Department of Human Movement Sciences, @AgeAmsterdam, Amsterdam Movement Sciences, Vrije Universiteit Amsterdam, Van der Boechorststraat 7, 1081 BT Amsterdam, the Netherlands.
Department of Medicine and Aged Care, @AgeMelbourne, The University of Melbourne, The Royal Melbourne Hospital, City Campus, Level 6 North, 300 Grattan Street, Parkville, Victoria 3050, Australia; Department of Rehabilitation Medicine, Amsterdam UMC, Vrije Universiteit Amsterdam, Amsterdam Movement Sciences, de Boelelaan 1117, 1081 HZ Amsterdam, the Netherlands.
Arch Gerontol Geriatr. 2021 Sep-Oct;96:104482. doi: 10.1016/j.archger.2021.104482. Epub 2021 Jul 11.
Geriatric rehabilitation inpatients who suffer from acute and chronic diseases that aggravate blood pressure (BP) dysregulation, may be particularly susceptible to orthostatic hypotension (OH). OH may increase the risk of cerebral small vessel disease and subsequent white matter hyperintensities inducing cognitive impairment (CI). This study investigates the association between OH and cognition in geriatric rehabilitation inpatients.
Geriatric rehabilitation inpatients of the observational, longitudinal REStORing health of acutely unwell adulTs (RESORT) cohort in Melbourne, Australia, underwent intermittent BP measurements during active standing or partial postural change to sitting (when unable to stand). OH was defined as a systolic BP drop ≥20 mmHg and/or diastolic BP drop ≥10 mmHg within three minutes after postural change. CI included dementia diagnosis, Mini-Mental State Examination (MMSE) score <24 points (categorized as 18-23 (mild CI) and <18 points (severe CI)), Montreal Cognitive Assessment score <26 points or Rowland Universal Dementia Assessment Scale score <23 points.
In geriatric rehabilitation inpatients (n=1232, mean age 82.3 years (SD 8.2), 57.5% female), OH, CI and dementia prevalence was 20.0%, 61.0% and 20.4% respectively. MMSE was scored 18-23 in 32.6% and <18 points in 27.8% of patients (n=1033). In standing patients (51.7%), OH was associated with CI (p=0.045) and dementia (p=0.021), with a trend for MMSE scores <18 points (p=0.080), but not for MMSE scores 18-23 points (p=0.528). No association was found between seated OH and cognition.
OH assessed by active standing using intermittent BP measurements was associated with worse cognition in geriatric rehabilitation inpatients.
患有急性和慢性疾病且血压（BP）调节恶化的老年康复住院患者可能特别容易发生体位性低血压（OH）。OH 可能会增加脑小血管疾病和随后的脑白质高信号导致认知障碍（CI）的风险。本研究调查了老年康复住院患者中 OH 与认知之间的关系。
澳大利亚墨尔本的观察性、纵向 REStORing health of acutely unwell adulTs (RESORT) 队列中的老年康复住院患者，在主动站立或部分姿势变化至坐姿（无法站立时）期间进行间歇性血压测量。OH 定义为体位变化后 3 分钟内收缩压下降≥20mmHg 和/或舒张压下降≥10mmHg。CI 包括痴呆诊断、简易精神状态检查（MMSE）评分<24 分（分为 18-23 分（轻度 CI）和<18 分（重度 CI））、蒙特利尔认知评估评分<26 分或罗文通用痴呆评估量表评分<23 分。
在老年康复住院患者（n=1232，平均年龄 82.3 岁（SD 8.2），57.5%为女性）中，OH、CI 和痴呆的患病率分别为 20.0%、61.0%和 20.4%。1033 名患者中有 32.6%的 MMSE 评分为 18-23 分，27.8%的 MMSE 评分<18 分。在站立患者（51.7%）中，OH 与 CI（p=0.045）和痴呆（p=0.021）相关，MMSE 评分<18 分呈趋势（p=0.080），但 MMSE 评分 18-23 分无相关性（p=0.528）。未发现坐姿 OH 与认知之间存在关联。
使用间歇性血压测量通过主动站立评估的 OH 与老年康复住院患者的认知障碍相关。
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