School of Medicine and UPRES EA 4638, University of Angers, Angers, France
| | - Jennifer Gautier
- Department of Geriatric Medicine, University Memory Center, Research Center on Autonomy and Longevity (CeRAL), Angers University Hospital, Angers, France
| | - Cédric Annweiler
- Department of Geriatric Medicine, University Memory Center, Research Center on Autonomy and Longevity (CeRAL), Angers University Hospital, Angers, France; School of Medicine and UPRES EA 4638, University of Angers, Angers, France; Robarts Research Institute, Schulich School of Medicine and Dentistry, the University of Western Ontario, London, Ontario, Canada
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Duval GT, Schott AM, Rolland Y, Gautier J, Blain H, Duque G, Annweiler C. Orthostatic hypotension and neurocognitive disorders in older women: Results from the EPIDOS cohort study. PLoS One 2023; 18:e0281634. [PMID: 36827394 PMCID: PMC9955614 DOI: 10.1371/journal.pone.0281634] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/28/2022] [Accepted: 01/27/2023] [Indexed: 02/26/2023] Open
Abstract
BACKGROUND Although it is well-admitted that cardiovascular health affects cognition, the association between orthostatic hypotension (OH) and cognition remains unclear. The objectives of the present study were i) to determine among the EPIDOS cohort (EPIdémiologie de l'OStéoporose) whether OH was cross-sectionally associated with cognitive impairment at baseline, and ii) whether baseline OH could predict incident cognitive decline after 7 years of follow-up. METHODS Systolic and Diastolic Blood Pressure (SBP and DBP) changes while standing (ie, ΔSBP and ΔDBP, in %) were measured at baseline among 2,715 community-dwelling older women aged 75 years and older using no antihypertensive drugs from the French EPIDOS cohort. OH was defined as a decrease in SBP ≥20 mmHg and/or a decrease in DBP ≥10 mmHg within 3 min after standing. Cognitive impairment was defined as a Short Portable Mental Status Questionnaire (SPMSQ) score <8 (/10). Among those without cognitive impairment at baseline, a possible incident onset of cognitive decline was then sought after 7 years of follow-up among 257 participants. RESULTS Baseline ΔSBP was associated with baseline cognitive impairment (adjusted OR = 1.01, p = 0.047), but not with incident onset of cognitive decline after 7 years (adjusted OR = 0.98, p = 0.371). Neither baseline OH nor baseline ΔDBP were associated with cognitive impairment neither at baseline (p = 0.426 and p = 0.325 respectively) nor after 7 years (p = 0.180 and p = 0.345 respectively). CONCLUSIONS SBP drop while standing, but neither OH per se nor DBP drop while standing, was associated with baseline cognitive impairment in older women. The relationship between OH and cognitive impairment appears more complex than previously expected.
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Affiliation(s)
- Guillaume T. Duval
- Department of Geriatric Medicine, University Memory Center, Research Center on Autonomy and Longevity (CeRAL), Angers University Hospital, Angers, France
- School of Medicine and UPRES EA 4638, University of Angers, Angers, France
- * E-mail:
| | - Anne-Marie Schott
- Research on Healthcare Performance (RESHAPE), INSERM U1290, Université Claude Bernard Lyon 1, Lyon, France
- Hospices Civils de Lyon, Pôle de Santé Publique, Service de Recherche et D’épidémiologie Cliniques, Lyon, France
| | - Yves Rolland
- Department of Geriatrics, Toulouse University Hospital, INSERM U1027, University of Toulouse III, Toulouse, France
| | - Jennifer Gautier
- Department of Geriatric Medicine, University Memory Center, Research Center on Autonomy and Longevity (CeRAL), Angers University Hospital, Angers, France
| | - Hubert Blain
- Department of Internal Medicine and Geriatrics, Montpellier University Hospital, University of Montpellier 1, Montpellier, France
| | - Gustavo Duque
- Australian Institute for Musculoskeletal Science (AIMSS), The University of Melbourne and Western Health, St. Albans, Victoria, Australia
- Department of Medicine, Melbourne Medical School–Western Precinct, The University of Melbourne, St. Albans, Victoria, Australia
| | - Cedric Annweiler
- Department of Geriatric Medicine, University Memory Center, Research Center on Autonomy and Longevity (CeRAL), Angers University Hospital, Angers, France
- School of Medicine and UPRES EA 4638, University of Angers, Angers, France
- Robarts Research Institute, Schulich School of Medicine and Dentistry, The University of Western Ontario, London, Ontario, Canada
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Isik AT, Kocyigit SE, Kaya D, Dost Gunay FS, Erken N, Dokuzlar O, Aydin AE, Ates Bulut E. The Relationship between the Most Common Subtypes of Dementia and Orthostatic Hypotension in Older Adults. Dement Geriatr Cogn Disord 2021; 49:628-635. [PMID: 33735870 DOI: 10.1159/000513978] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/09/2020] [Accepted: 12/21/2020] [Indexed: 11/19/2022] Open
Abstract
BACKGROUND It is crucial to evaluate the causes of morbidity and mortality in elderly patients with dementia, such as orthostatic hypotension (OH), which may affect their daily life activities, reduce the quality of life, and increase the caregiver burden. OBJECTIVE We aimed to investigate the relationship between OH and the most common subtypes of dementia in detail. METHODS A total of 268 older adults with dementia diagnosed with Alzheimer's disease (AD), dementia with Lewy bodies (DLB), vascular dementia (VaD), and behavioral variant frontotemporal dementia (bvFTD), and 539 older adults without dementia were included in this prospective study. Comprehensive geriatric assessment including comorbidity, medication evaluation, and the head-up tilt test was also performed. RESULTS Of the participants, 13.8, 8.3, 6.4, and 4.8% had AD, DLB, bvFTD, and VaD, respectively. After adjusting for age, gender, the presence of comorbidities, and usage of OH-induced drugs; AD, DLB, and VaD were associated with OH (odds ratio [OR]: 2.23 confidence interval [CI] 95% 1.31-3.80; p = 0.003; OR: 3.68 CI 95% 1.98-6.83; p < 0.001, and OR: 3.56 CI 95% 1.46-8.69; p = 0.005, respectively). Furthermore, VaD was independently related to diastolic OH (OR: 4.19 CI 95% 1.66-10.57; p = 0.002), whereas AD and DLB were not. CONCLUSIONS This study shows that elderly patients with DLB, AD, and VaD often have OH, a disabling autonomic dysfunction feature. Moreover, diastolic OH may play a role in the development of VaD. Therefore, considering potential complications of OH, it is essential to evaluate OH in the follow-up and management of those patients.
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Affiliation(s)
- Ahmet Turan Isik
- Department of Geriatric Medicine, Unit for Aging Brain and Dementia, Faculty of Medicine, Dokuz Eylul University, Izmir, Turkey, .,The Geriatric Science Association, Izmir, Turkey,
| | - Suleyman Emre Kocyigit
- The Geriatric Science Association, Izmir, Turkey.,Department of Geriatric Medicine, Tepecik Training and Research Hospital, Izmir, Turkey
| | - Derya Kaya
- Department of Geriatric Medicine, Unit for Aging Brain and Dementia, Faculty of Medicine, Dokuz Eylul University, Izmir, Turkey.,The Geriatric Science Association, Izmir, Turkey
| | - Fatma Sena Dost Gunay
- Department of Geriatric Medicine, Unit for Aging Brain and Dementia, Faculty of Medicine, Dokuz Eylul University, Izmir, Turkey.,The Geriatric Science Association, Izmir, Turkey
| | - Neziha Erken
- Department of Geriatric Medicine, Unit for Aging Brain and Dementia, Faculty of Medicine, Dokuz Eylul University, Izmir, Turkey.,The Geriatric Science Association, Izmir, Turkey
| | | | - Ali Ekrem Aydin
- The Geriatric Science Association, Izmir, Turkey.,Department of Geriatric Medicine, Sivas State Hospital, Sivas, Turkey
| | - Esra Ates Bulut
- The Geriatric Science Association, Izmir, Turkey.,Department of Geriatric Medicine, Adana State Hospital, Adana, Turkey
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Abstract
Cardiovascular disorders, e.g., atherosclerosis and hypertension, increase susceptibility to neurodegenerative diseases, like dementia and Alzheimer's disease (AD), with undetermined mechanisms. Moreover, whether myocardial infarction (MI) may similarly increases occurrence of AD is unknown. In the current study, we performed a MI model in wild-type and AD-prone APP/PS1 mice and assessed the development of AD in these mice. We found that MI-treated mice of both wild-type and APP/PS1 behaved poorer in a social recognition test, the Morris water maze, and the plus-maze discriminative avoidance task, compared to sham-treated controls. Mechanistically, MI significantly increased the levels of reactive oxygen species, as well as increased deposition of amyloid-β peptide aggregates and phosphorylation of tau protein in mouse brain, two signature pathological features for AD. Moreover, the microglia in the MI-mice appeared to alter polarization to a more proinflammatory phenotype. Together, our data suggest that MI may be a predisposing factor for AD development.
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Affiliation(s)
- Wei Zhang
- Departments of Geriatric Medicine, Sichuan Academy of Medical Sciences & Sichuan Provincial People's Hospital, Chengdu, China
| | - Peng Luo
- Departments of Cardiology, Sichuan Academy of Medical Sciences & Sichuan Provincial People's Hospital, Chengdu, China
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Xia X, Wang R, Vetrano DL, Grande G, Laukka EJ, Ding M, Fratiglioni L, Qiu C. From Normal Cognition to Cognitive Impairment and Dementia: Impact of Orthostatic Hypotension. Hypertension 2021; 78:769-778. [PMID: 34225472 PMCID: PMC8357050 DOI: 10.1161/hypertensionaha.121.17454] [Citation(s) in RCA: 13] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/04/2022]
Abstract
Supplemental Digital Content is available in the text. The role of orthostatic hypotension (OH) in the continuum of cognitive aging remains to be clarified. We sought to investigate the associations of OH with dementia, cognitive impairment, no dementia (CIND), and CIND progression to dementia in older adults while considering orthostatic symptoms. This population-based cohort study included 2532 baseline (2001–2004) dementia-free participants (age ≥60 years; 62.6% women) in the SNAC-K (Swedish National Study on Aging and Care in Kungsholmen) who were regularly examined over 12 years. We further divided the participants into a baseline CIND-free cohort and a CIND cohort. OH was defined as a decrease by ≥20/10 mm Hg in systolic/diastolic blood pressure upon standing and further divided into asymptomatic and symptomatic OH. Dementia was diagnosed following the international criteria. CIND was defined as scoring ≥1.5 SDs below age group-specific means in ≥1 cognitive domain. Data were analyzed with flexible parametric survival models, controlling for confounding factors. Of the 2532 participants, 615 were defined with OH at baseline, and 322 were diagnosed with dementia during the entire follow-up period. OH was associated with an adjusted hazard ratio of 1.40 for dementia (95% CI, 1.10–1.76), 1.15 (0.94–1.40) for CIND, and 1.54 (1.05–2.25) for CIND progression to dementia. The associations of dementia and CIND progression to dementia with asymptomatic OH were similar to overall OH, whereas symptomatic OH was only associated with CIND progression to dementia. Our study suggests that OH, even asymptomatic OH, is associated with increased risk of dementia and accelerated progression from CIND to dementia in older adults.
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Affiliation(s)
- Xin Xia
- Aging Research Center, Department of Neurobiology, Care Sciences and Society (NVS), Karolinska Institutet-Stockholm University, Sweden (X.X., R.W., D.L.V., G.G., E.J.L., M.D., L.F., C.Q.)
| | - Rui Wang
- Aging Research Center, Department of Neurobiology, Care Sciences and Society (NVS), Karolinska Institutet-Stockholm University, Sweden (X.X., R.W., D.L.V., G.G., E.J.L., M.D., L.F., C.Q.).,The Swedish School of Sport and Health Sciences, GIH, Stockholm, Sweden (R.W.).,Department of Medicine and Wisconsin Alzheimer's Disease Research Center, University of Wisconsin School of Medicine and Public Health, Madison (R.W.)
| | - Davide L Vetrano
- Aging Research Center, Department of Neurobiology, Care Sciences and Society (NVS), Karolinska Institutet-Stockholm University, Sweden (X.X., R.W., D.L.V., G.G., E.J.L., M.D., L.F., C.Q.).,Department of Geriatrics, Catholic University of Rome, Italy (D.L.V.).,Centro di Medicina dell'Invecchiamento, Fondazione Policlinico A. Gemelli, Rome, Italy (D.L.V.)
| | - Giulia Grande
- Aging Research Center, Department of Neurobiology, Care Sciences and Society (NVS), Karolinska Institutet-Stockholm University, Sweden (X.X., R.W., D.L.V., G.G., E.J.L., M.D., L.F., C.Q.)
| | - Erika J Laukka
- Aging Research Center, Department of Neurobiology, Care Sciences and Society (NVS), Karolinska Institutet-Stockholm University, Sweden (X.X., R.W., D.L.V., G.G., E.J.L., M.D., L.F., C.Q.).,Stockholm Gerontology Research Center, Sweden (E.J.L., L.F.)
| | - Mozhu Ding
- Aging Research Center, Department of Neurobiology, Care Sciences and Society (NVS), Karolinska Institutet-Stockholm University, Sweden (X.X., R.W., D.L.V., G.G., E.J.L., M.D., L.F., C.Q.).,Unit of Epidemiology, Institute of Environmental Medicine, Karolinska Institutet, Stockholm, Sweden (M.D.)
| | - Laura Fratiglioni
- Aging Research Center, Department of Neurobiology, Care Sciences and Society (NVS), Karolinska Institutet-Stockholm University, Sweden (X.X., R.W., D.L.V., G.G., E.J.L., M.D., L.F., C.Q.).,Stockholm Gerontology Research Center, Sweden (E.J.L., L.F.)
| | - Chengxuan Qiu
- Aging Research Center, Department of Neurobiology, Care Sciences and Society (NVS), Karolinska Institutet-Stockholm University, Sweden (X.X., R.W., D.L.V., G.G., E.J.L., M.D., L.F., C.Q.)
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Abstract
Falls are a common presenting complaint, particularly in older patients, and are associated with significant morbidity. Inpatient falls also have financial implications for healthcare systems, including litigation costs. This article provides an approach to assessing a patient presenting with a fall, encompassing the cause and consequence of the event. It also highlights the need to consider both the acute and chronic factors that predispose a particular patient to fall. Chronic factors such as frailty, sarcopenia, cognitive impairment, and continence issues are often under-recognised and, as a result, not managed optimally. A comprehensive geriatric assessment is an ideal structure to identify modifiable risks. Practical interventions that can be of benefit to minimise a patient's risk of falling include a medication review, assessment of their mobility and their environment. In addition, continence review and visual assessment may be appropriate.
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Affiliation(s)
- Anna N Barnard
- Department of Ageing and Health, Guy's and St Thomas NHS Foundation Trust, London, UK
| | - Daniel S Furmedge
- Department of Ageing and Health, Guy's and St Thomas NHS Foundation Trust, London, UK
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10
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Blood Pressure and Risk of Cognitive Impairment: The Role of Vascular Disease in Neurodegeneration. Brain Sci 2021; 11:brainsci11030385. [PMID: 33803713 PMCID: PMC8003102 DOI: 10.3390/brainsci11030385] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/02/2021] [Revised: 03/12/2021] [Accepted: 03/14/2021] [Indexed: 02/06/2023] Open
Abstract
(1) Background: Both cerebral vascular disorders and cognitive decline increase in incidence with age. The role of cerebral vascular disease and hemodynamic changes in the development of cognitive deficits is controversial. The objective of this study was to assess the cardiovascular response during cardiac stress testing in neurologically asymptomatic individuals who developed cognitive impairment several years after previous cardiac stress testing. (2) Methods: This was a retrospective cohort study of patients who underwent cardiac stress testing between January 2001 and December 2010. Patients were followed up until May 2015, and we selected those who developed cognitive dysfunction including dementia, mild cognitive impairment, and subjective cognitive decline, after the stress test. Heart rate and blood pressure both at rest and at peak exercise, and the mean R-R interval at rest were recorded. For each patient who developed cognitive impairment, we selected one matched control who did not show cognitive decline by the end of the follow-up period. (3) Results: From the cohort of 7224 patients, 371 developed cognitive impairment; of these, 186 (124 men) met the inclusion criteria, and 186 of the other patients were selected as matched controls. During follow-up, cognitive impairment appeared 6.2 ± 4.7 years after the cardiac stress test. These patients who had subsequently developed cognitive impairment had significantly lower at-rest systolic, diastolic, and mean blood pressure than controls (p < 0.05). Further, compared with controls, their maximum heart rate was significantly higher at peak exercise. (4) Conclusion: The results from this study suggest that differences in cardiovascular response to stress might be present in individuals who develop cognitive decline. These findings challenge the possibility of assessing blood pressure and heart rate variability at rest and during cardiac stress as potential risk factors associated with cognitive impairment.
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11
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Moore EE, Jefferson AL. Impact of Cardiovascular Hemodynamics on Cognitive Aging. Arterioscler Thromb Vasc Biol 2021; 41:1255-1264. [PMID: 33567862 DOI: 10.1161/atvbaha.120.311909] [Citation(s) in RCA: 14] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/11/2022]
Abstract
[Figure: see text].
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Affiliation(s)
- Elizabeth E Moore
- Vanderbilt Memory & Alzheimer's Center (E.E.M., A.L.J.), Vanderbilt University Medical Center, Nashville, TN.,Medical Scientist Training Program, School of Medicine, Vanderbilt University, Nashville, TN (E.E.M.)
| | - Angela L Jefferson
- Vanderbilt Memory & Alzheimer's Center (E.E.M., A.L.J.), Vanderbilt University Medical Center, Nashville, TN.,Department of Neurology (A.L.J.), Vanderbilt University Medical Center, Nashville, TN
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12
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McDonagh STJ, Mejzner N, Clark CE. Prevalence of postural hypotension in primary, community and institutional care: a systematic review and meta-analysis. BMC FAMILY PRACTICE 2021; 22:1. [PMID: 33388038 PMCID: PMC7777418 DOI: 10.1186/s12875-020-01313-8] [Citation(s) in RCA: 18] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 06/26/2020] [Accepted: 11/12/2020] [Indexed: 12/11/2022]
Abstract
BACKGROUND Postural hypotension (PH), the reduction in blood pressure when rising from sitting or lying 0to standing, is a risk factor for falls, cognitive decline and mortality. However, it is not often tested for in primary care. PH prevalence varies according to definition, population, care setting and measurement method. The aim of this study was to determine the prevalence of PH across different care settings and disease subgroups. METHODS Systematic review, meta-analyses and meta-regression. We searched Medline and Embase to October 2019 for studies based in primary, community or institutional care settings reporting PH prevalence. Data and study level demographics were extracted independently by two reviewers. Pooled estimates for mean PH prevalence were compared between care settings and disease subgroups using random effects meta-analyses. Predictors of PH were explored using meta-regression. Quality assessment was undertaken using an adapted Newcastle-Ottawa Scale. RESULTS One thousand eight hundred sixteen studies were identified; 61 contributed to analyses. Pooled prevalences for PH using the consensus definition were 17% (95% CI, 14-20%; I2 = 99%) for 34 community cohorts, 19% (15-25%; I2 = 98%) for 23 primary care cohorts and 31% (15-50%; I2 = 0%) for 3 residential care or nursing homes cohorts (P = 0.16 between groups). By condition, prevalences were 20% (16-23%; I2 = 98%) with hypertension (20 cohorts), 21% (16-26%; I2 = 92%) with diabetes (4 cohorts), 25% (18-33%; I2 = 88%) with Parkinson's disease (7 cohorts) and 29% (25-33%, I2 = 0%) with dementia (3 cohorts), compared to 14% (12-17%, I2 = 99%) without these conditions (P < 0.01 between groups). Multivariable meta-regression modelling identified increasing age and diabetes as predictors of PH (P < 0.01, P = 0.13, respectively; R2 = 36%). PH prevalence was not affected by blood pressure measurement device (P = 0.65) or sitting or supine resting position (P = 0.24), however, when the definition of PH did not fulfil the consensus description, but fell within its parameters, prevalence was underestimated (P = 0.01) irrespective of study quality (P = 0.04). CONCLUSIONS PH prevalence in populations relevant to primary care is substantial and the definition of PH used is important. Our findings emphasise the importance of considering checking for PH, particularly in vulnerable populations, to enable interventions to manage it. These data should contribute to future guidelines relevant to the detection and treatment of PH. PROSPERO CRD42017075423.
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Affiliation(s)
- Sinead T J McDonagh
- Primary Care Research Group, University of Exeter Medical School, College of Medicine and Health, St Luke's Campus, Magdalen Road, Exeter, Devon, EX1 2LU, England.
| | - Natasha Mejzner
- Primary Care Research Group, University of Exeter Medical School, College of Medicine and Health, St Luke's Campus, Magdalen Road, Exeter, Devon, EX1 2LU, England
| | - Christopher E Clark
- Primary Care Research Group, University of Exeter Medical School, College of Medicine and Health, St Luke's Campus, Magdalen Road, Exeter, Devon, EX1 2LU, England
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13
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Dyer AH, Murphy C, Briggs R, Lawlor B, Kennelly SP. Antidepressant use and orthostatic hypotension in older adults living with mild-to-moderate Alzheimer disease. Int J Geriatr Psychiatry 2020; 35:1367-1375. [PMID: 32668020 DOI: 10.1002/gps.5377] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/04/2019] [Revised: 05/05/2020] [Accepted: 07/06/2020] [Indexed: 11/07/2022]
Abstract
OBJECTIVES Antidepressant use is often reported as a risk factor for Orthostatic Hypotension (OH), however this relationship has never been explored in those with mild/moderate Alzheimer Disease (AD), who may represent a particularly vulnerable cohort. METHODS We performed a cross-sectional analysis of baseline data from the NILVAD study. Participants with mild-moderate AD were recruited from 23 centres in nine countries. Systolic and Diastolic Blood Pressure (SBP/DBP) was recorded in the seated position and after both 1 and 5 minutes of standing. OH was defined as a drop of ≥20 mmHg SBP/≥10 mmHg DBP. We examined the relationship between antidepressant use, orthostatic BP drop and the presence of OH, controlling for important covariates. RESULTS Of 509 participants (72.9 ± 8.3 years, 61.9% female), two-fifths (39.1%; 199/509) were prescribed a regular antidepressant. Antidepressant use was associated with a significantly greater SBP and DBP drop at 5 minutes (β: 1.83, 0.16-3.50, P = .03 for SBP; β: 1.13, 0.02-2.25, P < .05 for DBP). Selective Serotonin Reuptake Inhibitor (SSRI) use was associated with a significantly greater likelihood of OH (OR 2.0, 1.1-3.6, P = .02). Both findings persisted following robust covariate adjustment. CONCLUSIONS In older adults with AD, antidepressants were associated with a significantly greater SBP/DBP drop at 5 minutes. SSRI use in particular may be a risk factor for OH. This emphasises the need to screen older antidepressant users, and particularly those with AD, for ongoing orthostatic symptoms in order to reduce the risk of falls in this vulnerable cohort.
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Affiliation(s)
- Adam H Dyer
- Department of Age-Related Healthcare, Tallaght University Hospital, Tallaght, Ireland
- Department of Medical Gerontology, School of Medicine, Trinity College Dublin, Dublin, Ireland
| | - Claire Murphy
- Department of Age-Related Healthcare, Tallaght University Hospital, Tallaght, Ireland
| | - Robert Briggs
- Department of Age-Related Healthcare, Tallaght University Hospital, Tallaght, Ireland
- Department of Medical Gerontology, School of Medicine, Trinity College Dublin, Dublin, Ireland
- Mercer's Institute for Research on Ageing, St James's Hospital, Dublin, Ireland
| | - Brian Lawlor
- Mercer's Institute for Research on Ageing, St James's Hospital, Dublin, Ireland
| | - Sean P Kennelly
- Department of Age-Related Healthcare, Tallaght University Hospital, Tallaght, Ireland
- Department of Medical Gerontology, School of Medicine, Trinity College Dublin, Dublin, Ireland
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14
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Shibao CA, Biaggioni I. Management of Orthostatic Hypotension, Postprandial Hypotension, and Supine Hypertension. Semin Neurol 2020; 40:515-522. [PMID: 33058087 DOI: 10.1055/s-0040-1713886] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
Abstract
This review provides recommendations for the treatment of neurogenic orthostatic hypotension (nOH), postprandial hypotension, and supine hypertension. It focuses on novel treatment strategies and new insights into the mechanism underlying these conditions. Our goal is to provide practical advice for clinicians on how to screen, diagnose, and treat these conditions with nonpharmacological and pharmacological approaches. For each disorder, we offered a stepwise recommendation on how to apply these new concepts to successfully ameliorate the symptoms associated with OH to prevent syncope and falls. The management of OH in patients who also have supine hypertension requires special considerations and pharmacotherapy. It is noteworthy that there are few therapeutic options for OH and only two Food and Drug Administration-approved drugs for the treatment of OH and nOH based on randomized clinical trials. We will use these studies to develop evidence-based guidelines for OH. The research is limited for postprandial hypotension and supine hypertension, and therefore the recommendations will be based on small studies, clinical expertise, and, above all, an understanding of the underlying pathophysiology.
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Affiliation(s)
- Cyndya A Shibao
- Division of Clinical Pharmacology, Department of Medicine, Vanderbilt University Medical Center, Nashville, Tennessee
| | - Italo Biaggioni
- Division of Clinical Pharmacology, Department of Medicine, Vanderbilt University Medical Center, Nashville, Tennessee
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15
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Kleipool EEF, Trappenburg MC, Rhodius-Meester HFM, Lemstra AW, van der Flier WM, Peters MJL, Muller M. Orthostatic Hypotension: An Important Risk Factor for Clinical Progression to Mild Cognitive Impairment or Dementia. The Amsterdam Dementia Cohort. J Alzheimers Dis 2020; 71:317-325. [PMID: 31381517 PMCID: PMC6839486 DOI: 10.3233/jad-190402] [Citation(s) in RCA: 14] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/20/2022]
Abstract
Background: Orthostatic hypotension (OH) has been cross-sectionally and longitudinally related to dementia in the general population. Whether OH contributes to clinical progression to mild cognitive impairment (MCI) or dementia is less certain. Also, differences in risk of progression between patients with early OH (EOH) versus delayed and/or prolonged OH (DPOH) are unclear. Objective: Assess the prevalence of EOH and DPOH, investigate the longitudinal association between EOH and DPOH and either incident MCI or dementia. Methods: 1,882 patients from the Amsterdam Dementia Cohort [64±8 years; 43% female; n = 500 with subjective cognitive decline (SCD), n = 341 MCI, n = 758 Alzheimer’s disease (AD), n = 49 vascular dementia (VaD), n = 146 frontotemporal dementia (FTD), n = 88 Lewy body dementia (DLB)]. Definition OH: systolic blood pressure (BP) drop≥20 mmHg and/or a diastolic BP drop≥10 mmHg at 1 and/or 3 minutes after standing. EOH: OH only at 1 minute, DPOH: OH at (1 and) 3 minutes. Results: Prevalence OH: 19% SCD, 28% MCI, 41% dementia. Compared to SCD, odds of having OH were highest in patients with VaD and DLB; ORs (95% CI) were 2.6 (1.4–4.7) and 5.1 (3.1–8.4), respectively. After a mean (SD) follow-up of 2.2 (1.4) years, 105 (22%) of SCD or MCI patients showed clinical progression. Compared to patients without OH, those with DPOH had an increased risk of progression; hazard ratio (95% CI) was 1.7 (1.1–2.7), and those with EOH did not; 0.8 (0.3–1.9). Conclusion: Compared to SCD, prevalence of OH was higher in MCI and highest in dementia, particularly in VaD and DLB. DPOH, more likely associated with autonomic dysfunction, is a risk factor for incident MCI or dementia.
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Affiliation(s)
- Emma E F Kleipool
- Department of Internal Medicine and Geriatrics, Amsterdam UMC, location VUmc, Amsterdam Cardiovascular Sciences, Amsterdam, the Netherlands
| | - Marijke C Trappenburg
- Department of Internal Medicine and Geriatrics, Amsterdam UMC, location VUmc, Amsterdam Cardiovascular Sciences, Amsterdam, the Netherlands.,Department of Internal Medicine, Amstelland Hospital, Amstelveen, the Netherlands
| | - Hannke F M Rhodius-Meester
- Department of Internal Medicine and Geriatrics, Amsterdam UMC, location VUmc, Amsterdam Cardiovascular Sciences, Amsterdam, the Netherlands.,Department of Neurology, Alzheimer Center, Amsterdam UMC, location VUmc, Amsterdam Neuroscience, Amsterdam, the Netherlands
| | - Afina W Lemstra
- Department of Neurology, Alzheimer Center, Amsterdam UMC, location VUmc, Amsterdam Neuroscience, Amsterdam, the Netherlands
| | - Wiesje M van der Flier
- Department of Neurology, Alzheimer Center, Amsterdam UMC, location VUmc, Amsterdam Neuroscience, Amsterdam, the Netherlands
| | - Mike J L Peters
- Department of Internal Medicine and Geriatrics, Amsterdam UMC, location VUmc, Amsterdam Cardiovascular Sciences, Amsterdam, the Netherlands
| | - Majon Muller
- Department of Internal Medicine and Geriatrics, Amsterdam UMC, location VUmc, Amsterdam Cardiovascular Sciences, Amsterdam, the Netherlands
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16
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Farrell MC, Shibao CA. Morbidity and mortality in orthostatic hypotension. Auton Neurosci 2020; 229:102717. [PMID: 32896712 DOI: 10.1016/j.autneu.2020.102717] [Citation(s) in RCA: 13] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/06/2020] [Revised: 07/27/2020] [Accepted: 08/07/2020] [Indexed: 02/07/2023]
Abstract
This review summarizes the current literature on the epidemiology of orthostatic hypotension (OH) in the elderly and in patients with autonomic impairment also known as neurogenic OH (nOH); these two conditions have distinct pathophysiologies and affect different patient populations. The prevalence of OH in the elderly varies depending on the study population. In community dwellers, OH prevalence is estimated at 16%, whereas in institutionalized patients, it may be as high as 60%. The prevalence of OH increases exponentially with age, particularly in those 75 years and older. Multiple epidemiological studies have identified OH as a risk factor for all-cause mortality and cardiovascular disease including heart failure and stroke. Real-world data from administrative databases found polypharmacy, multiple co-morbid conditions, and high health-care utilization as common characteristics in OH patients. A comprehensive evaluation of medications associated with OH is discussed with particular emphasis on the use of anti-hypertensive therapy from two large clinical trials on high-intensive versus standard blood pressure management. Finally, we also review the epidemiology of nOH based on the underlying neurodegenerative disorder (either Parkinson's disease or multiple system atrophy), and the presence of co-morbid conditions such as hypertension and cognitive impairment.
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Affiliation(s)
- Maureen C Farrell
- Drexel University College of Medicine, Philadelphia, PA, United States of America
| | - Cyndya A Shibao
- Department of Medicine, Division of Clinical Pharmacology, Vanderbilt Autonomic Dysfunction Center, Vanderbilt University Medical Center, Nashville, TN, United States of America.
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17
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Lei LY, Chew DS, Raj SR. Differential diagnosis of orthostatic hypotension. Auton Neurosci 2020; 228:102713. [PMID: 32805514 DOI: 10.1016/j.autneu.2020.102713] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/09/2020] [Revised: 06/07/2020] [Accepted: 07/27/2020] [Indexed: 11/30/2022]
Abstract
Orthostatic hypotension (OH) is a common clinical manifestation characterized by a significant fall in blood pressure with postural change and is frequently accompanied by debilitating symptoms of orthostatic intolerance. The reported prevalence of OH ranges between 5 and 10% in middle-aged adults with a burden that increases concomitantly with age; in those over 60 years of age, the prevalence is estimated to be over 20%. Unfortunately, the clinical course of OH is not necessarily benign. OH patients are at an increased risk of adverse clinical outcomes including death, falls, cardiovascular and cerebrovascular events, syncope, and impaired quality of life. The differential diagnosis of OH is broad and includes acute precipitants as well as chronic underlying medical conditions, especially of neurological origin. Appropriate diagnosis relies on a systematic history and physical examination with particular attention to orthostatic vital signs, keeping in mind that ambient conditions during diagnostic testing may affect OH detection due to factors such as diurnal variation.
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Affiliation(s)
- Lucy Y Lei
- Department of Cardiac Sciences, Libin Cardiovascular Institute of Alberta, University of Calgary, Calgary, AB, Canada
| | - Derek S Chew
- Department of Cardiac Sciences, Libin Cardiovascular Institute of Alberta, University of Calgary, Calgary, AB, Canada; Duke Clinical Research Institute, Duke University, Durham, NC, USA
| | - Satish R Raj
- Department of Cardiac Sciences, Libin Cardiovascular Institute of Alberta, University of Calgary, Calgary, AB, Canada; Autonomic Dysfunction Center, Division of Clinical Pharmacology, Department of Medicine, Vanderbilt University Medical Center, Nashville, TN, USA.
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18
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Vu M, Koponen M, Taipale H, Tanskanen A, Tiihonen J, Kettunen R, Hartikainen S, Tolppanen AM. Prevalence of cardiovascular drug use before and after diagnosis of Alzheimer's disease. Int J Cardiol 2020; 300:221-225. [PMID: 31810814 DOI: 10.1016/j.ijcard.2019.09.036] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/01/2019] [Revised: 09/11/2019] [Accepted: 09/16/2019] [Indexed: 01/10/2023]
Abstract
BACKGROUND Both cardiovascular diseases and Alzheimer's disease (AD) are common in aging populations. We investigated the prevalence of cardiovascular (CV) drug use in relation to AD diagnosis, and compared the prevalence to a matched cohort without AD. METHODS Point prevalence of CV drugs was counted every six months, from five years before to five years after AD diagnosis in the register-based Medication Use and Alzheimer's disease (MEDALZ) study, including community dwellers who received a clinically verified AD diagnosis during 2005-2011 in Finland, and compared to a matched cohort without AD. Data on drugs purchases was extracted from the Prescription Register by Anatomical Therapeutic Chemical-classification system codes C* (excluding C04 and C05) and modelled to use periods with PRE2DUP method. RESULTS Before AD diagnosis, the prevalence of CV drug use was higher in persons with AD (RR 1.04; confidence interval (CI) 1.02-1.06). At the index date (AD diagnosis date), the prevalence of CV drug use was similarly among persons with AD (75.8%), in comparison to matched cohort without AD (73.4%). However, after that, the prevalence of CV drug use started decline in persons with AD. CONCLUSIONS The decline in use of CV drugs after AD diagnosis likely reflects discontinued need for treatment due to weight loss, frailty, decline in blood pressure and serum lipid levels. It may also reflect the change in prescribing due to adverse events and priorities of care to improve the quality of end-of-life.
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Affiliation(s)
- Mai Vu
- Kuopio Research Centre of Geriatric Care, University of Eastern Finland, Kuopio, Finland; School of Pharmacy, University of Eastern Finland, Kuopio, Finland.
| | - Marjaana Koponen
- Kuopio Research Centre of Geriatric Care, University of Eastern Finland, Kuopio, Finland; School of Pharmacy, University of Eastern Finland, Kuopio, Finland; Centre for Medicine Use and Safety, Faculty of Pharmacy and Pharmaceutical Sciences, Monash University, Parkville, Victoria, Australia
| | - Heidi Taipale
- Kuopio Research Centre of Geriatric Care, University of Eastern Finland, Kuopio, Finland; School of Pharmacy, University of Eastern Finland, Kuopio, Finland; Department of Clinical Neuroscience, Karolinska Institutet, Stockholm, Sweden; Department of Forensic Psychiatry, Niuvanniemi Hospital, University of Eastern Finland, Kuopio, Finland
| | - Antti Tanskanen
- Department of Clinical Neuroscience, Karolinska Institutet, Stockholm, Sweden; Department of Forensic Psychiatry, Niuvanniemi Hospital, University of Eastern Finland, Kuopio, Finland; Public Health Solutions, National Institute for Health and Welfare, Helsinki, Finland
| | - Jari Tiihonen
- Department of Clinical Neuroscience, Karolinska Institutet, Stockholm, Sweden; Department of Forensic Psychiatry, Niuvanniemi Hospital, University of Eastern Finland, Kuopio, Finland
| | - Raimo Kettunen
- School of Medicine, University of Eastern Finland, Kuopio, Finland
| | - Sirpa Hartikainen
- Kuopio Research Centre of Geriatric Care, University of Eastern Finland, Kuopio, Finland; School of Pharmacy, University of Eastern Finland, Kuopio, Finland
| | - Anna-Maija Tolppanen
- Kuopio Research Centre of Geriatric Care, University of Eastern Finland, Kuopio, Finland; School of Pharmacy, University of Eastern Finland, Kuopio, Finland
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19
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McNicholas T, Tobin K, Carey D, O'Callaghan S, Kenny RA. Is Baseline Orthostatic Hypotension Associated With a Decline in Global Cognitive Performance at 4-Year Follow-Up? Data From TILDA (The Irish Longitudinal Study on Ageing). J Am Heart Assoc 2019; 7:e008976. [PMID: 30371298 PMCID: PMC6404900 DOI: 10.1161/jaha.118.008976] [Citation(s) in RCA: 30] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
Abstract
Background It is postulated that orthostatic hypotension ( OH ), a reduction in blood pressure (≥20/10 mm Hg) within 3 minutes of standing, may increase cognitive decline because of cerebral hypoperfusion. This study assesses the impact of OH on global cognition at 4-year follow-up, and the impact of age and hypertension on this association. Methods and Results Data from waves 1 and 3 of TILDA (The Irish Longitudinal Study on Ageing) were used. Baseline blood pressure response to active stand was assessed using beat-to-beat blood pressure monitoring. Two measures of OH were used-at 40 seconds ( OH 40) and 110 seconds ( OH 110). Global cognition was measured using the Montreal Cognitive Assessment. Mixed-effects Poisson regression assessed whether baseline OH was associated with a decline in global cognition at 4-year follow-up. The analysis was repeated, stratifying by age (age 50-64 years and age ≥65 years), and including an interaction between OH and hypertension. Baseline OH 110 was associated with an increased error rate in Montreal Cognitive Assessment at follow-up (incident rate ratio 1.17, P=0.028). On stratification by age, the association persists in ages 50 to 64 years (incident rate ratio 1.25, P=0.048), but not ages ≥65 years. Including an interaction with hypertension found those with co-existent OH 110 and hypertension (incident rate ratio 1.27, P=0.011), or OH 40 and hypertension (incident rate ratio 1.18, P=0.017), showed an increased error rate; however, those with isolated OH 110, OH 40, or isolated hypertension did not. Conclusions OH is associated with a decline in global cognition at 4-year follow-up, and this association is dependent on age and co-existent hypertension.
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Affiliation(s)
- Triona McNicholas
- 1 The Irish Longitudinal Study on Ageing Trinity College Dublin Ireland.,2 The Department of Medical Gerontology Trinity College Dublin Ireland
| | - Katy Tobin
- 1 The Irish Longitudinal Study on Ageing Trinity College Dublin Ireland.,4 Global Brain Health Institute School of Medicine Trinity College Dublin Ireland
| | - Daniel Carey
- 1 The Irish Longitudinal Study on Ageing Trinity College Dublin Ireland
| | - Susan O'Callaghan
- 1 The Irish Longitudinal Study on Ageing Trinity College Dublin Ireland.,2 The Department of Medical Gerontology Trinity College Dublin Ireland
| | - Rose Anne Kenny
- 1 The Irish Longitudinal Study on Ageing Trinity College Dublin Ireland.,2 The Department of Medical Gerontology Trinity College Dublin Ireland.,3 Mercer's Institute for Successful Ageing St James' Hospital Dublin Ireland
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20
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Robinson L, Kimpinski K. Neurogenic orthostatic hypotension impairs information processing speed and attention. Physiol Behav 2019; 211:112682. [PMID: 31526820 DOI: 10.1016/j.physbeh.2019.112682] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/22/2019] [Revised: 09/11/2019] [Accepted: 09/12/2019] [Indexed: 11/15/2022]
Abstract
Neurogenic orthostatic hypotension (NOH) is characterized by a drop in systolic blood pressure (SBP) ≥20 mmHg or diastolic blood pressure (DBP) ≥10 mmHg within three minutes of upright posture. NOH is common in the elderly population. This group of individuals is at an increased risk for deficits in multiple cognitive domains such as information processing speed (IPS) and attention. The objective of the current study was to investigate the change in IPS and attention during head-up tilt (HUT) in patients with NOH compared to controls. Cognitive function was assessed in the supine and HUT positions using the symbol digit modalities test (SDMT) which assesses IPS and the Stroop Test which measures attention. 40 participants completed the study, 20 controls (age 64.50 ± 9.25) and 20 NOH patients (age 69.55 ± 7.43) with associated conditions of Parkinson's disease (n = 11), multiple systems atrophy (n = 3), early Lewy body dementia (n = 1) and idiopathic NOH (n = 5). NOH patients had no difference in IPS between supine (43.20 ± 15.26) and HUT (42.90 ± 14.33; p = .77). Controls had significantly faster IPS in the HUT position (69.90 ± 12.02) compared to supine (63.55 ± 9.96; p < .001). NOH patients had significantly slower IPS in both the supine and HUT position compared to controls (p < .001). Attention in the HUT position was significantly worse in NOH patients (-14.86 ± 8.96) compared to controls (-8.68 ± 7.13; p = .029). During HUT, NOH patients experienced a significant decrease in mean SBP by -64.11 ± 18.96 from baseline, whereas controls only had a mean decrease of -5.69 ± 7.65. It is evident that NOH patients have impaired IPS and attention compared to controls and likely plays an important role in the morbidity of these individuals.
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Affiliation(s)
| | - Kurt Kimpinski
- School of Kinesiology, Western University, London, ON, Canada; Department of Clinical Neurological Sciences, Rm B7-140, University Hospital, London Health Sciences Centre, 339 Windermere Road, London, ON N6A 5A5, Canada; Schulich School of Medicine and Dentistry, Western University, London, ON, Canada
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21
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Zimmermann M, Wurster I, Lerche S, Roeben B, Machetanz G, Sünkel U, von Thaler A, Eschweiler G, Fallgatter AJ, Maetzler W, Berg D, Brockmann K. Orthostatic hypotension as a risk factor for longitudinal deterioration of cognitive function in the elderly. Eur J Neurol 2019; 27:160-167. [DOI: 10.1111/ene.14050] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/31/2019] [Accepted: 07/22/2019] [Indexed: 01/08/2023]
Affiliation(s)
- M. Zimmermann
- Center of Neurology Department of Neurodegeneration and Hertie‐Institute for Clinical Brain Research University of Tübingen TübingenGermany
- German Center for Neurodegenerative Diseases (DZNE) University of Tübingen TübingenGermany
| | - I. Wurster
- Center of Neurology Department of Neurodegeneration and Hertie‐Institute for Clinical Brain Research University of Tübingen TübingenGermany
- German Center for Neurodegenerative Diseases (DZNE) University of Tübingen TübingenGermany
| | - S. Lerche
- Center of Neurology Department of Neurodegeneration and Hertie‐Institute for Clinical Brain Research University of Tübingen TübingenGermany
- German Center for Neurodegenerative Diseases (DZNE) University of Tübingen TübingenGermany
| | - B. Roeben
- Center of Neurology Department of Neurodegeneration and Hertie‐Institute for Clinical Brain Research University of Tübingen TübingenGermany
- German Center for Neurodegenerative Diseases (DZNE) University of Tübingen TübingenGermany
| | - G. Machetanz
- Center of Neurology Department of Neurodegeneration and Hertie‐Institute for Clinical Brain Research University of Tübingen TübingenGermany
- German Center for Neurodegenerative Diseases (DZNE) University of Tübingen TübingenGermany
| | - U. Sünkel
- Center of Neurology Department of Neurodegeneration and Hertie‐Institute for Clinical Brain Research University of Tübingen TübingenGermany
| | - A.‐K. von Thaler
- Center of Neurology Department of Neurodegeneration and Hertie‐Institute for Clinical Brain Research University of Tübingen TübingenGermany
| | - G. Eschweiler
- German Center for Neurodegenerative Diseases (DZNE) University of Tübingen TübingenGermany
- Department of Psychiatry University of Tübingen TübingenGermany
| | - A. J. Fallgatter
- German Center for Neurodegenerative Diseases (DZNE) University of Tübingen TübingenGermany
- Department of Psychiatry University of Tübingen TübingenGermany
| | - W. Maetzler
- Department of Neurology Christian‐Albrechts‐University of Kiel Kiel Germany
| | - D. Berg
- Department of Neurology Christian‐Albrechts‐University of Kiel Kiel Germany
| | - K. Brockmann
- Center of Neurology Department of Neurodegeneration and Hertie‐Institute for Clinical Brain Research University of Tübingen TübingenGermany
- German Center for Neurodegenerative Diseases (DZNE) University of Tübingen TübingenGermany
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22
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Cohen A, Vidal JS, Roca F, Rananja H, Hernandorena I, Coude du Foresto L, Seux ML, Rigaud AS, Hanon O, Duron E. Feasibility and Determinants of Orthostatic Hypotension Self-measurement at Home in an Elderly Community-Dwelling Population. Am J Hypertens 2019; 32:824-832. [PMID: 31045224 DOI: 10.1093/ajh/hpz066] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/16/2018] [Revised: 02/25/2019] [Accepted: 04/19/2019] [Indexed: 11/12/2022] Open
Abstract
BACKGROUND Orthostatic hypotension (OH) measurement reproducibility is poor. Our objectives were to assess feasibility of self-detection home-measured OH (HOH) and HOH determinants. METHODS Subjects older than 65 years, attending a geriatric outpatient clinic, able to understand the HOH protocol: 3 blood pressure (BP) measures after 5 minutes of seating and BP measures after 1 and 3 minutes of standing, each morning and evening for 3 consecutive days were lent a validated digital automatic sphygmomanometer. Reports containing at least 4 correct measurements were deemed a success. Factors associated with HOH were studied. RESULTS HOH feasibility was 82.8% (241 subjects) with no difference between participants who failed or succeeded. Among the 241 subjects (mean age (SD) = 78.0 (8.3) years old; 62.1% of women), 139 were free of HOH, 70 had 1 HOH episode and 32 had 2 or more HOH episodes. Hypertension, dementia, atrial fibrillation, diabetes, and heart failure were found in 70.0%, 10.4%, 9.4%, 8.8%, and 3.4% of cases, respectively. Subjects were treated with antihypertensive, benzodiazepine, statin medication in 47.3%, 9.3%, 7.4% of cases, respectively, and 42.4% experienced polypharmacy. HOH episodes were associated with dementia (P = 0.01), presence of OH during the geriatric outpatient clinic assessment (P = 0.0002), statin therapy (P = 0.04), and polypharmacy (P = 0.0002). In multivariate analysis, benzodiazepine (OR (95% CI) = 2.59 (1.10-6.08) and statin medication (OR (95% CI) = 1.92 (1.10-3.33)) remained significantly associated with HOH. CONCLUSIONS HOH had a good feasibility and relevant determinants. A study to address the predictive value of HOH will be conducted.
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Affiliation(s)
- Adrien Cohen
- Service de Gériatrie, AP-HP, Hôpital Broca, Paris, France
- EA 4468, Sorbonne Paris Cité, Université Paris Descartes, Paris, France
| | - Jean-Sébastien Vidal
- Service de Gériatrie, AP-HP, Hôpital Broca, Paris, France
- EA 4468, Sorbonne Paris Cité, Université Paris Descartes, Paris, France
| | - Frédéric Roca
- Service de Gériatrie, AP-HP, Hôpital Broca, Paris, France
- EA 4468, Sorbonne Paris Cité, Université Paris Descartes, Paris, France
- Service de médecine interne gériatrique, CHU Rouen, Rouen, France
| | - Hanta Rananja
- Service de Gériatrie, AP-HP, Hôpital Broca, Paris, France
- EA 4468, Sorbonne Paris Cité, Université Paris Descartes, Paris, France
| | - Intza Hernandorena
- Service de Gériatrie, AP-HP, Hôpital Broca, Paris, France
- EA 4468, Sorbonne Paris Cité, Université Paris Descartes, Paris, France
| | - Laurent Coude du Foresto
- Service de Gériatrie, AP-HP, Hôpital Broca, Paris, France
- EA 4468, Sorbonne Paris Cité, Université Paris Descartes, Paris, France
| | - Marie-Laure Seux
- Service de Gériatrie, AP-HP, Hôpital Broca, Paris, France
- EA 4468, Sorbonne Paris Cité, Université Paris Descartes, Paris, France
| | - Anne-Sophie Rigaud
- Service de Gériatrie, AP-HP, Hôpital Broca, Paris, France
- EA 4468, Sorbonne Paris Cité, Université Paris Descartes, Paris, France
| | - Olivier Hanon
- Service de Gériatrie, AP-HP, Hôpital Broca, Paris, France
- EA 4468, Sorbonne Paris Cité, Université Paris Descartes, Paris, France
| | - Emmanuelle Duron
- Service de Gériatrie, AP-HP, Hôpital Broca, Paris, France
- APHP, Hôpital Paul Brousse, Villejuif, Paris, France
- Université Paris-Sud XI, Le Kremlin-Bicêtre, Paris, France
- Centre de recherche en Epidémiologie et Santé des Populations, INSERM UMR-1178, Université Paris-Sud XI, Le Kremlin Bicêtre, Paris, France
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Abstract
PURPOSE OF REVIEW Autonomic dysfunction is common in dementia, particularly in the Lewy body dementias. This review considers the evidence for autonomic dysfunction in dementia, common symptoms and potential management options. RECENT FINDINGS Autonomic dysfunction has been shown in Alzheimer's disease and Lewy body dementias. Common symptoms include orthostatic dizziness, syncope, falls, urinary tract symptoms and constipation. Non-pharmacological management of orthostatic hypotension should include bolus water drinking. Pharmacological management may include the use of midodrine or droxidopa although the latter is not available in Europe. Atomoxetine is a noradrenaline reuptake inhibitor which may be useful if further clinical trials become available. Management of constipation may include the use o f probiotics, osmotic laxatives such as macrogol and chloride type 2 channel activators such as lubiprostone. Management of urinary tract symptoms may include the use of mirabegron. There is a dearth of clinical trials for autonomic dysfunction in dementia and most of the evidence is imputed from trials in Parkinson's disease. However, pragmatic recommendations may be made. There is a need for controlled clinical trials in people with dementia.
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Affiliation(s)
- Louise M Allan
- Institute of Health Research, College of Medicine and Health, University of Exeter, South Cloisters Building, St Luke's Campus, Heavitree Road, Exeter, EX1 2LU, UK.
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Orthostatic hypotension in older persons is not associated with cognitive functioning, features of cerebral damage or cerebral blood flow. J Hypertens 2019; 36:1201-1206. [PMID: 29373479 DOI: 10.1097/hjh.0000000000001681] [Citation(s) in RCA: 16] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
OBJECTIVE Particularly in old age, orthostatic hypotension has been related to worse cognitive functioning, possibly caused by reduced cerebral blood flow (CBF). This study investigates whether orthostatic hypotension in older people is associated with cognitive dysfunction and, if so, whether this association is mediated by cerebral vascular damage and/or decreased CBF. METHODS Four hundred and twenty participants of the Discontinuation of ANtihypertensive Treatment in Elderly People (DANTE) Study Leiden (mean age 81 years, all using antihypertensive medication and with mild cognitive deficits), and MRI data from 214 participants of the nested DANTE MRI sub-study. Orthostatic hypotension was defined as either a SBP decrease at least 20 mmHg and/or a DBP decrease of at least 10 mmHg within 3 min of standing up. Cognitive functioning was assessed using a battery of six cognitive tests covering global cognition, memory function, executive function and psychomotor speed. Cerebral vascular damage and CBF were assessed using MRI. RESULTS The prevalence of orthostatic hypotension was 47% (n = 199). Compared with the group without orthostatic hypotension, participants with orthostatic hypotension showed no differences in any of the cognitive functions, features of cerebral small vessel disease, microstructural integrity or CBF. CONCLUSION In this population of older persons, the presence of orthostatic hypotension was not associated with decreased cognition. In addition, no differences were found in the supposedly underlying cerebral vascular mechanisms.
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de Heus RAA, Donders R, Santoso AMM, Olde Rikkert MGM, Lawlor BA, Claassen JAHR. Blood Pressure Lowering With Nilvadipine in Patients With Mild-to-Moderate Alzheimer Disease Does Not Increase the Prevalence of Orthostatic Hypotension. J Am Heart Assoc 2019; 8:e011938. [PMID: 31088188 PMCID: PMC6585342 DOI: 10.1161/jaha.119.011938] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/28/2019] [Accepted: 04/16/2019] [Indexed: 12/23/2022]
Abstract
Background Hypertension is common among patients with Alzheimer disease. Because this group has been excluded from hypertension trials, evidence regarding safety of treatment is lacking. This secondary analysis of a randomized controlled trial assessed whether antihypertensive treatment increases the prevalence of orthostatic hypotension (OH) in patients with Alzheimer disease. Methods and Results Four hundred seventy-seven patients with mild-to-moderate Alzheimer disease were randomized to the calcium-channel blocker nilvadipine 8 mg/day or placebo for 78 weeks. Presence of OH (blood pressure drop ≥20/≥10 mm Hg after 1 minute of standing) and OH-related adverse events (dizziness, syncope, falls, and fractures) was determined at 7 follow-up visits. Mean age of the study population was 72.2±8.2 years and mean Mini-Mental State Examination score was 20.4±3.8. Baseline blood pressure was 137.8±14.0/77.0±8.6 mm Hg. Grade I hypertension was present in 53.4% (n=255). After 13 weeks, blood pressure had fallen by -7.8/-3.9 mm Hg for nilvadipine and by -0.4/-0.8 mm Hg for placebo ( P<0.001). Across the 78-week intervention period, there was no difference between groups in the proportion of patients with OH at a study visit (odds ratio [95% CI]=1.1 [0.8-1.5], P=0.62), nor in the proportion of visits where a patient met criteria for OH, corrected for number of visits (7.7±13.8% versus 7.3±11.6%). OH-related adverse events were not more often reported in the intervention group compared with placebo. Results were similar for those with baseline hypertension. Conclusions This study suggests that initiation of a low dose of antihypertensive treatment does not significantly increase the risk of OH in patients with mild-to-moderate Alzheimer disease. Clinical Trial Registration URL: https://www.clinicaltrials.gov . Unique identifier: NCT02017340.
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Affiliation(s)
- Rianne A. A. de Heus
- Department of Geriatric MedicineRadboud University Medical CenterDonders Institute for Brain Cognition and BehaviourNijmegenThe Netherlands
- Radboudumc Alzheimer CenterNijmegenThe Netherlands
| | - Rogier Donders
- Department for Health EvidenceRadboud University Medical CenterNijmegenThe Netherlands
| | - Angelina M. M. Santoso
- Department of Geriatric MedicineRadboud University Medical CenterDonders Institute for Brain Cognition and BehaviourNijmegenThe Netherlands
- Radboudumc Alzheimer CenterNijmegenThe Netherlands
| | - Marcel G. M. Olde Rikkert
- Department of Geriatric MedicineRadboud University Medical CenterDonders Institute for Brain Cognition and BehaviourNijmegenThe Netherlands
- Radboudumc Alzheimer CenterNijmegenThe Netherlands
| | - Brian A. Lawlor
- Mercer's Institute for Research on AgeingSt. James's HospitalDublinIreland
- Department of Medical GerontologyTrinity College Institute of NeuroscienceDublinIreland
| | - Jurgen A. H. R. Claassen
- Department of Geriatric MedicineRadboud University Medical CenterDonders Institute for Brain Cognition and BehaviourNijmegenThe Netherlands
- Radboudumc Alzheimer CenterNijmegenThe Netherlands
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Formigo Couceiro FJ, Pena Seijo M, Pose Reino A, Mayán Santos JM, Ayape Amigot FJ, Sueiro Justel J. [Prevalence and relations of orthostatic hypotension in patients 80 years old and over from a primary care unit]. Aten Primaria 2019; 51:294-299. [PMID: 29609870 PMCID: PMC6837008 DOI: 10.1016/j.aprim.2017.12.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/24/2017] [Revised: 12/11/2017] [Accepted: 12/11/2017] [Indexed: 11/25/2022] Open
Abstract
OBJECTIVE To estimate the prevalence of orthostatic hypotension (OH) in patients 80 years old and over attending a primary care unit. To relate OH to the most prevalent pathologies and to the most used drugs. DESIGN Transversal observational study. LOCATION Primary care unit, Santiago de Compostela. PARTICIPANTS Eighty one patients 80 years old or over representative of a primary care unit were recruited. Ten patients were excluded. MAIN MEASUREMENTS Blood pressure was measured in decubitus and later in erect position first immediately after standing and then after 3 minutes. Diagnoses and active treatments were reviewed in the electronic clinical history and through an interview with the patient and caregiver. RESULTS In 26.76% of patients the systolic blood pressure fell by 20mmHg or more and/or the diastolic blood pressure fell by 10mmHg in the instant following the postural shift. In 16.90% of patients the drop persisted after 3 minutes of standing from decubitus position. None of the patients was diagnosed with OH. The highest prevalence ratio was observed for diabetes mellitus (1.6; P=.412), not existing differences for arterial hypertension (P=.881). OH related in a statistically meaningful way to the use of renin angiotensin aldosterone system inhibitors (OR: 8.174, CI95%: 1.182-56.536); P=.033] and benzodiazepines (OR: 5.938, CI95%: 1.242-28.397; P=.026)]. CONCLUSION OH had a prevalence of 16.90% among the elderly patients who had a consultation. Its connection with some drugs (renin angiotensin aldosterone system inhibitors and benzodiazepines) must be considered.
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Affiliation(s)
| | - Marta Pena Seijo
- Hospital Provincial de Conxo, Complexo Hospitalario Universitario de Santiago, Santiago de Compostela, España
| | - Antonio Pose Reino
- Hospital Provincial de Conxo, Complexo Hospitalario Universitario de Santiago, Santiago de Compostela, España
| | - José Manuel Mayán Santos
- Escuela Universitaria de Enfermería, Universidad de Santiago de Compostela, Santiago de Compostela, España
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Ceccofiglio A, Mussi C, Rafanelli M, Rivasi G, Bo M, Mossello E, Martone AM, Abete P, Ungar A. Increasing Prevalence of Orthostatic Hypotension as a Cause of Syncope With Advancing Age and Multimorbidity. J Am Med Dir Assoc 2019; 20:586-588. [PMID: 30926410 DOI: 10.1016/j.jamda.2019.01.149] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/09/2019] [Revised: 01/27/2019] [Accepted: 01/28/2019] [Indexed: 11/26/2022]
Affiliation(s)
- Alice Ceccofiglio
- Department of Geriatrics, Azienda Ospedaliero-Universitaria Careggi and University of Florence, Italy
| | - Chiara Mussi
- Centro di Valutazione e Ricerca Gerontologica, Chair of Geriatrics, University of Modena and Reggio Emilia, Modena, Italy
| | - Martina Rafanelli
- Department of Geriatrics, Azienda Ospedaliero-Universitaria Careggi and University of Florence, Italy
| | - Giulia Rivasi
- Department of Geriatrics, Azienda Ospedaliero-Universitaria Careggi and University of Florence, Italy
| | - Mario Bo
- Section of Geriatrics, Department of Medical Sciences, Città della Salute e della Scienza-Molinette, Torino, Italy
| | - Enrico Mossello
- Department of Geriatrics, Azienda Ospedaliero-Universitaria Careggi and University of Florence, Italy
| | - Anna Maria Martone
- Department of Geriatrics, Neurosciences and Orthopedics, Catholic University of the Sacred Heart, Rome, Italy
| | - Pasquale Abete
- Department of Translational Medical Sciences, University of Naples, Federico II, Naples, Italy
| | - Andrea Ungar
- Department of Geriatrics, Azienda Ospedaliero-Universitaria Careggi and University of Florence, Italy.
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28
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Shaw BH, Borrel D, Sabbaghan K, Kum C, Yang Y, Robinovitch SN, Claydon VE. Relationships between orthostatic hypotension, frailty, falling and mortality in elderly care home residents. BMC Geriatr 2019; 19:80. [PMID: 30866845 PMCID: PMC6415493 DOI: 10.1186/s12877-019-1082-6] [Citation(s) in RCA: 36] [Impact Index Per Article: 7.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/05/2018] [Accepted: 02/21/2019] [Indexed: 12/19/2022] Open
Abstract
BACKGROUND Orthostatic hypotension (OH; profound falls in blood pressure when upright) is a common deficit that increases in incidence with age, and may be associated with falling risk. Deficit accumulation results in frailty, regarded as enhanced vulnerability to adverse outcomes. We aimed to evaluate the relationships between OH, frailty, falling and mortality in elderly care home residents. METHODS From the Minimum Data Set (MDS) document, a frailty index (FI-MDS) was generated from a list of 58 deficits, ranging from 0 (no deficits) to 1.0 (58 deficits). OH was evaluated from beat-to-beat blood pressure and heart rate (finger plethysmography) collected during a 15-min supine-seated orthostatic stress test. Retrospective and prospective falling rates (falls/year) were extracted from facility falls incident reports. All-cause 3-year mortality was determined. Data are reported as mean ± standard error. RESULTS Data were obtained from 116 older adults (aged 84.2 ± 0.9 years; 44% males) living in two long term care facilities. The mean FI-MDS was 0.36 ± 0.01; FI-MDS was correlated with age (r = 0.277; p = 0.003). Those who were frail (FI ≥ 0.27) had larger Initial (- 17.8 ± 4.2 vs - 6.1 ± 3.3 mmHg, p = 0.03) and Consensus (- 22.7 ± 4.3 vs - 11.5 ± 3.3 mmHg, p = 0.04) orthostatic reductions in systolic arterial pressure. Frail individuals had higher prospective and retrospective falling rates and higher 3-year mortality. Receiver operating characteristic curves evaluated the ability of FI-MDS alone to predict prospective falls (sensitivity 72%, specificity 36%), Consensus OH (sensitivity 68%, specificity 60%) and 3-year mortality (sensitivity 77%, specificity 49%). Kaplan Meier survival analyses showed significantly higher 3-year mortality in those who were frail compared to the non-frail (p = 0.005). CONCLUSIONS Frailty can be captured using a frailty index based on MDS data in elderly individuals living in long term care, and is related to susceptibility to orthostatic hypotension, falling risk and 3-year mortality. Use of the MDS to generate a frailty index may represent a simple and convenient risk assessment tool for older adults living in long term care. Older adults who are both frail and have impaired orthostatic blood pressure control have a particularly high risk of falling and should receive tailored management to mitigate this risk.
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Affiliation(s)
- Brett H Shaw
- Department of Biomedical Physiology and Kinesiology, Simon Fraser University, Burnaby, BC, V5A 1S6, Canada
| | - Dave Borrel
- Department of Biomedical Physiology and Kinesiology, Simon Fraser University, Burnaby, BC, V5A 1S6, Canada
| | - Kimiya Sabbaghan
- Department of Biomedical Physiology and Kinesiology, Simon Fraser University, Burnaby, BC, V5A 1S6, Canada
| | - Colton Kum
- Department of Biomedical Physiology and Kinesiology, Simon Fraser University, Burnaby, BC, V5A 1S6, Canada
| | - Yijian Yang
- Department of Biomedical Physiology and Kinesiology, Simon Fraser University, Burnaby, BC, V5A 1S6, Canada
| | - Stephen N Robinovitch
- Department of Biomedical Physiology and Kinesiology, Simon Fraser University, Burnaby, BC, V5A 1S6, Canada
| | - Victoria E Claydon
- Department of Biomedical Physiology and Kinesiology, Simon Fraser University, Burnaby, BC, V5A 1S6, Canada.
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Liu W, Wang L, Huang X, Yuan C, Li H, Yang J. Orthostatic blood pressure reduction as a possible explanation for memory deficits in dialysis patients. Hypertens Res 2019; 42:1049-1056. [DOI: 10.1038/s41440-019-0236-4] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/23/2018] [Revised: 01/16/2019] [Accepted: 01/26/2019] [Indexed: 11/09/2022]
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Iseli R, Nguyen VTV, Sharmin S, Reijnierse EM, Lim WK, Maier AB. Orthostatic hypotension and cognition in older adults: A systematic review and meta-analysis. Exp Gerontol 2019; 120:40-49. [PMID: 30825549 DOI: 10.1016/j.exger.2019.02.017] [Citation(s) in RCA: 27] [Impact Index Per Article: 5.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/22/2018] [Revised: 02/09/2019] [Accepted: 02/25/2019] [Indexed: 12/26/2022]
Abstract
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.
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Affiliation(s)
- Rebecca Iseli
- Department of Medicine and Aged Care, @AgeMelbourne, The Royal Melbourne Hospital, The University of Melbourne, Parkville, Victoria, Australia.
| | - Vi Truc Vo Nguyen
- Department of Medicine and Aged Care, @AgeMelbourne, The Royal Melbourne Hospital, The University of Melbourne, Parkville, Victoria, Australia
| | - Sifat Sharmin
- Melbourne Academic Centre for Health, Faculty of Medicine, Dentistry and Health Sciences, University of Melbourne, Parkville, Victoria, Australia
| | - Esmee M Reijnierse
- Department of Medicine and Aged Care, @AgeMelbourne, The Royal Melbourne Hospital, The University of Melbourne, Parkville, Victoria, Australia
| | - Wen Kwang Lim
- Department of Medicine and Aged Care, @AgeMelbourne, The Royal Melbourne Hospital, The University of Melbourne, Parkville, Victoria, Australia
| | - Andrea B Maier
- Department of Medicine and Aged Care, @AgeMelbourne, The Royal Melbourne Hospital, The University of Melbourne, Parkville, Victoria, Australia; Department of Human Movement Sciences, @AgeAmsterdam, Amsterdam Movement Sciences, Vrije Universiteit, Van der Boechorststraat, Amsterdam, the Netherlands
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31
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Mol A, Reijnierse EM, Bui Hoang PTS, van Wezel RJ, Meskers CG, Maier AB. Orthostatic hypotension and physical functioning in older adults: A systematic review and meta-analysis. Ageing Res Rev 2018; 48:122-144. [PMID: 30394339 DOI: 10.1016/j.arr.2018.10.007] [Citation(s) in RCA: 31] [Impact Index Per Article: 5.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/09/2018] [Revised: 09/17/2018] [Accepted: 10/17/2018] [Indexed: 12/23/2022]
Abstract
BACKGROUND Orthostatic hypotension (OH) may negatively affect physical functioning and aggravate morbidities, but existing evidence is contradictory. METHODS MEDLINE (from 1946), PubMed (from 1966) and EMBASE databases (from 1947) were systematically searched for studies on the association of OH and physical functioning in older adults, categorized as: balance, gait characteristics, walking speed, Timed Up and Go time, handgrip strength (HGS), physical frailty, exercise tolerance, physical activity, activities of daily living (ADL), and performance on the Hoehn and Yahr scale (HY) and Unified Parkinson's Disease Rating Scale (UPDRS). Study quality was assessed using the Newcastle Ottawa Scale. RESULTS Forty-two studies were included in the systematic review (29,421 individuals) and 29 studies in the meta-analyses (23,879 individuals). Sixteen out of 42 studies reported a significant association of OH with worse physical functioning. Meta-analysis showed a significant association of OH with impaired balance, ADL performance and HY/UPDRS III performance, but not with gait characteristics, mobility, walking speed, TUG, HGS, physical frailty, exercise tolerance, physical activity and UPDRS II performance. CONCLUSIONS OH was associated with impaired balance, ADL performance and HY/UPDRS III performance, but not with other physical functioning categories. The results suggest that OH interventions could potentially improve some aspects of physical functioning.
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Min M, Shi T, Sun C, Liang M, Zhang Y, Wu Y, Sun Y. The association between orthostatic hypotension and dementia: A meta-analysis of prospective cohort studies. Int J Geriatr Psychiatry 2018; 33:1541-1547. [PMID: 30247788 DOI: 10.1002/gps.4964] [Citation(s) in RCA: 19] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/05/2018] [Accepted: 07/22/2018] [Indexed: 01/23/2023]
Abstract
OBJECTIVES As for the association between orthostatic hypotension (OH) and dementia, results of published studies are inconsistent; therefore, current substantive conclusions have yet been obtained. This meta-analysis was conducted in hopes of producing progress in this topic. METHODS A systematic database search was performed towards electronic databases including Chinese Biomedical Database, PubMed, Web of Science, Wiley Online Library, ScienceDirect, and the Cochrane Library. Five prospective cohort studies were included. Summary hazard ratio (HR) estimates with 95% confidence intervals (CIs) were calculated by random-effects model. Statistical heterogeneity was assessed with the Cochran Q test and I2 statistic. A sensitivity analysis was also conducted in this meta-analysis. RESULTS A 22.4% higher prevalence of dementia in subjects with OH was obtained (adjusted pooled HR was 1.224; 95% CI: 1.106-1.354; P < .001). This meta-analysis also showed significant associations between OH and 2 dementia subtypes: Alzheimer disease (adjusted pooled HR was 1.175; 95% CI: 1.022-1.351; P = .023) and Vascular dementia (adjusted pooled HR was 1.403; 95% CI: 1.042-1.889; P = .026), respectively. CONCLUSIONS Orthostatic hypotension is positively associated with the overall prevalence of dementia, and it may contribute to the prevalence of Alzheimer disease and Vascular dementia as well.
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Affiliation(s)
- Min Min
- Department of Epidemiology and Health Statistics, School of Public Health, Anhui Medical University, Hefei, Anhui, China
| | - Tingting Shi
- Department of Epidemiology and Health Statistics, School of Public Health, Anhui Medical University, Hefei, Anhui, China
| | - Chenyu Sun
- The First Affiliated Hospital of Anhui Medical University, Hefei, Anhui, China
| | - Mingming Liang
- Department of Epidemiology and Health Statistics, School of Public Health, Anhui Medical University, Hefei, Anhui, China
| | - Yun Zhang
- Department of Epidemiology and Health Statistics, School of Public Health, Anhui Medical University, Hefei, Anhui, China
| | - Yile Wu
- The Second Affiliated Hospital of Anhui Medical University, Hefei, Anhui, China
| | - Yehuan Sun
- Department of Epidemiology and Health Statistics, School of Public Health, Anhui Medical University, Hefei, Anhui, China.,Centre for Evidence-Based Practice, Anhui Medical University, Hefei, Anhui, China
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Ostroumova OD, Kochetkov AI, Cherniaeva MS. Arterial Hypertension in Older Adults in the Light of New European Guidelines 2018. RATIONAL PHARMACOTHERAPY IN CARDIOLOGY 2018. [DOI: 10.20996/1819-6446-2018-14-5-774-784] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Affiliation(s)
- O. D. Ostroumova
- A.I. Evdokimov Moscow State University of Medicine and Dentistry; Pirogov Russian National Research Medical University
| | - A. I. Kochetkov
- A.I. Evdokimov Moscow State University of Medicine and Dentistry; Pirogov Russian National Research Medical University
| | - M. S. Cherniaeva
- Central State Medical Academy of Administrative Department of the President of the Russian Federation
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Ostroumova OD, Cherniaeva MS, Petrova MM, Golovina OV. Orthostatic Hypotension: Definition, Pathophysiology, Classification, Prognostic Aspects, Diagnostics and Treatment. RATIONAL PHARMACOTHERAPY IN CARDIOLOGY 2018. [DOI: 10.20996/1819-6446-2018-14-5-747-756] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Affiliation(s)
- O. D. Ostroumova
- A.I. Evdokimov Moscow State University of Medicine and Dentistry; I.M. Sechenov First Moscow State Medical University (Sechenov University)
| | - M. S. Cherniaeva
- Central State Medical Academy of Administrative Department of the President of the Russian Federation
| | - M. M. Petrova
- Krasnoyarsk State Medical University named after Prof. V.F. Voino-Yasenetsky
| | - O. V. Golovina
- Russian Medical Academy of Continuous Professional Education
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Rawlings AM, Juraschek SP, Heiss G, Hughes T, Meyer ML, Selvin E, Sharrett AR, Windham BG, Gottesman RF. Association of orthostatic hypotension with incident dementia, stroke, and cognitive decline. Neurology 2018; 91:e759-e768. [PMID: 30045960 DOI: 10.1212/wnl.0000000000006027] [Citation(s) in RCA: 55] [Impact Index Per Article: 9.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/13/2017] [Accepted: 05/19/2018] [Indexed: 11/15/2022] Open
Abstract
OBJECTIVE To examine associations of orthostatic hypotension (OH) with dementia and long-term cognitive decline and to update previously published results in the same cohort for stroke with an additional 16 years of follow-up. METHODS We analyzed data from 11,709 participants without a history of coronary heart disease or stroke who attended the baseline examination (1987-1989) of the prospective Atherosclerosis Risk in Communities (ARIC) study. OH was defined as a drop in systolic blood pressure (BP) of at least 20 mm Hg or a drop in diastolic BP of at least 10 mm Hg on standing. Dementia was ascertained via examination, contact with participants or their proxy, or medical record surveillance. Ischemic stroke was ascertained via cohort surveillance of hospitalizations, cohort follow-up, and linkage with registries. Both outcomes were adjudicated. Cognitive function was ascertained via 3 neuropsychological tests administered in 1990 to 1992 and 1996 to 1998 and a full battery of tests in 2011 to 2013. Scores were summarized and reported as SDs. We used adjusted Cox regression and linear mixed models. RESULTS Over ≈25 years, 1,068 participants developed dementia and 842 had an ischemic stroke. Compared to persons without OH at baseline, those with OH had a higher risk of dementia (hazard ratio [HR] 1.54, 95% confidence interval [CI] 1.20-1.97) and ischemic stroke (HR 2.08, 95% CI 1.65-2.62). Persons with OH had greater, although nonsignificant, cognitive decline over 20 years (SD 0.09, 95% CI -0.02 to 0.21). CONCLUSIONS OH assessed in midlife was independently associated with incident dementia and ischemic stroke. Additional studies are needed to elucidate potential mechanisms for these associations and possible applications for prevention.
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Affiliation(s)
- Andreea M Rawlings
- From the Department of Epidemiology (A.M.R., S.P.J., E.S., A.R.S., R.F.G.), Johns Hopkins Bloomberg School of Public Health, Baltimore, MD; School of Biological and Population Health Sciences (A.M.R.), Oregon State University, Corvallis; Departments of Medicine (S.P.J.) and Neurology (R.F.G.), Johns Hopkins School of Medicine, Baltimore, MD; Harvard Medical School and Beth Israel Deaconess Medical Center (S.P.J.), Boston MA; Department of Epidemiology (G.H., M.L.M.), University of North Carolina at Chapel Hill; Department of Internal Medicine (T.M.H.), Division of Gerontology and Geriatric Medicine, Wake Forest School of Medicine, Winston-Salem, NC; and Division of Geriatrics (B.G.W.), Department of Medicine, University of Mississippi Medical Center, Jackson.
| | - Stephen P Juraschek
- From the Department of Epidemiology (A.M.R., S.P.J., E.S., A.R.S., R.F.G.), Johns Hopkins Bloomberg School of Public Health, Baltimore, MD; School of Biological and Population Health Sciences (A.M.R.), Oregon State University, Corvallis; Departments of Medicine (S.P.J.) and Neurology (R.F.G.), Johns Hopkins School of Medicine, Baltimore, MD; Harvard Medical School and Beth Israel Deaconess Medical Center (S.P.J.), Boston MA; Department of Epidemiology (G.H., M.L.M.), University of North Carolina at Chapel Hill; Department of Internal Medicine (T.M.H.), Division of Gerontology and Geriatric Medicine, Wake Forest School of Medicine, Winston-Salem, NC; and Division of Geriatrics (B.G.W.), Department of Medicine, University of Mississippi Medical Center, Jackson
| | - Gerardo Heiss
- From the Department of Epidemiology (A.M.R., S.P.J., E.S., A.R.S., R.F.G.), Johns Hopkins Bloomberg School of Public Health, Baltimore, MD; School of Biological and Population Health Sciences (A.M.R.), Oregon State University, Corvallis; Departments of Medicine (S.P.J.) and Neurology (R.F.G.), Johns Hopkins School of Medicine, Baltimore, MD; Harvard Medical School and Beth Israel Deaconess Medical Center (S.P.J.), Boston MA; Department of Epidemiology (G.H., M.L.M.), University of North Carolina at Chapel Hill; Department of Internal Medicine (T.M.H.), Division of Gerontology and Geriatric Medicine, Wake Forest School of Medicine, Winston-Salem, NC; and Division of Geriatrics (B.G.W.), Department of Medicine, University of Mississippi Medical Center, Jackson
| | - Timothy Hughes
- From the Department of Epidemiology (A.M.R., S.P.J., E.S., A.R.S., R.F.G.), Johns Hopkins Bloomberg School of Public Health, Baltimore, MD; School of Biological and Population Health Sciences (A.M.R.), Oregon State University, Corvallis; Departments of Medicine (S.P.J.) and Neurology (R.F.G.), Johns Hopkins School of Medicine, Baltimore, MD; Harvard Medical School and Beth Israel Deaconess Medical Center (S.P.J.), Boston MA; Department of Epidemiology (G.H., M.L.M.), University of North Carolina at Chapel Hill; Department of Internal Medicine (T.M.H.), Division of Gerontology and Geriatric Medicine, Wake Forest School of Medicine, Winston-Salem, NC; and Division of Geriatrics (B.G.W.), Department of Medicine, University of Mississippi Medical Center, Jackson
| | - Michelle L Meyer
- From the Department of Epidemiology (A.M.R., S.P.J., E.S., A.R.S., R.F.G.), Johns Hopkins Bloomberg School of Public Health, Baltimore, MD; School of Biological and Population Health Sciences (A.M.R.), Oregon State University, Corvallis; Departments of Medicine (S.P.J.) and Neurology (R.F.G.), Johns Hopkins School of Medicine, Baltimore, MD; Harvard Medical School and Beth Israel Deaconess Medical Center (S.P.J.), Boston MA; Department of Epidemiology (G.H., M.L.M.), University of North Carolina at Chapel Hill; Department of Internal Medicine (T.M.H.), Division of Gerontology and Geriatric Medicine, Wake Forest School of Medicine, Winston-Salem, NC; and Division of Geriatrics (B.G.W.), Department of Medicine, University of Mississippi Medical Center, Jackson
| | - Elizabeth Selvin
- From the Department of Epidemiology (A.M.R., S.P.J., E.S., A.R.S., R.F.G.), Johns Hopkins Bloomberg School of Public Health, Baltimore, MD; School of Biological and Population Health Sciences (A.M.R.), Oregon State University, Corvallis; Departments of Medicine (S.P.J.) and Neurology (R.F.G.), Johns Hopkins School of Medicine, Baltimore, MD; Harvard Medical School and Beth Israel Deaconess Medical Center (S.P.J.), Boston MA; Department of Epidemiology (G.H., M.L.M.), University of North Carolina at Chapel Hill; Department of Internal Medicine (T.M.H.), Division of Gerontology and Geriatric Medicine, Wake Forest School of Medicine, Winston-Salem, NC; and Division of Geriatrics (B.G.W.), Department of Medicine, University of Mississippi Medical Center, Jackson
| | - A Richey Sharrett
- From the Department of Epidemiology (A.M.R., S.P.J., E.S., A.R.S., R.F.G.), Johns Hopkins Bloomberg School of Public Health, Baltimore, MD; School of Biological and Population Health Sciences (A.M.R.), Oregon State University, Corvallis; Departments of Medicine (S.P.J.) and Neurology (R.F.G.), Johns Hopkins School of Medicine, Baltimore, MD; Harvard Medical School and Beth Israel Deaconess Medical Center (S.P.J.), Boston MA; Department of Epidemiology (G.H., M.L.M.), University of North Carolina at Chapel Hill; Department of Internal Medicine (T.M.H.), Division of Gerontology and Geriatric Medicine, Wake Forest School of Medicine, Winston-Salem, NC; and Division of Geriatrics (B.G.W.), Department of Medicine, University of Mississippi Medical Center, Jackson
| | - B Gwen Windham
- From the Department of Epidemiology (A.M.R., S.P.J., E.S., A.R.S., R.F.G.), Johns Hopkins Bloomberg School of Public Health, Baltimore, MD; School of Biological and Population Health Sciences (A.M.R.), Oregon State University, Corvallis; Departments of Medicine (S.P.J.) and Neurology (R.F.G.), Johns Hopkins School of Medicine, Baltimore, MD; Harvard Medical School and Beth Israel Deaconess Medical Center (S.P.J.), Boston MA; Department of Epidemiology (G.H., M.L.M.), University of North Carolina at Chapel Hill; Department of Internal Medicine (T.M.H.), Division of Gerontology and Geriatric Medicine, Wake Forest School of Medicine, Winston-Salem, NC; and Division of Geriatrics (B.G.W.), Department of Medicine, University of Mississippi Medical Center, Jackson
| | - Rebecca F Gottesman
- From the Department of Epidemiology (A.M.R., S.P.J., E.S., A.R.S., R.F.G.), Johns Hopkins Bloomberg School of Public Health, Baltimore, MD; School of Biological and Population Health Sciences (A.M.R.), Oregon State University, Corvallis; Departments of Medicine (S.P.J.) and Neurology (R.F.G.), Johns Hopkins School of Medicine, Baltimore, MD; Harvard Medical School and Beth Israel Deaconess Medical Center (S.P.J.), Boston MA; Department of Epidemiology (G.H., M.L.M.), University of North Carolina at Chapel Hill; Department of Internal Medicine (T.M.H.), Division of Gerontology and Geriatric Medicine, Wake Forest School of Medicine, Winston-Salem, NC; and Division of Geriatrics (B.G.W.), Department of Medicine, University of Mississippi Medical Center, Jackson
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Bhuachalla BN, McGarrigle CA, O'Leary N, Akuffo KO, Peto T, Beatty S, Kenny RA. Orthostatic hypertension as a risk factor for age-related macular degeneration: Evidence from the Irish longitudinal study on ageing. Exp Gerontol 2018; 106:80-87. [DOI: 10.1016/j.exger.2018.02.029] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/03/2017] [Accepted: 02/25/2018] [Indexed: 10/17/2022]
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Clark CE, Thomas D, Warren FC, Llewellyn DJ, Ferrucci L, Campbell JL. Detecting Risk Of Postural hypotension (DROP): derivation and validation of a prediction score for primary care. BMJ Open 2018; 8:e020740. [PMID: 29678986 PMCID: PMC5914723 DOI: 10.1136/bmjopen-2017-020740] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/24/2022] Open
Abstract
OBJECTIVES Falls are a common problem in older people. Postural hypotension contributes to falls but is often asymptomatic. In the absence of symptoms, postural hypotension is only infrequently checked for in clinical practice. We undertook this study to derive, validate and explore the prospective associations of a prediction tool to identify people likely to have unrecognised postural hypotension. DESIGN AND SETTING Cross-sectional and prospective multivariable cohort analysis. PARTICIPANTS 1317 participants of the Invecchiare in Chianti study, a population-based cohort representative of the older Italian population. PRIMARY OUTCOME MEASURES Predictive value of score to suggest presence of postural hypotension. METHODS Subjects were randomised 1:1 to derivation or validation cohorts. Within the derivation cohort, univariable associations for candidate predictors of postural hypotension were tested. Variables with p<0.1 entered multivariable linear regression models. Factors retaining multivariable significance were incorporated into unweighted and weighted Detecting Risk Of Postural hypotension (DROP) scores. These scores were tested in the validation cohort against prediction of postural hypotension, cognitive decline and mortality over 9 years of follow-up. RESULTS Postural hypotension was present in 203 (15.4%) of participants. Factors predicting postural hypotension were: digoxin use, Parkinson's disease, hypertension, stroke or cardiovascular disease and an interarm systolic blood pressure difference. Area under the curve was consistent at 0.65 for all models, with significant ORs of 1.8 to 2.4 per unit increase in score for predicting postural hypotension. For a DROP score ≥1, five cases need to be tested to identify one with postural hypotension.Increasing DROP scores predicted mortality (OR 1.8 to 2.8 per unit rise) and increasing rates of decline of Mini Mental State Examination score (analysis of variance p<0.001) over 9 years of follow-up. CONCLUSIONS The DROP score provides a simple method to identify people likely to have postural hypotension and increased risks to health who require further evaluation.
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Affiliation(s)
- Christopher Elles Clark
- Primary Care Research Group, Institute of Health Research, University of Exeter Medical School, Exeter, UK
| | - Daniel Thomas
- Primary Care Research Group, Institute of Health Research, University of Exeter Medical School, Exeter, UK
| | - Fiona C Warren
- Primary Care Research Group, Institute of Health Research, University of Exeter Medical School, Exeter, UK
| | - David J Llewellyn
- Mental Health Research Group, Institute of Health Research, University of Exeter Medical School, Exeter, UK
| | - Luigi Ferrucci
- Longitudinal Studies Section, National Institute on Aging, Baltimore, Maryland, USA
| | - John L Campbell
- Primary Care Research Group, Institute of Health Research, University of Exeter Medical School, Exeter, UK
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Momtaz YA, Hamid TA, Haron SA, Bagat MF, Mohammadi F. Prevalence of hypotension and its association with cognitive function among older adults. Aging Ment Health 2018; 22:447-452. [PMID: 28060530 DOI: 10.1080/13607863.2016.1268093] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/06/2023]
Abstract
BACKGROUND AND OBJECTIVE The negative effect of hypertension has overshadowed possible health problems associated with hypotension. The purposes of this study were to describe the prevalence of hypotension in older adults and to determine the association between hypotension and cognitive function, after adjusting for possible covariates. METHODOLOGY The data for the study consisting of 1067 community-dwelling older adults were obtained from a national survey entitled "Identifying Psychosocial and Identifying Economic Risk Factor of Cognitive Impairment among Elderly", conducted in Malaysia. The hypotension was considered as blood pressure <120/75 mm Hg, measuring by standard mercury manometer. Data analysis was performed using the SPSS Version 22.0. RESULTS The mean age of the respondents was 68.27 (SD = 5.93). Mean score of cognitive function as measured by MMSE was 22.70 (SD = 4.95). The prevalence of hypotension was 29.3%. The prevalence of cognitive impairment for hypotension group was 25.6%. Results of multiple linear regression analysis revealed that hypotension is negatively associated with cognitive function (Beta = -0.11, p<.01), after adjusting for age, gender, education, marital status, employment status, diabetes, heart disease, stroke and gastritis. CONCLUSION The study showing hypotension is significantly associated with decreased cognitive function in later life, implies more attention to low blood pressure in old age.
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Affiliation(s)
- Yadollah Abolfathi Momtaz
- a Iranian Research Center on Aging , University of Social Welfare and Rehabilitation Sciences , Tehran , Iran.,b Malaysian Research Institute on Ageing (MyAgeing) , Universiti Putra Malaysia , Selangor , Malaysia
| | - Tengku Aizan Hamid
- b Malaysian Research Institute on Ageing (MyAgeing) , Universiti Putra Malaysia , Selangor , Malaysia
| | - Sharifah Azizah Haron
- b Malaysian Research Institute on Ageing (MyAgeing) , Universiti Putra Malaysia , Selangor , Malaysia
| | - Mohamad Fazdillah Bagat
- b Malaysian Research Institute on Ageing (MyAgeing) , Universiti Putra Malaysia , Selangor , Malaysia
| | - Fatemeh Mohammadi
- c School of Nursing & Midwifery , Qazvin University of Medical Sciences , Qazvin , Iran
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Suemoto CK, Baena CP, Mill JG, Santos IS, Lotufo PA, Benseñor I. Orthostatic Hypotension and Cognitive Function: Cross-sectional Results From the ELSA-Brasil Study. J Gerontol A Biol Sci Med Sci 2018; 74:358-365. [DOI: 10.1093/gerona/gly061] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/25/2017] [Indexed: 11/14/2022] Open
Affiliation(s)
- Claudia K Suemoto
- Center for Clinical and Epidemiological Research, University of São Paulo, Brazil
- Division of Geriatrics, University of São Paulo Medical School, Brazil
| | - Cristina P Baena
- Center for Clinical and Epidemiological Research, University of São Paulo, Brazil
- School of Medicine, Pontifícia Universidade Católica do Paraná, Curitiba, Brazil
| | - Jose G Mill
- Department of Physiological Science, Federal University of Espírito Santo, Vitoria, Brazil
| | - Itamar S Santos
- Center for Clinical and Epidemiological Research, University of São Paulo, Brazil
| | - Paulo A Lotufo
- Center for Clinical and Epidemiological Research, University of São Paulo, Brazil
| | - Isabela Benseñor
- Center for Clinical and Epidemiological Research, University of São Paulo, Brazil
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Tarumi T, Zhang R. Cerebral blood flow in normal aging adults: cardiovascular determinants, clinical implications, and aerobic fitness. J Neurochem 2018; 144:595-608. [PMID: 28986925 PMCID: PMC5874160 DOI: 10.1111/jnc.14234] [Citation(s) in RCA: 137] [Impact Index Per Article: 22.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/21/2017] [Revised: 09/05/2017] [Accepted: 10/02/2017] [Indexed: 12/13/2022]
Abstract
Senescence is a leading cause of mortality, disability, and non-communicable chronic diseases in older adults. Mounting evidence indicates that the presence of cardiovascular disease and risk factors elevates the incidence of both vascular cognitive impairment and Alzheimer's disease (AD). Age-related declines in cardiovascular function may impair cerebral blood flow (CBF) regulation, leading to the disruption of neuronal micro-environmental homeostasis. The brain is the most metabolically active organ with limited intracellular energy storage and critically depends on CBF to sustain neuronal metabolism. In patients with AD, cerebral hypoperfusion, increased CBF pulsatility, and impaired blood pressure control during orthostatic stress have been reported, indicating exaggerated, age-related decline in both cerebro- and cardiovascular function. Currently, AD lacks effective treatments; therefore, the development of preventive strategy is urgently needed. Regular aerobic exercise improves cardiovascular function, which in turn may lead to a better CBF regulation, thus reducing the dementia risk. In this review, we discuss the effects of aging on cardiovascular regulation of CBF and provide new insights into the vascular mechanisms of cognitive impairment and potential effects of aerobic exercise training on CBF regulation. This article is part of the Special Issue "Vascular Dementia".
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Affiliation(s)
- Takashi Tarumi
- Institute for Exercise and Environmental Medicine, Texas Health Presbyterian Hospital Dallas (8200 Walnut Hill Ln, Dallas, TX, USA 75231)
- Department of Neurology and Neurotherapeutics, University of Texas Southwestern Medical Center (5323 Harry Hines Blvd, TX, USA 75390)
| | - Rong Zhang
- Institute for Exercise and Environmental Medicine, Texas Health Presbyterian Hospital Dallas (8200 Walnut Hill Ln, Dallas, TX, USA 75231)
- Department of Neurology and Neurotherapeutics, University of Texas Southwestern Medical Center (5323 Harry Hines Blvd, TX, USA 75390)
- Department of Internal Medicine, University of Texas Southwestern Medical Center (5323 Harry Hines Blvd, TX, USA 75390)
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Abstract
Cardiovascular autonomic dysfunctions, including neurogenic orthostatic hypotension, supine hypertension and post-prandial hypotension, are relatively common in patients with Parkinson disease. Recent evidence suggests that early autonomic impairment such as cardiac autonomic denervation and even neurogenic orthostatic hypotension occur prior to the appearance of the typical motor deficits associated with the disease. When neurogenic orthostatic hypotension develops, patients with Parkinson disease have an increased risk of mortality, falls, and trauma-related to falls. Neurogenic orthostatic hypotension reduces quality of life and contributes to cognitive decline and physical deconditioning. The co-existence of supine hypertension complicates the treatment of neurogenic orthostatic hypotension because it involves the use of drugs with opposing effects. Furthermore, treatment of neurogenic orthostatic hypotension is challenging because of few therapeutic options; in the past 20 years, the US Food and Drug Administration approved only two drugs for the treatment of this condition. Small, open-label or randomized studies using acute doses of different pharmacologic probes suggest benefit of other drugs as well, which could be used in individual patients under close monitoring. This review describes the pathophysiology of neurogenic orthostatic hypotension and supine hypertension in Parkinson disease. We discuss the mode of action and therapeutic efficacy of different pharmacologic agents used in the treatment of patients with cardiovascular autonomic failure.
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Affiliation(s)
- Cyndya A. Shibao
- Department of Medicine, Division of Clinical Pharmacology, Vanderbilt Autonomic Dysfunction Center, Vanderbilt University Medical Center, Nashville, TN
| | - Horacio Kaufmann
- Department of Neurology, NYU Langone Medical Center, Dysautonomia Center, 530 1st Avenue, New York, NY, USA.
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Orthostatic hypotension associated with executive dysfunction in mild cognitive impairment. J Neurol Sci 2017; 382:79-83. [PMID: 29111025 DOI: 10.1016/j.jns.2017.09.028] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/27/2017] [Revised: 08/29/2017] [Accepted: 09/19/2017] [Indexed: 01/25/2023]
Abstract
INTRODUCTION Midlife hypertension is associated with dementia in longitudinal studies while chronic hypotension in the elderly is associated with dementia onset. Orthostatic hypotension could influence cognitive performance in the elderly. The objective of this study was to assess the relationship between orthostatic hypotension and cognitive functions. METHODS Consecutive participants with complete neuropsychological evaluation from a Memory Clinic were included. Orthostatic hypotension (OH) was defined by a fall≥20/10mmHg systolic/diastolic pressure. Participants were classified into one of 3 groups: 1) subjective cognitive impairment (SCI), 2) mild cognitive impairment (MCI), and 3) dementia. Neuropsychological tests were analyzed for patients with and without OH. RESULTS One hundred and twenty participants were included, of which 16 (13%) were classified as SCI, 42 (35%) as MCI, and 63 (52%) with dementia. Prevalence of OH was 0% for the SCI group, 26% (n=11) for the MCI group, and 38% (n=24) for the dementia group. Age, sex, education, and brief cognitive test scores (MMSE & MoCA) were not different between groups with or without OH. In the MCI group, OH was associated with lower cognitive performance in several executive functions tests: visual working memory (p<0.001), processing speed (p=0.006), Stroop flexibility (p=0.030) and Trail-Making Test part B (p=0.024). There was no difference in episodic memory performance. OH was associated with a diagnosis of hypertension and the use of antihypertensive medication. No differences were observed in vascular brain injury between groups with and without OH. CONCLUSIONS This study found that orthostatic hypotension prevalence is correlated to severity of cognitive deficits in a Memory Clinic. In MCI, OH is associated with lower performance in executive functions. OH could represent an under-recognized correlate of cognitive performance.
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Cooper LL, Himali JJ, Torjesen A, Tsao CW, Beiser A, Hamburg NM, DeCarli C, Vasan RS, Seshadri S, Pase MP, Mitchell GF. Inter-Relations of Orthostatic Blood Pressure Change, Aortic Stiffness, and Brain Structure and Function in Young Adults. J Am Heart Assoc 2017; 6:JAHA.117.006206. [PMID: 28862943 PMCID: PMC5586458 DOI: 10.1161/jaha.117.006206] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
BACKGROUND Relations of orthostatic change in blood pressure with brain structure and function have not been studied thoroughly, particularly in younger, healthier individuals. Elucidation of factors that contribute to early changes in brain integrity may lead to development of interventions that delay or prevent cognitive impairment. METHODS AND RESULTS In a sample of the Framingham Heart Study Third Generation (N=2119; 53% women; mean age±SD, 47±8 years), we assessed orthostatic change in mean arterial pressure (MAP), aortic stiffness (carotid-femoral pulse wave velocity), neuropsychological function, and markers of subclinical brain injury on magnetic resonance imaging. Multivariable regression analyses were used to assess relations between orthostatic change in MAP and brain structural and neuropsychological outcomes. Greater orthostatic increase in MAP on standing was related to better Trails B-A performance among participants aged <49 years (β±SE, 0.062±0.029; P=0.031) and among participants with carotid-femoral pulse wave velocity <6.9 m/s (β±SE, 0.063±0.026; P=0.016). This relation was not significant among participants who were older or had stiffer aortas. Conversely, greater orthostatic increase in MAP was related to larger total brain volume among older participants (β±SE, 0.065±0.029; P=0.023) and among participants with carotid-femoral pulse wave velocity ≥6.9 m/s (β±SE, 0.078±0.031; P=0.011). CONCLUSIONS Blunted orthostatic increase in MAP was associated with smaller brain volume among participants who were older or had stiffer aortas and with poorer executive function among persons who were younger or who had more-elastic aortas. Our findings suggest that the brain is sensitive to orthostatic change in MAP, with results dependent on age and aortic stiffness.
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Affiliation(s)
| | - Jayandra J Himali
- Boston University and NHLBI's Framingham Study, Framingham, MA.,Department of Biostatistics, Boston University School of Public Health, Boston, MA.,Department of Neurology, Boston University School of Medicine, Boston, MA
| | | | - Connie W Tsao
- Cardiovascular Division, Beth Israel Deaconess Medical Center and Harvard Medical School, Boston, MA
| | - Alexa Beiser
- Boston University and NHLBI's Framingham Study, Framingham, MA.,Department of Biostatistics, Boston University School of Public Health, Boston, MA.,Department of Neurology, Boston University School of Medicine, Boston, MA
| | - Naomi M Hamburg
- Evans Department of Medicine, Boston University School of Medicine, Boston, MA.,Whitaker Cardiovascular Institute, Boston University School of Medicine, Boston, MA
| | | | - Ramachandran S Vasan
- Boston University and NHLBI's Framingham Study, Framingham, MA.,Evans Department of Medicine, Boston University School of Medicine, Boston, MA.,Whitaker Cardiovascular Institute, Boston University School of Medicine, Boston, MA.,Cardiology and Preventive Medicine Sections, Department of Medicine, Boston University School of Medicine, Boston, MA.,Department of Epidemiology, Boston University School of Public Health, Hawthorn, Australia
| | - Sudha Seshadri
- Department of Neurology, Boston University School of Medicine, Boston, MA
| | - Matthew P Pase
- Boston University and NHLBI's Framingham Study, Framingham, MA.,Department of Neurology, Boston University School of Medicine, Boston, MA.,Centre for Human Psychopharmacology, Swinburne University of Technology, Hawthorn, Australia
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Zhu QO, Tan CSG, Tan HL, Wong RG, Joshi CS, Cuttilan RA, Sng GKJ, Tan NC. Orthostatic hypotension: prevalence and associated risk factors among the ambulatory elderly in an Asian population. Singapore Med J 2017; 57:444-51. [PMID: 27549316 DOI: 10.11622/smedj.2016135] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/01/2023]
Abstract
INTRODUCTION The prevalence of orthostatic hypotension (OH) among the elderly population in Singapore, as defined by a decline in blood pressure upon a change in position, is not well-established. Studies associate OH with clinically significant outcomes such as falls. This study aims to determine the prevalence of OH among elderly patients attending a public primary care clinic (polyclinic) for chronic disease management, and examine the relationships between postulated risk factors and OH. METHODS Patients aged ≥ 65 years attending a typical polyclinic in Geylang were identified and targeted for recruitment at the study site. A questionnaire on symptoms and postulated risk factors was administered, followed by supine and standing blood pressure measurements. Cross-sectional analysis was performed with independent sample t-test for continuous data and chi-square test for categorical data. Prevalence rate ratios with 95% confidence interval were calculated for the latter. RESULTS A total of 364 multiethnic patients participated in the study. The prevalence of OH was 11.0%. Older age, comorbidities such as cardiac failure and kidney disease, being physically inactive at work, fatigue, self-reported dizziness in the past year, and the use of loop diuretics were found to be significantly associated with OH. CONCLUSION About one in ten elderly patients at a local polyclinic was affected by OH, which was associated with multiple factors. Some of these factors are modifiable and can be addressed to reduce the incidence of OH.
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Affiliation(s)
| | | | | | | | | | | | - Gek Khim Judy Sng
- Saw Swee Hock School of Public Health, National University of Singapore
| | - Ngiap Chuan Tan
- Department of Research, Sing Health Polyclinics, Singapore.,Duke-NUS Medical School, Singapore
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Kohara K, Okada Y, Ochi M, Ohara M, Nagai T, Tabara Y, Igase M. Muscle mass decline, arterial stiffness, white matter hyperintensity, and cognitive impairment: Japan Shimanami Health Promoting Program study. J Cachexia Sarcopenia Muscle 2017; 8:557-566. [PMID: 28371474 PMCID: PMC5566649 DOI: 10.1002/jcsm.12195] [Citation(s) in RCA: 60] [Impact Index Per Article: 8.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/07/2016] [Revised: 12/08/2016] [Accepted: 01/26/2017] [Indexed: 01/06/2023] Open
Abstract
BACKGROUND There is a close association between frailty and cognitive impairment. However, the underlying contribution of sarcopenia to the development of cognitive impairment is unclear. We investigated the possible association between muscle mass decline and cognitive impairment in a cross-sectional study of 1518 subjects aged 55 years or above. We also evaluated arterial stiffness and white matter hyperintensities (WMHs) as possible underlying mechanisms for this association. METHODS Two sarcopenic indices were measured: thigh muscle cross-sectional area (CSA; calculated by computed tomography) and skeletal muscle mass (bioelectric impedance). Muscle mass decline was defined as either the bottom 10% or 20% of participants for each sex. Cognitive function was assessed using the Touch Panel-type Dementia Assessment Scale, and brachial-ankle pulse wave velocity was measured as an index of arterial stiffness. RESULTS Both sarcopenic indices were modestly but significantly associated with brachial-ankle pulse wave velocity in male and female subjects. The presence of WMHs was significantly associated with low thigh muscle CSA in men and with low skeletal muscle mass in women. The Touch Panel-type Dementia Assessment Scale score was modestly but significantly and positively associated with thigh muscle CSA in men and skeletal muscle mass in women. Muscle mass decline in the bottom 10% of participants on both sarcopenic indices was significantly and independently related to cognitive impairment in women. CONCLUSIONS Lower sarcopenic indices are significantly related to lower cognitive scores. Arterial stiffness and WMHs could account, at least in part, for this association.
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Affiliation(s)
- Katsuhiko Kohara
- Faculty of Collaborative Regional Innovation, Ehime University, 3 Bunkyo-cho, Matsuyama, Ehime, 790-8577, Japan
| | - Yoko Okada
- Department of Geriatric Medicine and Neurology, Ehime University Graduate School of Medicine, Toon City, Ehime, 791-0295, Japan
| | - Masayuki Ochi
- Department of Geriatric Medicine and Neurology, Ehime University Graduate School of Medicine, Toon City, Ehime, 791-0295, Japan
| | - Maya Ohara
- Department of Geriatric Medicine and Neurology, Ehime University Graduate School of Medicine, Toon City, Ehime, 791-0295, Japan
| | - Tokihisa Nagai
- Department of Geriatric Medicine and Neurology, Ehime University Graduate School of Medicine, Toon City, Ehime, 791-0295, Japan
| | - Yasuharu Tabara
- Department of Medical Genetics, Kyoto University Graduate School of Medicine, 53 Shogoinkawara-cho, Sakyo-ku, Kyoto, 606-8507, Japan
| | - Michiya Igase
- Department of Geriatric Medicine and Neurology, Ehime University Graduate School of Medicine, Toon City, Ehime, 791-0295, Japan
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Ong HL, Abdin E, Seow E, Pang S, Sagayadevan V, Chang S, Vaingankar JA, Chong SA, Subramaniam M. Prevalence and associative factors of orthostatic hypotension in older adults: Results from the Well-being of the Singapore Elderly (WiSE) study. Arch Gerontol Geriatr 2017. [PMID: 28647615 DOI: 10.1016/j.archger.2017.06.004] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
BACKGROUND Orthostatic hypotension (OH) is commonly reported among older adults and is associated with an increased risk of mortality. This study aimed to describe the prevalence and investigate the possible associations between OH with sociodemographic variables, chronic medical conditions, health service utilisation, dementia and cognitive status among older adults residing in Singapore. METHODS Data was collected from 2266 participants aged 60 years and older who participated in the Well-being of the Singapore Elderly (WiSE) study in 2013. Face-to-face interviews were conducted and data collected includes sociodemographic information, blood pressure measurements, medical history, health services utilisation, and cognitive status. RESULTS The prevalence of OH among older adults in Singapore was 7.8%. OH was highest in participants aged 85 years and above (OR: 2.33; 1.26-4.30; p=0.007) compared to those aged 75-84 years (OR: 1.76; 1.08-2.85; p=0.023). Participants with hypertension were more likely to have OH (OR: 3.03; 1.56-5.88, p=0.001) than those without hypertension. Those with dementia were also more likely to have OH than those with normal cognitive status (p=0.007). CONCLUSIONS Older age, hypertension, and dementia were independently associated with OH in the older adult population in Singapore. Interventions such as home safety assessment and preventive measures should be implemented to improve older adult's functional capacity and quality of life to prevent injury.
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Affiliation(s)
- Hui Lin Ong
- Research Division, Institute of Mental Health, Singapore
| | | | - Esmond Seow
- Research Division, Institute of Mental Health, Singapore
| | - Shirlene Pang
- Research Division, Institute of Mental Health, Singapore
| | | | - Sherilyn Chang
- Research Division, Institute of Mental Health, Singapore
| | | | - Siow Ann Chong
- Research Division, Institute of Mental Health, Singapore
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Huang H, Zheng T, Liu F, Wu Z, Liang H, Wang S. Orthostatic Hypotension Predicts Cognitive Impairment in the Elderly: Findings from a Cohort Study. Front Neurol 2017; 8:121. [PMID: 28421033 PMCID: PMC5377264 DOI: 10.3389/fneur.2017.00121] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/23/2016] [Accepted: 03/15/2017] [Indexed: 11/13/2022] Open
Abstract
BACKGROUND Orthostatic hypotension (OH) is a known risk factor for cerebral ischemia, but its correlation with cognitive impairment (CI) is not well established. OBJECTIVE The aim of this study is to explore the relationship between OH and CI in the elderly. METHODS The study group consisted of 44 OH patients who presented with drowsiness, vertigo, and fatigue between January 2009 and December 2011 (OH group). Eighty-eight healthy elderly were paired with those in the OH group in a 1:2 based on their education levels (NOH group). Baseline sociodemographic information and cognition-related measures were collected for both groups. Cognitive function was assessed 4 years later using MMSE. RESULTS The overall incidence of CI was 14.0% among the 114 subjects who completed the follow-up assessment. There was a significant difference in the incidence of CI between the OH group (23.7%) and the NOH group (9.2%) (χ2 = 4.399, P = 0.036). After excluding the influence of age (OR = 1.199, 95% CI: 1.072-1.340, P = 0.001) and education years (OR = 0.568, 95% CI: 0.371-0.869, P = 0.009), OH (OR = 4.047, 95% CI: 1.144-14.313, P = 0.030) became an independent risk factor for CI. CONCLUSION OH can lead to CI. We suggest that future studies, with a larger sample size, use OH exposure time instead of OH exposure population to verify the conclusion of this study.
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Affiliation(s)
- Haixia Huang
- Department of Neurology, North Sichuan Branch of Shanghai No.1 People's Hospital, Shanghai, China
| | - Tianheng Zheng
- Department of Neurology, North Sichuan Branch of Shanghai No.1 People's Hospital, Shanghai, China
| | - Fang Liu
- Department of Neurology, The Affiliated Hospital of Guizhou Medical University, Guiyang, China
| | - Zhuoli Wu
- Department of Neurology, North Sichuan Branch of Shanghai No.1 People's Hospital, Shanghai, China
| | - Huazheng Liang
- Neuroscience Research Australia, Randwick, NSW, Australia
| | - Shaoshi Wang
- Department of Neurology, North Sichuan Branch of Shanghai No.1 People's Hospital, Shanghai, China
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48
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Aydin AE, Soysal P, Isik AT. Which is preferable for orthostatic hypotension diagnosis in older adults: active standing test or head-up tilt table test? Clin Interv Aging 2017; 12:207-212. [PMID: 28182163 PMCID: PMC5283070 DOI: 10.2147/cia.s129868] [Citation(s) in RCA: 28] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
Abstract
BACKGROUND Correct evaluation of orthostatic hypotension (OH) is crucial in geriatric practice, since OH is associated with mortality and morbidity. The study aimed to determine the most appropriate method for measuring blood pressure in transition from supine to upright position in order to diagnose OH in older adults. METHODS Active standing test (AST) and head-up tilt table (HUT) test as well as comprehensive geriatric assessment (CGA), including mini-mental state examination or the cognitive state test, mini-nutritional assessment, basic and instrumental activities of daily living, and Tinetti performance-oriented mobility assessment indexes, were performed in 290 geriatric patients. RESULTS The prevalence of OH during HUT and AST was 19% and 37%, respectively. In patients with OH during HUT, the frequency of dementia and recurrent falls were higher (P<0.05); on the other hand, the levels of serum vitamin D and albumin and estimated glomerular filtration rate were lower (P<0.05). However, all these parameters for OH during AST were not significant (P>0.05). Comparison of the groups according to CGA measurements revealed significant differences in terms of cognition, nutritional status, activities of daily life, and balance function in patients with OH only during HUT (P<0.05), but not during AST (P>0.05). The sensitivity, specificity, positive predictive value, and negative predictive values of AST were 49.0%, 65.5%, 25.0%, and 84.6% respectively, according to HUT. CONCLUSION The results suggest that orthostatic blood pressure changes determined by HUT might be of higher clinical significance than that by AST in older adults. It might be important that the evaluation of OH by HUT should be included in daily geriatric practice.
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Affiliation(s)
- Ali Ekrem Aydin
- Center for Aging Brain and Dementia, Department of Geriatric Medicine, Faculty of Medicine, Dokuz Eylul University, Izmir, Turkey
| | - Pinar Soysal
- Kayseri Education and Research Hospital, Geriatric Center, Kayseri, Turkey
| | - Ahmet Turan Isik
- Center for Aging Brain and Dementia, Department of Geriatric Medicine, Faculty of Medicine, Dokuz Eylul University, Izmir, Turkey
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Harrison JK, Van Der Wardt V, Conroy SP, Stott DJ, Dening T, Gordon AL, Logan P, Welsh TJ, Taggar J, Harwood R, Gladman JRF. New horizons: the management of hypertension in people with dementia. Age Ageing 2016; 45:740-746. [PMID: 27836926 DOI: 10.1093/ageing/afw155] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/15/2016] [Accepted: 08/03/2016] [Indexed: 12/13/2022] Open
Abstract
The optimal management of hypertension in people with dementia is uncertain. This review explores if people with dementia experience greater adverse effects from antihypertensive medications, if cognitive function is protected or worsened by controlling blood pressure (BP) and if there are subgroups of people with dementia for whom antihypertensive therapy is more likely to be harmful. Robust evidence is scant, trials of antihypertensive medications have generally excluded those with dementia. Observational data show changes in risk association over the life course, with high BP being a risk factor for cognitive decline in mid-life, while low BP is predictive in later life. It is therefore possible that excessive BP lowering in older people with dementia might harm cognition. From the existing literature, there is no direct evidence of benefit or harm from treating hypertension in people with dementia. So what practical steps can the clinician take? Assess capacity, establish patient preferences when making treatment decisions, use ambulatory monitoring to thoroughly assess BP, individualise and consider deprescribing where side effects (e.g. hypotension) outweigh the benefits. Future research might include pragmatic randomised trials of targeted deprescribing, which include patient-centred outcome measures to help support decision-making and studies to address mechanistic uncertainties.
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Affiliation(s)
- Jennifer Kirsty Harrison
- The Alzheimer Scotland Dementia Research Centre, Centre for Cognitive Ageing and Cognitive Epidemiology, University of Edinburgh, Edinburgh, UK
| | | | - Simon Paul Conroy
- Department of Health Sciences, University of Leicester, Leicester, UK
| | - David J Stott
- Institute of Cardiovascular and Medical Sciences, University of Glasgow, Glasgow, UK
| | - Tom Dening
- Division of Psychiatry and Applied Psychology, University of Nottingham, Nottingham, UK
| | - Adam Lee Gordon
- University of Nottingham - Division of Medical Sciences and Graduate Entry Medicine, Nottingham, UK
| | - Pip Logan
- Division of Rehabilitation & Ageing, University of Nottingham, Nottingham, UK
| | - Tomas James Welsh
- Division of Rehabilitation & Ageing, University of Nottingham, Nottingham, UK
| | - Jaspal Taggar
- Division of Primary Care, University of Nottingham, Nottingham, UK
| | - Rowan Harwood
- Nottingham University Hospitals NHS Trust, Nottingham, UK
| | - John R F Gladman
- Division of Rehabilitation & Ageing, University of Nottingham, Nottingham, UK
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Isik AT, Soysal P, Usarel C. Effects of Acetylcholinesterase Inhibitors on Balance and Gait Functions and Orthostatic Hypotension in Elderly Patients With Alzheimer Disease. Am J Alzheimers Dis Other Demen 2016; 31:580-584. [PMID: 27585748 PMCID: PMC10852938 DOI: 10.1177/1533317516666195] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
OBJECTIVE The present study was designed to evaluate the effect of acetylcholinesterase inhibitor (AchEI) therapy on balance, gait, and orthostatic hypotension (OH) in elderly patients with Alzheimer's disease (AD). METHODS A total of 102 elderly patients with AD have been recently diagnosed and were treated with AchEI and underwent comprehensive geriatric assessment at baseline and at the end of the sixth month. RESULTS Timed Up and Go test and Tinetti Performance-Oriented Mobility Assessment values and the prevalence of OH were not different at the end of the sixth month versus baseline (P > .05). However, it was determined that changes in balance were better in the patients who showed cognitive improvement at the end of the sixth month (P < .05). CONCLUSION Curative effects of AchEIs, which are used in the treatment of AD, on cognitive performance are reflected also in balance functions. Moreover, it was observed that these drugs do not increase the prevalence of OH.
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Affiliation(s)
- Ahmet Turan Isik
- Department of Geriatric Medicine, Faculty of Medicine, Center for Aging Brain and Dementia, Dokuz Eylul University, Izmir, Turkey
| | - Pinar Soysal
- Department of Geriatric Medicine, Faculty of Medicine, Center for Aging Brain and Dementia, Dokuz Eylul University, Izmir, Turkey
| | - Cansu Usarel
- Department of Geriatric Medicine, Faculty of Medicine, Center for Aging Brain and Dementia, Dokuz Eylul University, Izmir, Turkey
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