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.
References
1.
Fisher
TJ
, Schwartz
AC
, Greenspan
HN
, Heinrich
TW
. Dementia: a complex disease with multiple etiologies and multiple treatments
. Int J Psychiatry Med
. 2016
;51
(2
):171
–81
. .2.
Robertson
AD
, Udow
SJ
, Espay
AJ
, Merola
A
, Camicioli
R
, Lang
AE
, et al. Orthostatic hypotension and dementia incidence: links and implications
. Neuropsychiatr Dis Treat
. 2019
;15
:2181
–94
. .3.
Freeman
R
, Abuzinadah
AR
, Gibbons
C
, Jones
P
, Miglis
MG
, Sinn
DI
. Orthostatic hypotension: JACC state-of-the-art review
. J Am Coll Cardiol
. 2018
;72
(11
):1294
–309
. .4.
Isik
AT
, Kocyigit
SE
, Smith
L
, Aydin
AE
, Soysal
P
. A comparison of the prevalence of orthostatic hypotension between older patients with Alzheimer’s disease, lewy body dementia, and without dementia
. Exp Gerontol
. 2019
;124
:110628
. .5.
Kleipool
EEF
, Trappenburg
MC
, Rhodius-Meester
HFM
, Lemstra
AW
, van der Flier
WM
, Peters
MJL
, et al. Orthostatic hypotension: an important risk factor for clinical progression to mild cognitive impairment or dementia. the amsterdam dementia cohort
. J Alzheimer’s Dis
. 2019
;71
(1
):317
–25
.6.
Livingston
G
, Sommerlad
A
, Orgeta
V
, Costafreda
SG
, Huntley
J
, Ames
D
, et al. Dementia prevention, intervention, and care
. Lancet
. 2017
;390
(10113
):2673
–734
. .7.
Femminella
GD
, Rengo
G
, Komici
K
, Iacotucci
P
, Petraglia
L
, Pagano
G
, et al. Autonomic dysfunction in Alzheimer’s disease: tools for assessment and review of the literature
; 2014
.8.
Zhang
W
, Low
LF
, Schwenk
M
, Mills
N
, Gwynn
JD
, Clemson
L
. Review of gait, cognition, and fall risks with implications for fall prevention in older adults with dementia
. Dement Geriatr Cogn Disord
. 2019
;48
(1–2
):17
–29
. .9.
Soysal
P
, Veronese
N
, Veronese
N
, Smith
L
, Torbahn
G
, Jackson
SE
, et al. Orthostatic hypotension and health outcomes: an umbrella review of observational studies
. Eur Geriatr Med
. 2019
;10
(6
):863
–70
. .10.
Sonnesyn
H
, Nilsen
DW
, Rongve
A
, Nore
S
, Ballard
C
, Tysnes
OB
, et al. High prevalence of orthostatic hypotension in mild dementia
. Dement Geriatr Cogn Disord
. 2009
;28
(4
):307
–13
. .11.
Zimmermann
M
, Wurster
I
, Lerche
S
, Roeben
B
, Machetanz
G
, Sünkel
U
, et al. Orthostatic hypotension as a risk factor for longitudinal deterioration of cognitive function in the elderly
. Eur J Neurol
. 2020
;27
(1
):160
–7
. .12.
Postuma
RB
, Gagnon
JF
, Pelletier
A
, Montplaisir
J
. Prodromal autonomic symptoms and signs in Parkinson’s disease and dementia with lewy bodies
. Mov Disord
. 2013
;28
(5
):597
–604
. .13.
Bermejo-Pareja
F
, Benito-León
J
, Vega
S
, Medrano
MJ
, Román
GC
. Incidence and subtypes of dementia in three elderly populations of central Spain
. J Neurol Sci
. 2008
;264
(1–2
):63
–72
. .14.
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
. .15.
American Psychiatric Association. DSM-5 Diagnostic Classification
. Diagnostic and statistical manual of mental disorders
; 2013
.16.
McKhann
GM
, Knopman
DS
, Chertkow
H
, Hyman
BT
, Jack
CR
Jr, Kawas
CH
, et al. The diagnosis of dementia due to Alzheimer’s disease: recommendations from the national institute on aging-Alzheimer’s association workgroups on diagnostic guidelines for Alzheimer’s disease
. Alzheimers Dement
. 2011
;7
(3
):263
–9
.17.
McKeith
IG
, Boeve
BF
, Dickson
DW
, Halliday
G
, Taylor
JP
, Weintraub
D
, et al. Diagnosis and management of dementia with Lewy bodies: fourth consensus report of the DLB Consortium
. Neurology
. 2017
;89
(1
):88
–100
. .18.
Rascovsky
K
, Hodges
JR
, Knopman
D
, Mendez
MF
, Kramer
JH
, Neuhaus
J
, et al. Sensitivity of revised diagnostic criteria for the behavioural variant of frontotemporal dementia
. Brain
. 2011
;134
(Pt 9
):2456
–77
. .19.
Soysal
P
, Aydin
AE
, Koc Okudur
S
, Isik
AT
. When should orthostatic blood pressure changes be evaluated in elderly: 1st, 3rd or 5th minute?
Arch Gerontol Geriatr
. 2016
;65
:199
–203
. .20.
Parry
SW
, Reeve
P
, Lawson
J
, Shaw
FE
, Davison
J
, Norton
M
, et al. The newcastle protocols 2008: an update on head-up tilt table testing and the management of vasovagal syncope and related disorders
. Heart
. 2009
;95
(5
):416
–20
.21.
Unutmaz
GD
, Soysal
P
, Tuven
B
, Isik
AT
. Costs of medication in older patients: before and after comprehensive geriatric assessment
. Clin Interv Aging
. 2018
;13
:607
. .22.
Yap
PL
, Niti
M
, Yap
KB
, Ng
TP
. Orthostatic hypotension, hypotension and cognitive status: early comorbid markers of primary dementia?
Dement Geriatr Cogn Disord
. 2008
;26
(3
):239
–46
. .23.
Isik
AT
, Ates Bulut
E
, Dokuzlar
O
, Kaya
D
, Erken
N
, Dost Gunay
FS
, et al. Cardiac and blood pressure safety of transdermal rivastigmine in elderly patients with dementia with lewy bodies
. Alzheimer Dis Assoc Disord
. 2020 Oct–Dec
;34
(4
):339
–43
. .24.
Mehrabian
S
, Duron
E
, Labouree
F
, Rollot
F
, Bune
A
, Traykov
L
, et al. Relationship between orthostatic hypotension and cognitive impairment in the elderly
. J Neurol Sci
. 2010
;299
(1–2
):45
–8
. .25.
Vishram
JKK
, Borglykke
A
, Andreasen
AH
, Jeppesen
J
, Ibsen
H
, Jørgensen
T
, et al. Impact of age on the importance of systolic and diastolic blood pressures for stroke risk: the monica, risk, genetics, archiving, and monograph (MORGAM) Project
. Hypertension
. 2012
;60
(5
):1117
–23
. .26.
Ballard
C
, O’Brien
J
, Barber
B
, Scheltens
P
, Shaw
F
, McKeith
I
, et al. Neurocardiovascular instability, hypotensive episodes, and MRI lesions in neurodegenerative dementia
. Ann N Y Acad Sci
. 2000
;903
:442
–5
. 27.
Yatsuya
H
, Folsom
AR
, Alonso
A
, Gottesman
RF
, Rose
KM
. Postural changes in blood pressure and incidence of ischemic stroke subtypes: the ARIC study
. Hypertension
. 1979
;57
(2
):167
–73
. .201128.
Torres
RV
, Elias
MF
, Crichton
GE
, Dore
GA
, Davey
A
. Systolic orthostatic hypotension is related to lowered cognitive function: findings from the maine-syracuse longitudinal study
. J Clin Hypertens
. 2017
;19
(12
):1357
–65
. .29.
Mattace-Raso
FU
, van den Meiracker
AH
, Bos
WJ
, van der Cammen
TJ
, Westerhof
BE
, Elias-Smale
S
, et al. Arterial stiffness, cardiovagal baroreflex sensitivity and postural blood pressure changes in older adults: the Rotterdam Study
. J Hypertens
. 2007
;25
(7
):1421
–6
. .30.
Webb
AJS
. Progression of arterial stiffness is associated with midlife diastolic blood pressure and transition to late-life hypertensive phenotypes
. JAHA
. 2020
;9
(1
):e014547
. .31.
Fedorowski
A
, Hamrefors
V
, Sutton
R
, van Dijk
JG
, Freeman
R
, Lenders
JW
, et al. Do we need to evaluate diastolic blood pressure in patients with suspected orthostatic hypotension?
Clin Auton Res
. 2017
;27
(3
):167
–73
. .32.
Chrysant
SG
, Chrysant
GS
. The age-related hemodynamic changes of blood pressure and their impact on the incidence of cardiovascular disease and stroke: new evidence
. J Clin Hypertens
. 2014
;16
(2
):87
–90
. .33.
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
(7
):580
–4
. .34.
Isik
AT
, Yildiz
GB
, Bozoglu
E
, Yay
A
, Aydemir
E
. Cardiac safety of donepezil in elderly patients with Alzheimer disease
. Intern Med
. 2012
;51
(6
):575
–8
. .35.
Struhal
W
, Javor
A
, Brunner
C
, Benesch
T
, Schmidt
V
, Vosko
MR
, et al. The phoenix from the ashes: cardiovascular autonomic dysfunction in behavioral variant of frontotemporal dementia
. J Alzheimers Dis
. 2014
;42
(3
):1041
–6
. .36.
Cremer
A
, Soumaré
A
, Berr
C
, Dartigues
JF
, Gabelle
A
, Gosse
P
, et al. Orthostatic hypotension and risk of incident dementia: results from a 12-year follow-up of the three-city study cohort
. Hypertension
. 2017
;70
(1
):44
–9
. .37.
Wolters
FJ
, Mattace-Raso
FU
, Koudstaal
PJ
, Hofman
A
, Ikram
MA
. Heart brain connection collaborative research group. orthostatic hypotension and the long-term risk of dementia: a population-based study
. PLoS Med
. 2016
;13
(10
):e1002143
.© 2021 S. Karger AG, Basel
2021
Copyright / Drug Dosage / Disclaimer
Copyright: All rights reserved. No part of this publication may be translated into other languages, reproduced or utilized in any form or by any means, electronic or mechanical, including photocopying, recording, microcopying, or by any information storage and retrieval system, without permission in writing from the publisher.
Drug Dosage: The authors and the publisher have exerted every effort to ensure that drug selection and dosage set forth in this text are in accord with current recommendations and practice at the time of publication. However, in view of ongoing research, changes in government regulations, and the constant flow of information relating to drug therapy and drug reactions, the reader is urged to check the package insert for each drug for any changes in indications and dosage and for added warnings and precautions. This is particularly important when the recommended agent is a new and/or infrequently employed drug.
Disclaimer: The statements, opinions and data contained in this publication are solely those of the individual authors and contributors and not of the publishers and the editor(s). The appearance of advertisements or/and product references in the publication is not a warranty, endorsement, or approval of the products or services advertised or of their effectiveness, quality or safety. The publisher and the editor(s) disclaim responsibility for any injury to persons or property resulting from any ideas, methods, instructions or products referred to in the content or advertisements.
You do not currently have access to this content.
