Department of Geriatric Medicine, Unit for Aging Brain and Dementia, Faculty of Medicine, Dokuz Eylul University, Izmir, Turkey,
The Geriatric Science Association, Izmir, Turkey,
Dement Geriatr Cogn Disord. 2020;49(6):628-635. doi: 10.1159/000513978. Epub 2021 Mar 18.
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.
We aimed to investigate the relationship between OH and the most common subtypes of dementia in detail.
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.
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.
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.
评估痴呆老年患者发病率和死亡率的原因至关重要，例如体位性低血压（OH），这可能会影响他们的日常活动，降低生活质量，并增加护理人员的负担。
我们旨在详细研究 OH 与最常见的痴呆亚型之间的关系。
本前瞻性研究纳入了 268 名被诊断为阿尔茨海默病（AD）、路易体痴呆（DLB）、血管性痴呆（VaD）和行为变异额颞叶痴呆（bvFTD）的老年痴呆患者，以及 539 名无痴呆的老年患者。还对所有参与者进行了全面的老年评估，包括合并症、药物评估和直立倾斜试验。
参与者中 AD、DLB、bvFTD 和 VaD 的比例分别为 13.8%、8.3%、6.4%和 4.8%。在校正年龄、性别、合并症存在情况和使用 OH 诱发药物后；AD、DLB 和 VaD 与 OH 相关（优势比 [OR]：2.23，95%置信区间 [CI] 1.31-3.80；p = 0.003；OR：3.68，95% CI 1.98-6.83；p < 0.001，和 OR：3.56，95% CI 1.46-8.69；p = 0.005）。此外，VaD 与舒张期 OH 独立相关（OR：4.19，95% CI 1.66-10.57；p = 0.002），而 AD 和 DLB 则不然。
本研究表明，DLB、AD 和 VaD 老年患者常伴有 OH，这是一种致残性自主神经功能障碍特征。此外，舒张期 OH 可能在 VaD 的发生中起作用。因此，考虑到 OH 的潜在并发症，在这些患者的随访和管理中评估 OH 是必要的。
