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Romano A, Guglielmino V, Vitali F, Sciarrone MA, Siconolfi G, Di Paolantonio A, Primiano G, Luigetti M. Sudoscan in ATTRv Amyloidosis: A Potential Marker of Disease Progression? Neurol Ther 2025; 14:787-800. [PMID: 40091132 PMCID: PMC12089546 DOI: 10.1007/s40120-025-00721-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/07/2025] [Accepted: 02/18/2025] [Indexed: 03/19/2025] Open
Abstract
INTRODUCTION Hereditary transthyretin amyloidosis (ATTRv amyloidosis) is a severe, autosomal dominant disease resulting from multisystemic extracellular deposition of amyloid fibrils, leading to progressive organ damage and death. Sudoscan is a reproducible tool investigating sweat gland function and, indirectly, small nerve fiber impairment. The aim of this study was to evaluate any changes over time in electrochemical skin conductance (ESC) measured by Sudoscan in a cohort of late-onset patients with ATTRv from a single Italian center. Additionally, we investigated the role of Sudoscan as a marker of disease severity to confirm previous literature data. METHODS We enrolled 61 patients with a late-onset ATTRv amyloidosis harboring different TTR variants with at least one clinical and instrumental evaluation including Sudoscan. Correlations with clinical data (including both clinical scales and questionnaires) were investigated to confirm the role of Sudoscan as a marker of disease severity. Moreover, a longitudinal analysis was performed in the subgroup of patients with at least 4 complete yearly evaluations (n = 23) to assess the role of Sudoscan as a marker of disease progression. RESULTS At each yearly assessment, ESC values from both feet and hands significantly correlated with disease duration and neuropathy severity, as assessed by common clinical scales and questionnaires. No correlation was found with age at evaluation. Moreover, we observed a statistically significant change over time in ESC values measured at the feet (fESC) but not at the hands (hESC). CONCLUSIONS Sudoscan may represent a reliable marker of dysautonomia in ATTRv amyloidosis, displaying a potential role as a marker of both disease severity and progression. It could, therefore, serve as an outcome measure in future clinical trials. In addition, feet ESC seems to be a significant, independent predictor of autonomic dysfunction.
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Affiliation(s)
- Angela Romano
- UOC Neurologia, Dipartimento di Neuroscienze, Organi di Senso e Torace, Fondazione Policlinico Universitario Agostino Gemelli IRCCS, Largo Agostino Gemelli, 8, 00168, Rome, Italy
| | - Valeria Guglielmino
- Department of Neuroscience, Università Cattolica del Sacro Cuore, Rome, Italy
| | - Francesca Vitali
- Department of Neuroscience, Università Cattolica del Sacro Cuore, Rome, Italy
| | | | - Giovanni Siconolfi
- Department of Neuroscience, Università Cattolica del Sacro Cuore, Rome, Italy
| | | | - Guido Primiano
- Department of Neuroscience, Università Cattolica del Sacro Cuore, Rome, Italy
- UOC Neurofisiopatologia, Fondazione Policlinico Universitario Agostino Gemelli IRCCS, Rome, Italy
| | - Marco Luigetti
- UOC Neurologia, Dipartimento di Neuroscienze, Organi di Senso e Torace, Fondazione Policlinico Universitario Agostino Gemelli IRCCS, Largo Agostino Gemelli, 8, 00168, Rome, Italy.
- Department of Neuroscience, Università Cattolica del Sacro Cuore, Rome, Italy.
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Hilali AEK, Shacham D, Frenkel R, Abu-Ajaj A, Zikrin E, Freud T, Press Y. Successful Rehabilitation After Surgical Repair of Hip Fracture Has Been Associated With Handgrip Strength But Not With Orthostatic Hypotension in Patients 65 Yrs of Age and Above. Am J Phys Med Rehabil 2025; 104:407-414. [PMID: 39235903 DOI: 10.1097/phm.0000000000002618] [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] [Indexed: 09/07/2024]
Abstract
OBJECTIVE The identification of factors associated with successful rehabilitation after hip fractures enables more successful planning of the rehabilitation process and discharge from the hospital. Orthostatic hypotension and handgrip strength have been evaluated in previous studies as potential predictors of rehabilitation outcomes, with inconsistent results. DESIGN A retrospective study of patients 65 yrs of age and above who underwent rehabilitation after surgical repair of hip fracture in the geriatric department between July 2020 and October 2023. Handgrip strength was measured during the first 3 days of hospitalization using a digital dynamometer. Orthostatic hypotension was measured a week after admission to the ward by the tilt table test. Successful rehabilitation was defined as a Montebello Rehabilitation Factor Score Revised above 50%. RESULTS Data were collected for 253 patients. The mean age was 80.5 ± 7.7 and 32.4% were males. The mean handgrip strength was 17.2 ± 6.6 kg. Orthostatic hypotension was diagnosed in 32.8%. One hundred ninety-three patients (76.3%) reached the goal of Montebello Rehabilitation Factor Score Revised ≥ 50 at the end of the rehabilitation. In a logistic regression analysis, handgrip strength, cognitive state, and sex were associated with successful rehabilitation. CONCLUSIONS Measuring handgrip strength, but not orthostatic hypotension, can predict successful rehabilitation.
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Affiliation(s)
- Abdu El Karim Hilali
- From the Faculty of Health Sciences, Ben-Gurion University of the Negev, Beer-Sheva, Israel (AEKH, DS, RF, AAA, EZ, YP); Department of Geriatrics, Soroka Medical Center, Beer-Sheva, Israel (AEKH, DS, RF, AAA, EZ, YP); Siaal Research Center for Family Medicine and Primary Care, Faculty of Health Sciences, Ben-Gurion University of the Negev, Beer-Sheva, Israel (TF, YP), Unit for Community Geriatrics, Division of Health in the Community, Ben-Gurion University of the Negev, Beer-Sheva, Israel (YP), and Center for Multidisciplinary Research in Aging, Ben-Gurion University of the Negev, Beer-Sheva, Israel (YP)
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Miceli G, Cassataro G, Volpe V, Fertitta E, Canale C, Tomaiuolo L, Blasco M, Stella M, Velardo M, Renda M. Autonomic Dysfunction and Blood Pressure Variability in Botulinum Intoxication: A Prospective Observational Study from a Single-Center Italian Outbreak. Toxins (Basel) 2025; 17:205. [PMID: 40278703 PMCID: PMC12031082 DOI: 10.3390/toxins17040205] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/13/2025] [Revised: 04/15/2025] [Accepted: 04/17/2025] [Indexed: 04/26/2025] Open
Abstract
Botulinum neurotoxin (BoNT) intoxication is a rare but severe condition that is characterized by autonomic and neuromuscular dysfunction. This study aimed to evaluate autonomic impairment and blood pressure variability in patients with botulinum intoxication during an outbreak, compared to healthy controls, and to assess their progression over a six-month follow-up period. Methods: Twenty (n = 20) male patients diagnosed with BoNT intoxication and 34 age- and sex-matched healthy controls were enrolled. At baseline, all subjects underwent 24 h ambulatory blood pressure monitoring (ABPM), and clinostatic and orthostatic blood pressure measurements. Autonomic function parameters, including mean systolic blood pressure (SBP), mean diastolic blood pressure (DBP), SBP and DBP variability, SBP and DBP load, pulse pressure (PP), blood pressure variability ratio (BPVR), and morning surge, were analyzed. Follow-up assessments were conducted after six months. Results: Patients with botulinum intoxication exhibited significantly lower SBP, DBP, and blood pressure variability parameters compared to healthy controls. Orthostatic hypotension was present in 55% of patients at baseline, improving to 5% at follow-up. Respiratory failure occurred in 40% of cases, necessitating non-invasive ventilation in 35% and intubation in 20%. At six-month follow-up, mean SBP, DBP, heart rate, and blood pressure variability parameters increased significantly, indicating partial recovery of autonomic control. However, residual abnormalities in autonomic regulation persisted. Conclusions: BoNT intoxication leads to notable autonomic dysfunction, marked by impaired blood pressure regulation and a high prevalence of orthostatic hypotension. Although partial recovery occurs, long-term autonomic impairment persists, highlighting the necessity for ongoing cardiovascular monitoring and further research to accelerate autonomic recovery through targeted therapeutic interventions.
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Affiliation(s)
- Giuseppe Miceli
- Department of Health Promotion, Mother and Child Care, Internal Medicine and Medical Specialties (ProMISE), Università degli Studi di Palermo, Piazza delle Cliniche 2, 90127 Palermo, Italy
- Internal Medicine and Stroke Care Ward, University Hospital, Policlinico “P. Giaccone”, 90127 Palermo, Italy
| | - Giuliano Cassataro
- U.O.C. of Medicine and Pneumology, Fondazione Istituto G. Giglio, Contrada Pollastra, 90015 Cefalù, Italy
| | - Vito Volpe
- U.O.C. of Medicine and Pneumology, Fondazione Istituto G. Giglio, Contrada Pollastra, 90015 Cefalù, Italy
| | - Emanuela Fertitta
- U.O.C. of Medicine and Pneumology, Fondazione Istituto G. Giglio, Contrada Pollastra, 90015 Cefalù, Italy
| | - Carmelinda Canale
- U.O.C. of Medicine and Pneumology, Fondazione Istituto G. Giglio, Contrada Pollastra, 90015 Cefalù, Italy
| | - Lucia Tomaiuolo
- U.O.C. of Medicine and Pneumology, Fondazione Istituto G. Giglio, Contrada Pollastra, 90015 Cefalù, Italy
| | - Melania Blasco
- U.O.C. of Medicine and Pneumology, Fondazione Istituto G. Giglio, Contrada Pollastra, 90015 Cefalù, Italy
| | - Mariagrazia Stella
- U.O.C. of Medicine and Pneumology, Fondazione Istituto G. Giglio, Contrada Pollastra, 90015 Cefalù, Italy
| | - Matteo Velardo
- European School of Obstetric Anesthesia, EESOA Simulation Center, 00042 Rome, Italy
| | - Maurizio Renda
- U.O.C. of Medicine and Pneumology, Fondazione Istituto G. Giglio, Contrada Pollastra, 90015 Cefalù, Italy
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Holder AC, Dylewski A, Brown JN. Pyridostigmine for the Management of Neurogenic Orthostatic Hypotension: A Systemic Review. J Geriatr Psychiatry Neurol 2025; 38:85-93. [PMID: 39043171 DOI: 10.1177/08919887241266800] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 07/25/2024]
Abstract
BACKGROUND Pyridostigmine is hypothesized to improve neurogenic orthostatic hypotension (nOH) symptoms without causing or exacerbating supine hypertension. The objective of this review was to evaluate the safety and efficacy of pyridostigmine for management of nOH. METHODS A literature search of PubMed, Embase, and CENTRAL was performed in December 2023 for prospective trials with a placebo or active comparator. RESULTS Four randomized and two non-randomized studies were reviewed. Three studies utilizing a single dose, crossover design found significant differences of orthostatics using adjunctive pyridostigmine. Two studies assessing longer-term endpoints demonstrated conflicting efficacy of pyridostigmine with one trial finding significant improvement in orthostatics and symptoms after three months of therapy. Use of pyridostigmine did not lead to supine hypertension with most adverse effects being cholinergic. CONCLUSION Pyridostigmine may be considered as an adjunctive medication in individuals with nOH refractory to standard treatment options as it carries a favorable safety profile with low risk for supine hypertension.
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Affiliation(s)
- Amanda C Holder
- Geriatric Research Education and Clinical Center, Durham VA Health Care System, Durham, NC, USA
| | - Angela Dylewski
- Geriatric Research Education and Clinical Center, Durham VA Health Care System, Durham, NC, USA
| | - Jamie N Brown
- Pharmacy Service, Durham VA Health Care System, Durham, NC, USA
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Geng H, Fang D, Chen X, Liu M. Cardiovascular Outcomes in Initial and Sustained Orthostatic Hypotension: A Retrospective Cohort Study. J Clin Hypertens (Greenwich) 2025; 27:e14976. [PMID: 39999352 PMCID: PMC11856053 DOI: 10.1111/jch.14976] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/23/2024] [Revised: 12/19/2024] [Accepted: 12/26/2024] [Indexed: 02/27/2025]
Abstract
Classic orthostatic hypotension (OH) is a common geriatric disorder and is associated with cardiovascular risk. There is so far too few data available on the prognostic importance of initial OH and the comparison with sustained OH. This study investigated cardiovascular outcomes in initial and sustained OH in a cohort of patients aged ≥50 years. The study included 435 participants; 94 (21.6%) patients had initial (43, 45.7%) or sustained (51, 54.3%) OH, diagnosed by an active orthostatic test using the CNAP monitor. The median follow-up period was 65 months (inter-quartile range, 30 to 71). One hundred and fifty-nine (36.6%) of the patients had the primary outcome (a composite of major adverse cardiovascular events [MACE] and death from any cause), among which 142 (32.6%) had MACE, and 21 (4.8%) died. Analysis through Kaplan-Meier and further Cox regression models for multivariable adjustment both showed that, initial OH increased both the risk of the primary outcome and MACE (HR 2.20, 95% CI 1.39 to 3.50; HR 2.38, 95% CI 1.48 to 3.84), while didn't increase the mortality. In contrast, sustained OH increased both the risk of the primary outcome and MACE (HR 1.77, 95% CI 1.17 to 2.69; HR 1.71, 95% CI 1.09 to 2.70), as well as the mortality (HR 3.32, 95% CI 1.29 to 8.50). In conclusion, the preliminary exploration of this relatively small-sample study indicates that, OH, no matter initial or sustained OH, increased the cardiovascular risk in patients aged ≥50 years, while only sustained OH increased the risk of mortality.
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Affiliation(s)
- Hui Geng
- Department of GeriatricsPeking University First HospitalBeijingChina
| | - Dingfeng Fang
- Department of GeriatricsPeking University First HospitalBeijingChina
- Peking University Health Science CenterBeijingChina
| | - Xiahuan Chen
- Department of GeriatricsPeking University First HospitalBeijingChina
| | - Meilin Liu
- Department of GeriatricsPeking University First HospitalBeijingChina
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Hansen FO, Knudsen K, Damholdt MF, Bek T, Borghammer P, Okkels N. Non-motor asymmetry and dopamine degeneration in Parkinson's disease. Brain Commun 2025; 7:fcaf002. [PMID: 39845733 PMCID: PMC11752486 DOI: 10.1093/braincomms/fcaf002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/09/2024] [Revised: 12/03/2024] [Accepted: 01/05/2025] [Indexed: 01/24/2025] Open
Abstract
Asymmetric dopaminergic degeneration of the striatum is a characteristic feature of Parkinson's disease, associated with right-left asymmetry in motor function. As such, studying asymmetry provides insights into progressive neurodegeneration between cerebral hemispheres. Given the impact of Lewy pathology on various neurotransmitter systems beyond the dopaminergic, it may be that other neuronal systems in the predominantly affected hemisphere are similarly affected. According to this hypothesis, asymmetry in dopaminergic degeneration would be expected to coincide with asymmetry in other neurotransmitter systems. Consequently, asymmetry in functions primarily dependent on dopaminergic integrity, such as motor function, should correlate with asymmetry in bilateral non-motor functions that rely on other cerebral systems, such as pupillary function. Therefore, this study tested whether right-left asymmetry in bilateral non-motor measures correlates with asymmetry in dopaminergic striatal integrity. We also tested whether asymmetric striatal degeneration is associated with greater asymmetry in non-motor measures overall. Using a comparative cross-sectional design, we recruited newly diagnosed patients with Parkinson's disease with predominantly right-sided (n = 18), left-sided (n = 15) or symmetric nigrostriatal denervation (n = 15) assessed on dopamine PET. Detailed examinations of lateralized non-motor function included lacrimation, hand skin wrinkling, salivation, olfaction and pupillary function. Healthy controls were recruited for comparison. We observed a moderate-to-strong correlation between right-left asymmetry of putamen dopamine binding and asymmetry in pupillary redilation speed [Spearman's rank correlation coefficient (rs ) = -0.53, 95% confidence interval (-0.77; -0.14), P = 0.0084]. We also observed moderate correlations between non-negative putaminal asymmetry and lacrimation [rs = 0.35, (-0.00; 0.62), P = 0.0464] and word recognition [rs = 0.36, (0.01; 0.63), P = 0.0410]. However, none were significant after false discovery rate correction. We observed significant group differences in non-negative asymmetry in salivation (P = 0.0390, ANOVA) and a trend towards greater asymmetric lacrimation in participants with asymmetric striatal dopamine loss compared with healthy controls (P = 0.0330, unadjusted). Additionally, participants with asymmetric striatal dopaminergic binding showed greater, though non-significant, asymmetry in all pupillary measures compared with those with symmetric dopaminergic binding. In conclusion, this study contributes to our understanding of neurodegeneration progression in Parkinson's disease and suggests a link between dopaminergic degeneration and non-motor measures related to autonomic function, particularly salivation, lacrimation and pupillary function. While our findings do not support a strict right-left hemispheric association between non-motor functions and dopaminergic degeneration, potential relationships may exist between these features and asymmetrical degeneration in other neuronal systems, such as the cholinergic.
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Affiliation(s)
- Frederik O Hansen
- Department of Nuclear Medicine and PET, Aarhus University Hospital, Aarhus N, 8200 Aarhus, Denmark
| | - Karoline Knudsen
- Department of Nuclear Medicine and PET, Aarhus University Hospital, Aarhus N, 8200 Aarhus, Denmark
| | - Malene F Damholdt
- Department of Clinical Medicine, Aarhus University Hospital, Aarhus N, 8200 Aarhus, Denmark
| | - Toke Bek
- Department of Ophthalmology, Aarhus University Hospital, Aarhus N, 8200 Aarhus, Denmark
| | - Per Borghammer
- Department of Nuclear Medicine and PET, Aarhus University Hospital, Aarhus N, 8200 Aarhus, Denmark
- Department of Clinical Medicine, Aarhus University Hospital, Aarhus N, 8200 Aarhus, Denmark
| | - Niels Okkels
- Department of Clinical Medicine, Aarhus University Hospital, Aarhus N, 8200 Aarhus, Denmark
- Department of Neurology, Aarhus University Hospital, Aarhus N, 8200 Aarhus, Denmark
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Wiersinga JHI, Wolters FJ, Peters MJL, Rhodius-Meester HFM, Trappenburg MC, Muller M. Orthostatic hypotension and cerebral small vessel disease: A systematic review. J Cereb Blood Flow Metab 2025; 45:13-31. [PMID: 39283022 PMCID: PMC11563541 DOI: 10.1177/0271678x241283226] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/02/2024] [Revised: 08/21/2024] [Accepted: 08/23/2024] [Indexed: 11/17/2024]
Abstract
Orthostatic hypotension(OH) is highly prevalent in ageing populations and may contribute to cognitive decline through cerebral small vessel disease(CSVD). Research on the association between OH and CSVD is fragmented and inconsistent. We systematically reviewed the literature for studies assessing the association between OH and CSVD, published until December 1st 2023 in MEDLINE, PubMed or Web of Science. We included studies with populations aged ≥60, that assessed OH in relation to CSVD including white matter hyperintensities(WMH), lacunes and cerebral microbleeds. Modified JBI checklist was used to assess risk of bias. A narrative synthesis of the results was presented. Of 3180 identified studies, eighteen were included. Fifteen studies reported on WMH, four on lacunes, seven on microbleeds. Six of fifteen studies on WMH found that OH was related to an increased burden of WMH, neither longitudinal studies found associations with WMH progression. Findings were inconsistent across studies concerning lacunes and microbleeds. Across outcomes, adequate adjustment for systolic blood pressure tended to coincide with smaller effect estimates. Current evidence on the OH-CSVD association originates mostly from cross-sectional studies, providing inconsistent and inconclusive results. Longitudinal studies using standardized and fine-grained assessment of OH and CSVD and adequate adjustment for supine blood pressure are warranted.
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Affiliation(s)
- Julia HI Wiersinga
- Amsterdam UMC location Vrije Universiteit Amsterdam, Department of Internal Medicine Section Geriatrics, Amsterdam, The Netherlands
- Amsterdam Cardiovascular Sciences, Atherosclerosis & Ischemic Syndromes, Amsterdam, The Netherlands
| | - Frank J Wolters
- Erasmus Medical Center, Department of Epidemiology, Rotterdam, The Netherlands
- Erasmus Medical Center, Departments of Radiology & Nuclear Medicine and Alzheimer Center Erasmus MC, Rotterdam, The Netherlands
| | - Mike JL Peters
- UMC Utrecht, University of Utrecht, Department of Internal Medicine Section Geriatrics, Utrecht, The Netherlands
| | - Hanneke FM Rhodius-Meester
- Amsterdam UMC location Vrije Universiteit Amsterdam, Department of Internal Medicine Section Geriatrics, Amsterdam, The Netherlands
- Oslo University Hospital, Department of Geriatric Medicine, Ullevål, Oslo, Norway
- Alzheimer Center Amsterdam, Department of Neurology, Amsterdam UMC, Vrije Universiteit Amsterdam, Amsterdam Neuroscience, Amsterdam, The Netherlands
| | - Marijke C Trappenburg
- Amstelland Hospital, Department of Internal Medicine section Geriatrics, Amstelveen, The Netherlands
| | - Majon Muller
- Amsterdam UMC location Vrije Universiteit Amsterdam, Department of Internal Medicine Section Geriatrics, Amsterdam, The Netherlands
- Amsterdam Cardiovascular Sciences, Atherosclerosis & Ischemic Syndromes, Amsterdam, The Netherlands
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Han J, Park J, Kang H, Lee H, Kim N. The Effect of a Biofeedback-Based Integrated Program on Improving Orthostatic Hypotension in Community-Dwelling Older Adults: A Pilot Study. J Cardiovasc Nurs 2025; 40:E24-E36. [PMID: 37615610 DOI: 10.1097/jcn.0000000000001026] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 08/25/2023]
Abstract
BACKGROUND Orthostatic hypotension (OH) is prevalent among community-dwelling older adults and is associated with multiple negative health outcomes. Older adults are susceptible to developing OH because aging alters autonomic nervous system function. Biofeedback is a noninvasive, nonpharmacological intervention that can modulate autonomic nervous system dysfunction in older adults. OBJECTIVES Our aim in this study was to examine the effect of a biofeedback-based integrated program on community-dwelling older adults with OH. METHODS We conducted a controlled pilot study. Community-dwelling older adults 65 years or older who had nonneurogenic OH were eligible. Data from 51 participants, comprising 27 in the intervention group and 24 in the control group, were analyzed. Weekly biofeedback-based integrated program consisting of biofeedback training along with group education about behavioral modification, physical activities, and telephone counseling was provided for 12 weeks. Orthostatic hypotension was evaluated by measuring the drop in systolic and diastolic blood pressure after postural changes. Autonomic nervous system function was measured using heart rate variability. RESULTS Among the indicators of heart rate variability, total power ( P = .037) and low frequency ( P = .017) increased significantly, suggesting that autonomic function improved. Severity of orthostatic symptoms ( P < .001) and drops in systolic ( P = .003) and diastolic ( P = .012) blood pressure after postural changes decreased significantly in the intervention group. CONCLUSION Biofeedback-based integrated program was effective in improving autonomic nervous system function and alleviated OH. Therefore, biofeedback-based integrated program should be tested in a larger randomized controlled study with long-term follow-up.
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Benditt DG, Fedorowski A, Sutton R, van Dijk JG. Pathophysiology of syncope: current concepts and their development. Physiol Rev 2025; 105:209-266. [PMID: 39146249 DOI: 10.1152/physrev.00007.2024] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/05/2024] [Revised: 07/07/2024] [Accepted: 08/12/2024] [Indexed: 08/17/2024] Open
Abstract
Syncope is a symptom in which transient loss of consciousness occurs as a consequence of a self-limited, spontaneously terminating period of cerebral hypoperfusion. Many circulatory disturbances (e.g. brady- or tachyarrhythmias, reflex cardioinhibition-vasodepression-hypotension) may trigger a syncope or near-syncope episode, and identifying the cause(s) is often challenging. Some syncope may involve multiple etiologies operating in concert, whereas in other cases multiple syncope events may be due to various differing causes at different times. In this communication, we address the current understanding of the principal contributors to syncope pathophysiology including examination of the manner in which concepts evolved, an overview of factors that constitute consciousness and loss of consciousness, and aspects of neurovascular control and communication that are impacted by cerebral hypoperfusion leading to syncope. Emphasis focuses on 1) current understanding of the way transient systemic hypotension impacts brain blood flow and brain function; 2) the complexity and temporal sequence of vascular, humoral, and cardiac factors that may accompany the most common causes of syncope; 3) the range of circumstances and disease states that may lead to syncope; and 4) clinical features associated with syncope and in particular the reflex syncope syndromes.
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Affiliation(s)
- David G Benditt
- University of Minnesota Medical School, Minneapolis, Minnesota, United States
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Vichayanrat E, Hentzen C, Simeoni S, Pakzad M, Iodice V, Panicker JN. Pelvic autonomic dysfunction is common in patients with pure autonomic failure. Eur J Neurol 2024; 31:e16486. [PMID: 39344662 PMCID: PMC11555151 DOI: 10.1111/ene.16486] [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: 03/24/2024] [Revised: 08/23/2024] [Accepted: 08/29/2024] [Indexed: 10/01/2024]
Abstract
BACKGROUND AND PURPOSE Pure autonomic failure (PAF) presents primarily as cardiovascular autonomic failure and may phenoconvert to other neurodegenerative disorders. However, the involvement of other autonomic functions has been poorly evaluated. This study aims to characterize genitourinary and bowel dysfunction and explore their relationship with cardiovascular autonomic dysfunction. METHODS Pure autonomic failure patients underwent cardiovascular autonomic testing and an assessment of pelvic autonomic dysfunction using urinary, sexual symptoms questionnaires and a bladder diary. Demographic, clinical features and related medical comorbidities were assessed. RESULTS Twenty-five patients (10 males) with PAF were included (mean age 71 ± 8 years; disease duration 13 ± 8 years). 96% (24/25) reported lower urinary tract symptoms, of which overactive bladder symptoms were most commonly reported (n = 23; 92%; median overactive subscore 8, interquartile range [IQR] 3-11), followed by voiding difficulties (n = 19; 76%; median low stream subscore 2, IQR 1-3) using the Urinary Symptom Profile; however, only four (16%) required clean intermittent self-catheterization. Sexual dysfunction was common (n = 21; 84%) using the Arizona Sexual Experience Scale. Mild faecal incontinence and constipation were reported. 86% (19/22) had nocturnal polyuria (NP) and the median NP index was 47% (IQR 38%-51%; normal range <33%). 77% (10/13) had voiding dysfunction and 31% (4/13) had post-void residual urine >100 mL. There were no significant correlations between the need for catheterization and the degree of NP with age, disease duration and cardiovascular autonomic parameters (p > 0.05). CONCLUSIONS Nocturnal polyuria, genitourinary and bowel symptoms are commonly seen in PAF. The pathophysiology of NP in PAF is most likely multifactorial and may occur independent of cardiovascular autonomic failure.
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Affiliation(s)
- E. Vichayanrat
- Department of Uro‐NeurologyNational Hospital for Neurology and NeurosurgeryLondonUK
- Autonomic UnitNational Hospital for Neurology and NeurosurgeryLondonUK
- UCL Queen Square Institute of Neurology, Faculty of Brain SciencesUniversity College LondonLondonUK
| | - C. Hentzen
- Department of Uro‐NeurologyNational Hospital for Neurology and NeurosurgeryLondonUK
- Sorbonne UniversitéGRC 01, GREEN Groupe de Recherche Clinique en Neuro‐Urologie, AP‐HPParisFrance
| | - S. Simeoni
- Department of Uro‐NeurologyNational Hospital for Neurology and NeurosurgeryLondonUK
- UCL Queen Square Institute of Neurology, Faculty of Brain SciencesUniversity College LondonLondonUK
| | - M. Pakzad
- Department of Uro‐NeurologyNational Hospital for Neurology and NeurosurgeryLondonUK
- UCL Queen Square Institute of Neurology, Faculty of Brain SciencesUniversity College LondonLondonUK
| | - V. Iodice
- Autonomic UnitNational Hospital for Neurology and NeurosurgeryLondonUK
- UCL Queen Square Institute of Neurology, Faculty of Brain SciencesUniversity College LondonLondonUK
| | - Jalesh N. Panicker
- Department of Uro‐NeurologyNational Hospital for Neurology and NeurosurgeryLondonUK
- UCL Queen Square Institute of Neurology, Faculty of Brain SciencesUniversity College LondonLondonUK
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Carrozzo G, Miglis MG, Contin M, Cani I, Cortelli P, Guaraldi P, Calandra-Buonaura G. Intrasubject reproducibility of supine norepinephrine plasma concentrations in patients with cardiovascular sympathetic failure. Auton Neurosci 2024; 256:103216. [PMID: 39260098 DOI: 10.1016/j.autneu.2024.103216] [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: 03/13/2024] [Revised: 06/10/2024] [Accepted: 09/02/2024] [Indexed: 09/13/2024]
Abstract
BACKGROUND Plasma levels of the catecholamine norepinephrine (NE) has emerged as a useful tool to help differentiate pre- and post-ganglionic disorders in patients with cardiovascular autonomic failure (AF). However, data on intrasubject reliability in individuals with these conditions are limited. We evaluated the intrasubject reproducibility of supine plasma NE levels drawn across two consecutive time points under controlled conditions during head-up table testing in a large cohort of patients with alpha-synucleinopathies and both pre- and post-ganglionic cardiovascular AF. METHODS Antecubital venous blood drawn via an indwelling cannula with the subject supine was assayed for plasma level of catecholamines. We collected two consecutive samples, the first after 20 min of supine rest (NE1) and the second 5 min later (NE2), from a group of 279 participants including 57 with Parkinson's disease/Lewy body dementia (44 M; 65.5 ± 11.1 y), 131 with multiple system atrophy (81 M; 63.2 ± 8.5 y), 41 with pure autonomic failure (25 M, 65.1 ± 9.3 y), and 50 healthy controls (27 M; 46.7 ± 19.4 y). RESULTS We found no difference between NE1 and NE2 (p = 0.645), with a mean intrasubject reproducibility (NE maximum - NE minimum) × 100 / NE maximum) of 11.5 % ± 10.64. This finding was confirmed when controlling for diagnosis (p = 0.669), gender (p = 0.493), age (p = 0.865), disease duration (p = 0.596) or considering all factors together (p = 0.527). CONCLUSIONS We found excellent test-retest reliability of consecutive supine NE measurements in patients with alpha-synucleinopathies and cardiovascular AF, independent of age, gender and disease duration. This lends evidence to support the use of a single supine NE measurement in these conditions.
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Affiliation(s)
- Giannicola Carrozzo
- IRCCS Istituto delle Scienze Neurologiche di Bologna, Bologna, Italy; Department of Biomedical and NeuroMotor Sciences (DIBINEM), Alma Mater Studiorum, University of Bologna, Bologna, Italy
| | - Mitchell G Miglis
- Department of Neurology and Neurological Sciences, Stanford Medical Center, Palo Alto, CA, USA
| | - Manuela Contin
- IRCCS Istituto delle Scienze Neurologiche di Bologna, Bologna, Italy
| | - Ilaria Cani
- IRCCS Istituto delle Scienze Neurologiche di Bologna, Bologna, Italy; Department of Biomedical and NeuroMotor Sciences (DIBINEM), Alma Mater Studiorum, University of Bologna, Bologna, Italy
| | - Pietro Cortelli
- IRCCS Istituto delle Scienze Neurologiche di Bologna, Bologna, Italy; Department of Biomedical and NeuroMotor Sciences (DIBINEM), Alma Mater Studiorum, University of Bologna, Bologna, Italy
| | - Pietro Guaraldi
- IRCCS Istituto delle Scienze Neurologiche di Bologna, Bologna, Italy.
| | - Giovanna Calandra-Buonaura
- IRCCS Istituto delle Scienze Neurologiche di Bologna, Bologna, Italy; Department of Biomedical and NeuroMotor Sciences (DIBINEM), Alma Mater Studiorum, University of Bologna, Bologna, Italy
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Alexandres CA, McCarter SJ, Tabatabai GM, LeClair-Visonneau L, Feemster JC, Gossard TR, Strainis EP, Jagielski JT, Kelleher MR, Finstuen T, Ali F, Botha H, Graff-Radford J, Olson EJ, Sandness DJ, Morgenthaler TJ, Kantarci K, Savica R, Singer W, Covassin N, Somers VK, Kirkland JL, Junna M, Lipford M, Matarese CA, Moore JL, Tippmann-Peikert M, Carvalho DZ, Boeve BF, Silber MH, St Louis EK. Phenoconversion in Women and Men With Isolated REM Sleep Behavior Disorder: A Retrospective Cohort Study. Neurology 2024; 103:e209993. [PMID: 39454123 PMCID: PMC11515114 DOI: 10.1212/wnl.0000000000209993] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/09/2023] [Accepted: 09/16/2024] [Indexed: 10/27/2024] Open
Abstract
BACKGROUND AND OBJECTIVES Isolated REM sleep behavior disorder (iRBD) is strongly associated with synucleinopathies. Previous iRBD cohort studies have primarily focused on older (>50 years), male-predominant cohorts. Risk of phenoconversion in women and younger adults remains unclear. The study aimed to determine clinical features associated with conversion to a defined neurodegenerative disorder in women and men with iRBD. METHODS One hundred eighty-six women and 186 men with iRBD were matched by polysomnography month. Baseline clinical variables and subsequent neurodegenerative outcomes were abstracted by chart review. Kaplan-Meier curves assessed conversion rates. Cox proportional hazards modeling evaluated factors associated with phenoconversion risk. RESULTS Age at iRBD diagnosis was younger in women compared with men (54.9 vs 62.5 years, p < 0.01). Forty-eight patients (12.9%), including 18 women (9.7%) and 30 men (16.1%), phenoconverted during a median follow-up of 6.0 years. Conversion rates were lower in antidepressant users and patients with chronic pain or psychiatric comorbidity while rates were higher in those with vascular comorbidity. Only age at diagnosis (HR 1.09, 95% CI 1.06-1.13) was associated with phenoconversion after adjusting for RBD symptom duration; sex; antidepressant use; and psychiatric, chronic pain, and vascular comorbidities. DISCUSSION Age at diagnosis was independently associated with phenoconversion risk in women and men with iRBD.
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Affiliation(s)
- Christina A Alexandres
- From the Mayo Center for Sleep Medicine (C.A.A., S.J.M., G.M.T., L.L.-V., J.C.F., T.R.G., E.P.S., J.T.J., M.R.K., T.F., E.J.O., D.J.S., T.J.M., M.J., M.L., J.L.M., M.T.-P., D.Z.C., M.H.S., E.K.S.L.), Department of Neurology; Mayo Center for Sleep Medicine (S.J.M., G.M.T., L.L.-V., J.C.F., T.R.G., E.P.S., J.T.J., M.R.K., T.F., D.J.S., T.J.M., M.J., M.L., J.L.M., M.T.-P., D.Z.C., M.H.S., E.K.S.L.),; Department of Neurology (F.A., H.B., J.G.-R., R.S., W.S., B.F.B.); Department of Radiology (K.K.); Department of Cardiovascular Medicine (N.C., V.K.S.); Department of Medicine (J.L.K.); and Mayo Center for Sleep Medicine (C.A.M.), Department of Pediatrics, Mayo Clinic
| | - Stuart J McCarter
- From the Mayo Center for Sleep Medicine (C.A.A., S.J.M., G.M.T., L.L.-V., J.C.F., T.R.G., E.P.S., J.T.J., M.R.K., T.F., E.J.O., D.J.S., T.J.M., M.J., M.L., J.L.M., M.T.-P., D.Z.C., M.H.S., E.K.S.L.), Department of Neurology; Mayo Center for Sleep Medicine (S.J.M., G.M.T., L.L.-V., J.C.F., T.R.G., E.P.S., J.T.J., M.R.K., T.F., D.J.S., T.J.M., M.J., M.L., J.L.M., M.T.-P., D.Z.C., M.H.S., E.K.S.L.),; Department of Neurology (F.A., H.B., J.G.-R., R.S., W.S., B.F.B.); Department of Radiology (K.K.); Department of Cardiovascular Medicine (N.C., V.K.S.); Department of Medicine (J.L.K.); and Mayo Center for Sleep Medicine (C.A.M.), Department of Pediatrics, Mayo Clinic
| | - Grace M Tabatabai
- From the Mayo Center for Sleep Medicine (C.A.A., S.J.M., G.M.T., L.L.-V., J.C.F., T.R.G., E.P.S., J.T.J., M.R.K., T.F., E.J.O., D.J.S., T.J.M., M.J., M.L., J.L.M., M.T.-P., D.Z.C., M.H.S., E.K.S.L.), Department of Neurology; Mayo Center for Sleep Medicine (S.J.M., G.M.T., L.L.-V., J.C.F., T.R.G., E.P.S., J.T.J., M.R.K., T.F., D.J.S., T.J.M., M.J., M.L., J.L.M., M.T.-P., D.Z.C., M.H.S., E.K.S.L.),; Department of Neurology (F.A., H.B., J.G.-R., R.S., W.S., B.F.B.); Department of Radiology (K.K.); Department of Cardiovascular Medicine (N.C., V.K.S.); Department of Medicine (J.L.K.); and Mayo Center for Sleep Medicine (C.A.M.), Department of Pediatrics, Mayo Clinic
| | - Laurene LeClair-Visonneau
- From the Mayo Center for Sleep Medicine (C.A.A., S.J.M., G.M.T., L.L.-V., J.C.F., T.R.G., E.P.S., J.T.J., M.R.K., T.F., E.J.O., D.J.S., T.J.M., M.J., M.L., J.L.M., M.T.-P., D.Z.C., M.H.S., E.K.S.L.), Department of Neurology; Mayo Center for Sleep Medicine (S.J.M., G.M.T., L.L.-V., J.C.F., T.R.G., E.P.S., J.T.J., M.R.K., T.F., D.J.S., T.J.M., M.J., M.L., J.L.M., M.T.-P., D.Z.C., M.H.S., E.K.S.L.),; Department of Neurology (F.A., H.B., J.G.-R., R.S., W.S., B.F.B.); Department of Radiology (K.K.); Department of Cardiovascular Medicine (N.C., V.K.S.); Department of Medicine (J.L.K.); and Mayo Center for Sleep Medicine (C.A.M.), Department of Pediatrics, Mayo Clinic
| | - John C Feemster
- From the Mayo Center for Sleep Medicine (C.A.A., S.J.M., G.M.T., L.L.-V., J.C.F., T.R.G., E.P.S., J.T.J., M.R.K., T.F., E.J.O., D.J.S., T.J.M., M.J., M.L., J.L.M., M.T.-P., D.Z.C., M.H.S., E.K.S.L.), Department of Neurology; Mayo Center for Sleep Medicine (S.J.M., G.M.T., L.L.-V., J.C.F., T.R.G., E.P.S., J.T.J., M.R.K., T.F., D.J.S., T.J.M., M.J., M.L., J.L.M., M.T.-P., D.Z.C., M.H.S., E.K.S.L.),; Department of Neurology (F.A., H.B., J.G.-R., R.S., W.S., B.F.B.); Department of Radiology (K.K.); Department of Cardiovascular Medicine (N.C., V.K.S.); Department of Medicine (J.L.K.); and Mayo Center for Sleep Medicine (C.A.M.), Department of Pediatrics, Mayo Clinic
| | - Thomas R Gossard
- From the Mayo Center for Sleep Medicine (C.A.A., S.J.M., G.M.T., L.L.-V., J.C.F., T.R.G., E.P.S., J.T.J., M.R.K., T.F., E.J.O., D.J.S., T.J.M., M.J., M.L., J.L.M., M.T.-P., D.Z.C., M.H.S., E.K.S.L.), Department of Neurology; Mayo Center for Sleep Medicine (S.J.M., G.M.T., L.L.-V., J.C.F., T.R.G., E.P.S., J.T.J., M.R.K., T.F., D.J.S., T.J.M., M.J., M.L., J.L.M., M.T.-P., D.Z.C., M.H.S., E.K.S.L.),; Department of Neurology (F.A., H.B., J.G.-R., R.S., W.S., B.F.B.); Department of Radiology (K.K.); Department of Cardiovascular Medicine (N.C., V.K.S.); Department of Medicine (J.L.K.); and Mayo Center for Sleep Medicine (C.A.M.), Department of Pediatrics, Mayo Clinic
| | - Emma P Strainis
- From the Mayo Center for Sleep Medicine (C.A.A., S.J.M., G.M.T., L.L.-V., J.C.F., T.R.G., E.P.S., J.T.J., M.R.K., T.F., E.J.O., D.J.S., T.J.M., M.J., M.L., J.L.M., M.T.-P., D.Z.C., M.H.S., E.K.S.L.), Department of Neurology; Mayo Center for Sleep Medicine (S.J.M., G.M.T., L.L.-V., J.C.F., T.R.G., E.P.S., J.T.J., M.R.K., T.F., D.J.S., T.J.M., M.J., M.L., J.L.M., M.T.-P., D.Z.C., M.H.S., E.K.S.L.),; Department of Neurology (F.A., H.B., J.G.-R., R.S., W.S., B.F.B.); Department of Radiology (K.K.); Department of Cardiovascular Medicine (N.C., V.K.S.); Department of Medicine (J.L.K.); and Mayo Center for Sleep Medicine (C.A.M.), Department of Pediatrics, Mayo Clinic
| | - Jack T Jagielski
- From the Mayo Center for Sleep Medicine (C.A.A., S.J.M., G.M.T., L.L.-V., J.C.F., T.R.G., E.P.S., J.T.J., M.R.K., T.F., E.J.O., D.J.S., T.J.M., M.J., M.L., J.L.M., M.T.-P., D.Z.C., M.H.S., E.K.S.L.), Department of Neurology; Mayo Center for Sleep Medicine (S.J.M., G.M.T., L.L.-V., J.C.F., T.R.G., E.P.S., J.T.J., M.R.K., T.F., D.J.S., T.J.M., M.J., M.L., J.L.M., M.T.-P., D.Z.C., M.H.S., E.K.S.L.),; Department of Neurology (F.A., H.B., J.G.-R., R.S., W.S., B.F.B.); Department of Radiology (K.K.); Department of Cardiovascular Medicine (N.C., V.K.S.); Department of Medicine (J.L.K.); and Mayo Center for Sleep Medicine (C.A.M.), Department of Pediatrics, Mayo Clinic
| | - Makayla R Kelleher
- From the Mayo Center for Sleep Medicine (C.A.A., S.J.M., G.M.T., L.L.-V., J.C.F., T.R.G., E.P.S., J.T.J., M.R.K., T.F., E.J.O., D.J.S., T.J.M., M.J., M.L., J.L.M., M.T.-P., D.Z.C., M.H.S., E.K.S.L.), Department of Neurology; Mayo Center for Sleep Medicine (S.J.M., G.M.T., L.L.-V., J.C.F., T.R.G., E.P.S., J.T.J., M.R.K., T.F., D.J.S., T.J.M., M.J., M.L., J.L.M., M.T.-P., D.Z.C., M.H.S., E.K.S.L.),; Department of Neurology (F.A., H.B., J.G.-R., R.S., W.S., B.F.B.); Department of Radiology (K.K.); Department of Cardiovascular Medicine (N.C., V.K.S.); Department of Medicine (J.L.K.); and Mayo Center for Sleep Medicine (C.A.M.), Department of Pediatrics, Mayo Clinic
| | - Thomas Finstuen
- From the Mayo Center for Sleep Medicine (C.A.A., S.J.M., G.M.T., L.L.-V., J.C.F., T.R.G., E.P.S., J.T.J., M.R.K., T.F., E.J.O., D.J.S., T.J.M., M.J., M.L., J.L.M., M.T.-P., D.Z.C., M.H.S., E.K.S.L.), Department of Neurology; Mayo Center for Sleep Medicine (S.J.M., G.M.T., L.L.-V., J.C.F., T.R.G., E.P.S., J.T.J., M.R.K., T.F., D.J.S., T.J.M., M.J., M.L., J.L.M., M.T.-P., D.Z.C., M.H.S., E.K.S.L.),; Department of Neurology (F.A., H.B., J.G.-R., R.S., W.S., B.F.B.); Department of Radiology (K.K.); Department of Cardiovascular Medicine (N.C., V.K.S.); Department of Medicine (J.L.K.); and Mayo Center for Sleep Medicine (C.A.M.), Department of Pediatrics, Mayo Clinic
| | - Farwa Ali
- From the Mayo Center for Sleep Medicine (C.A.A., S.J.M., G.M.T., L.L.-V., J.C.F., T.R.G., E.P.S., J.T.J., M.R.K., T.F., E.J.O., D.J.S., T.J.M., M.J., M.L., J.L.M., M.T.-P., D.Z.C., M.H.S., E.K.S.L.), Department of Neurology; Mayo Center for Sleep Medicine (S.J.M., G.M.T., L.L.-V., J.C.F., T.R.G., E.P.S., J.T.J., M.R.K., T.F., D.J.S., T.J.M., M.J., M.L., J.L.M., M.T.-P., D.Z.C., M.H.S., E.K.S.L.),; Department of Neurology (F.A., H.B., J.G.-R., R.S., W.S., B.F.B.); Department of Radiology (K.K.); Department of Cardiovascular Medicine (N.C., V.K.S.); Department of Medicine (J.L.K.); and Mayo Center for Sleep Medicine (C.A.M.), Department of Pediatrics, Mayo Clinic
| | - Hugo Botha
- From the Mayo Center for Sleep Medicine (C.A.A., S.J.M., G.M.T., L.L.-V., J.C.F., T.R.G., E.P.S., J.T.J., M.R.K., T.F., E.J.O., D.J.S., T.J.M., M.J., M.L., J.L.M., M.T.-P., D.Z.C., M.H.S., E.K.S.L.), Department of Neurology; Mayo Center for Sleep Medicine (S.J.M., G.M.T., L.L.-V., J.C.F., T.R.G., E.P.S., J.T.J., M.R.K., T.F., D.J.S., T.J.M., M.J., M.L., J.L.M., M.T.-P., D.Z.C., M.H.S., E.K.S.L.),; Department of Neurology (F.A., H.B., J.G.-R., R.S., W.S., B.F.B.); Department of Radiology (K.K.); Department of Cardiovascular Medicine (N.C., V.K.S.); Department of Medicine (J.L.K.); and Mayo Center for Sleep Medicine (C.A.M.), Department of Pediatrics, Mayo Clinic
| | - Jonathan Graff-Radford
- From the Mayo Center for Sleep Medicine (C.A.A., S.J.M., G.M.T., L.L.-V., J.C.F., T.R.G., E.P.S., J.T.J., M.R.K., T.F., E.J.O., D.J.S., T.J.M., M.J., M.L., J.L.M., M.T.-P., D.Z.C., M.H.S., E.K.S.L.), Department of Neurology; Mayo Center for Sleep Medicine (S.J.M., G.M.T., L.L.-V., J.C.F., T.R.G., E.P.S., J.T.J., M.R.K., T.F., D.J.S., T.J.M., M.J., M.L., J.L.M., M.T.-P., D.Z.C., M.H.S., E.K.S.L.),; Department of Neurology (F.A., H.B., J.G.-R., R.S., W.S., B.F.B.); Department of Radiology (K.K.); Department of Cardiovascular Medicine (N.C., V.K.S.); Department of Medicine (J.L.K.); and Mayo Center for Sleep Medicine (C.A.M.), Department of Pediatrics, Mayo Clinic
| | - Eric J Olson
- From the Mayo Center for Sleep Medicine (C.A.A., S.J.M., G.M.T., L.L.-V., J.C.F., T.R.G., E.P.S., J.T.J., M.R.K., T.F., E.J.O., D.J.S., T.J.M., M.J., M.L., J.L.M., M.T.-P., D.Z.C., M.H.S., E.K.S.L.), Department of Neurology; Mayo Center for Sleep Medicine (S.J.M., G.M.T., L.L.-V., J.C.F., T.R.G., E.P.S., J.T.J., M.R.K., T.F., D.J.S., T.J.M., M.J., M.L., J.L.M., M.T.-P., D.Z.C., M.H.S., E.K.S.L.),; Department of Neurology (F.A., H.B., J.G.-R., R.S., W.S., B.F.B.); Department of Radiology (K.K.); Department of Cardiovascular Medicine (N.C., V.K.S.); Department of Medicine (J.L.K.); and Mayo Center for Sleep Medicine (C.A.M.), Department of Pediatrics, Mayo Clinic
| | - David J Sandness
- From the Mayo Center for Sleep Medicine (C.A.A., S.J.M., G.M.T., L.L.-V., J.C.F., T.R.G., E.P.S., J.T.J., M.R.K., T.F., E.J.O., D.J.S., T.J.M., M.J., M.L., J.L.M., M.T.-P., D.Z.C., M.H.S., E.K.S.L.), Department of Neurology; Mayo Center for Sleep Medicine (S.J.M., G.M.T., L.L.-V., J.C.F., T.R.G., E.P.S., J.T.J., M.R.K., T.F., D.J.S., T.J.M., M.J., M.L., J.L.M., M.T.-P., D.Z.C., M.H.S., E.K.S.L.),; Department of Neurology (F.A., H.B., J.G.-R., R.S., W.S., B.F.B.); Department of Radiology (K.K.); Department of Cardiovascular Medicine (N.C., V.K.S.); Department of Medicine (J.L.K.); and Mayo Center for Sleep Medicine (C.A.M.), Department of Pediatrics, Mayo Clinic
| | - Timothy J Morgenthaler
- From the Mayo Center for Sleep Medicine (C.A.A., S.J.M., G.M.T., L.L.-V., J.C.F., T.R.G., E.P.S., J.T.J., M.R.K., T.F., E.J.O., D.J.S., T.J.M., M.J., M.L., J.L.M., M.T.-P., D.Z.C., M.H.S., E.K.S.L.), Department of Neurology; Mayo Center for Sleep Medicine (S.J.M., G.M.T., L.L.-V., J.C.F., T.R.G., E.P.S., J.T.J., M.R.K., T.F., D.J.S., T.J.M., M.J., M.L., J.L.M., M.T.-P., D.Z.C., M.H.S., E.K.S.L.),; Department of Neurology (F.A., H.B., J.G.-R., R.S., W.S., B.F.B.); Department of Radiology (K.K.); Department of Cardiovascular Medicine (N.C., V.K.S.); Department of Medicine (J.L.K.); and Mayo Center for Sleep Medicine (C.A.M.), Department of Pediatrics, Mayo Clinic
| | - Kejal Kantarci
- From the Mayo Center for Sleep Medicine (C.A.A., S.J.M., G.M.T., L.L.-V., J.C.F., T.R.G., E.P.S., J.T.J., M.R.K., T.F., E.J.O., D.J.S., T.J.M., M.J., M.L., J.L.M., M.T.-P., D.Z.C., M.H.S., E.K.S.L.), Department of Neurology; Mayo Center for Sleep Medicine (S.J.M., G.M.T., L.L.-V., J.C.F., T.R.G., E.P.S., J.T.J., M.R.K., T.F., D.J.S., T.J.M., M.J., M.L., J.L.M., M.T.-P., D.Z.C., M.H.S., E.K.S.L.),; Department of Neurology (F.A., H.B., J.G.-R., R.S., W.S., B.F.B.); Department of Radiology (K.K.); Department of Cardiovascular Medicine (N.C., V.K.S.); Department of Medicine (J.L.K.); and Mayo Center for Sleep Medicine (C.A.M.), Department of Pediatrics, Mayo Clinic
| | - Rodolfo Savica
- From the Mayo Center for Sleep Medicine (C.A.A., S.J.M., G.M.T., L.L.-V., J.C.F., T.R.G., E.P.S., J.T.J., M.R.K., T.F., E.J.O., D.J.S., T.J.M., M.J., M.L., J.L.M., M.T.-P., D.Z.C., M.H.S., E.K.S.L.), Department of Neurology; Mayo Center for Sleep Medicine (S.J.M., G.M.T., L.L.-V., J.C.F., T.R.G., E.P.S., J.T.J., M.R.K., T.F., D.J.S., T.J.M., M.J., M.L., J.L.M., M.T.-P., D.Z.C., M.H.S., E.K.S.L.),; Department of Neurology (F.A., H.B., J.G.-R., R.S., W.S., B.F.B.); Department of Radiology (K.K.); Department of Cardiovascular Medicine (N.C., V.K.S.); Department of Medicine (J.L.K.); and Mayo Center for Sleep Medicine (C.A.M.), Department of Pediatrics, Mayo Clinic
| | - Wolfgang Singer
- From the Mayo Center for Sleep Medicine (C.A.A., S.J.M., G.M.T., L.L.-V., J.C.F., T.R.G., E.P.S., J.T.J., M.R.K., T.F., E.J.O., D.J.S., T.J.M., M.J., M.L., J.L.M., M.T.-P., D.Z.C., M.H.S., E.K.S.L.), Department of Neurology; Mayo Center for Sleep Medicine (S.J.M., G.M.T., L.L.-V., J.C.F., T.R.G., E.P.S., J.T.J., M.R.K., T.F., D.J.S., T.J.M., M.J., M.L., J.L.M., M.T.-P., D.Z.C., M.H.S., E.K.S.L.),; Department of Neurology (F.A., H.B., J.G.-R., R.S., W.S., B.F.B.); Department of Radiology (K.K.); Department of Cardiovascular Medicine (N.C., V.K.S.); Department of Medicine (J.L.K.); and Mayo Center for Sleep Medicine (C.A.M.), Department of Pediatrics, Mayo Clinic
| | - Naima Covassin
- From the Mayo Center for Sleep Medicine (C.A.A., S.J.M., G.M.T., L.L.-V., J.C.F., T.R.G., E.P.S., J.T.J., M.R.K., T.F., E.J.O., D.J.S., T.J.M., M.J., M.L., J.L.M., M.T.-P., D.Z.C., M.H.S., E.K.S.L.), Department of Neurology; Mayo Center for Sleep Medicine (S.J.M., G.M.T., L.L.-V., J.C.F., T.R.G., E.P.S., J.T.J., M.R.K., T.F., D.J.S., T.J.M., M.J., M.L., J.L.M., M.T.-P., D.Z.C., M.H.S., E.K.S.L.),; Department of Neurology (F.A., H.B., J.G.-R., R.S., W.S., B.F.B.); Department of Radiology (K.K.); Department of Cardiovascular Medicine (N.C., V.K.S.); Department of Medicine (J.L.K.); and Mayo Center for Sleep Medicine (C.A.M.), Department of Pediatrics, Mayo Clinic
| | - Virend K Somers
- From the Mayo Center for Sleep Medicine (C.A.A., S.J.M., G.M.T., L.L.-V., J.C.F., T.R.G., E.P.S., J.T.J., M.R.K., T.F., E.J.O., D.J.S., T.J.M., M.J., M.L., J.L.M., M.T.-P., D.Z.C., M.H.S., E.K.S.L.), Department of Neurology; Mayo Center for Sleep Medicine (S.J.M., G.M.T., L.L.-V., J.C.F., T.R.G., E.P.S., J.T.J., M.R.K., T.F., D.J.S., T.J.M., M.J., M.L., J.L.M., M.T.-P., D.Z.C., M.H.S., E.K.S.L.),; Department of Neurology (F.A., H.B., J.G.-R., R.S., W.S., B.F.B.); Department of Radiology (K.K.); Department of Cardiovascular Medicine (N.C., V.K.S.); Department of Medicine (J.L.K.); and Mayo Center for Sleep Medicine (C.A.M.), Department of Pediatrics, Mayo Clinic
| | - James L Kirkland
- From the Mayo Center for Sleep Medicine (C.A.A., S.J.M., G.M.T., L.L.-V., J.C.F., T.R.G., E.P.S., J.T.J., M.R.K., T.F., E.J.O., D.J.S., T.J.M., M.J., M.L., J.L.M., M.T.-P., D.Z.C., M.H.S., E.K.S.L.), Department of Neurology; Mayo Center for Sleep Medicine (S.J.M., G.M.T., L.L.-V., J.C.F., T.R.G., E.P.S., J.T.J., M.R.K., T.F., D.J.S., T.J.M., M.J., M.L., J.L.M., M.T.-P., D.Z.C., M.H.S., E.K.S.L.),; Department of Neurology (F.A., H.B., J.G.-R., R.S., W.S., B.F.B.); Department of Radiology (K.K.); Department of Cardiovascular Medicine (N.C., V.K.S.); Department of Medicine (J.L.K.); and Mayo Center for Sleep Medicine (C.A.M.), Department of Pediatrics, Mayo Clinic
| | - Mithri Junna
- From the Mayo Center for Sleep Medicine (C.A.A., S.J.M., G.M.T., L.L.-V., J.C.F., T.R.G., E.P.S., J.T.J., M.R.K., T.F., E.J.O., D.J.S., T.J.M., M.J., M.L., J.L.M., M.T.-P., D.Z.C., M.H.S., E.K.S.L.), Department of Neurology; Mayo Center for Sleep Medicine (S.J.M., G.M.T., L.L.-V., J.C.F., T.R.G., E.P.S., J.T.J., M.R.K., T.F., D.J.S., T.J.M., M.J., M.L., J.L.M., M.T.-P., D.Z.C., M.H.S., E.K.S.L.),; Department of Neurology (F.A., H.B., J.G.-R., R.S., W.S., B.F.B.); Department of Radiology (K.K.); Department of Cardiovascular Medicine (N.C., V.K.S.); Department of Medicine (J.L.K.); and Mayo Center for Sleep Medicine (C.A.M.), Department of Pediatrics, Mayo Clinic
| | - Melissa Lipford
- From the Mayo Center for Sleep Medicine (C.A.A., S.J.M., G.M.T., L.L.-V., J.C.F., T.R.G., E.P.S., J.T.J., M.R.K., T.F., E.J.O., D.J.S., T.J.M., M.J., M.L., J.L.M., M.T.-P., D.Z.C., M.H.S., E.K.S.L.), Department of Neurology; Mayo Center for Sleep Medicine (S.J.M., G.M.T., L.L.-V., J.C.F., T.R.G., E.P.S., J.T.J., M.R.K., T.F., D.J.S., T.J.M., M.J., M.L., J.L.M., M.T.-P., D.Z.C., M.H.S., E.K.S.L.),; Department of Neurology (F.A., H.B., J.G.-R., R.S., W.S., B.F.B.); Department of Radiology (K.K.); Department of Cardiovascular Medicine (N.C., V.K.S.); Department of Medicine (J.L.K.); and Mayo Center for Sleep Medicine (C.A.M.), Department of Pediatrics, Mayo Clinic
| | - Christine A Matarese
- From the Mayo Center for Sleep Medicine (C.A.A., S.J.M., G.M.T., L.L.-V., J.C.F., T.R.G., E.P.S., J.T.J., M.R.K., T.F., E.J.O., D.J.S., T.J.M., M.J., M.L., J.L.M., M.T.-P., D.Z.C., M.H.S., E.K.S.L.), Department of Neurology; Mayo Center for Sleep Medicine (S.J.M., G.M.T., L.L.-V., J.C.F., T.R.G., E.P.S., J.T.J., M.R.K., T.F., D.J.S., T.J.M., M.J., M.L., J.L.M., M.T.-P., D.Z.C., M.H.S., E.K.S.L.),; Department of Neurology (F.A., H.B., J.G.-R., R.S., W.S., B.F.B.); Department of Radiology (K.K.); Department of Cardiovascular Medicine (N.C., V.K.S.); Department of Medicine (J.L.K.); and Mayo Center for Sleep Medicine (C.A.M.), Department of Pediatrics, Mayo Clinic
| | - James L Moore
- From the Mayo Center for Sleep Medicine (C.A.A., S.J.M., G.M.T., L.L.-V., J.C.F., T.R.G., E.P.S., J.T.J., M.R.K., T.F., E.J.O., D.J.S., T.J.M., M.J., M.L., J.L.M., M.T.-P., D.Z.C., M.H.S., E.K.S.L.), Department of Neurology; Mayo Center for Sleep Medicine (S.J.M., G.M.T., L.L.-V., J.C.F., T.R.G., E.P.S., J.T.J., M.R.K., T.F., D.J.S., T.J.M., M.J., M.L., J.L.M., M.T.-P., D.Z.C., M.H.S., E.K.S.L.),; Department of Neurology (F.A., H.B., J.G.-R., R.S., W.S., B.F.B.); Department of Radiology (K.K.); Department of Cardiovascular Medicine (N.C., V.K.S.); Department of Medicine (J.L.K.); and Mayo Center for Sleep Medicine (C.A.M.), Department of Pediatrics, Mayo Clinic
| | - Maja Tippmann-Peikert
- From the Mayo Center for Sleep Medicine (C.A.A., S.J.M., G.M.T., L.L.-V., J.C.F., T.R.G., E.P.S., J.T.J., M.R.K., T.F., E.J.O., D.J.S., T.J.M., M.J., M.L., J.L.M., M.T.-P., D.Z.C., M.H.S., E.K.S.L.), Department of Neurology; Mayo Center for Sleep Medicine (S.J.M., G.M.T., L.L.-V., J.C.F., T.R.G., E.P.S., J.T.J., M.R.K., T.F., D.J.S., T.J.M., M.J., M.L., J.L.M., M.T.-P., D.Z.C., M.H.S., E.K.S.L.),; Department of Neurology (F.A., H.B., J.G.-R., R.S., W.S., B.F.B.); Department of Radiology (K.K.); Department of Cardiovascular Medicine (N.C., V.K.S.); Department of Medicine (J.L.K.); and Mayo Center for Sleep Medicine (C.A.M.), Department of Pediatrics, Mayo Clinic
| | - Diego Z Carvalho
- From the Mayo Center for Sleep Medicine (C.A.A., S.J.M., G.M.T., L.L.-V., J.C.F., T.R.G., E.P.S., J.T.J., M.R.K., T.F., E.J.O., D.J.S., T.J.M., M.J., M.L., J.L.M., M.T.-P., D.Z.C., M.H.S., E.K.S.L.), Department of Neurology; Mayo Center for Sleep Medicine (S.J.M., G.M.T., L.L.-V., J.C.F., T.R.G., E.P.S., J.T.J., M.R.K., T.F., D.J.S., T.J.M., M.J., M.L., J.L.M., M.T.-P., D.Z.C., M.H.S., E.K.S.L.),; Department of Neurology (F.A., H.B., J.G.-R., R.S., W.S., B.F.B.); Department of Radiology (K.K.); Department of Cardiovascular Medicine (N.C., V.K.S.); Department of Medicine (J.L.K.); and Mayo Center for Sleep Medicine (C.A.M.), Department of Pediatrics, Mayo Clinic
| | - Bradley F Boeve
- From the Mayo Center for Sleep Medicine (C.A.A., S.J.M., G.M.T., L.L.-V., J.C.F., T.R.G., E.P.S., J.T.J., M.R.K., T.F., E.J.O., D.J.S., T.J.M., M.J., M.L., J.L.M., M.T.-P., D.Z.C., M.H.S., E.K.S.L.), Department of Neurology; Mayo Center for Sleep Medicine (S.J.M., G.M.T., L.L.-V., J.C.F., T.R.G., E.P.S., J.T.J., M.R.K., T.F., D.J.S., T.J.M., M.J., M.L., J.L.M., M.T.-P., D.Z.C., M.H.S., E.K.S.L.),; Department of Neurology (F.A., H.B., J.G.-R., R.S., W.S., B.F.B.); Department of Radiology (K.K.); Department of Cardiovascular Medicine (N.C., V.K.S.); Department of Medicine (J.L.K.); and Mayo Center for Sleep Medicine (C.A.M.), Department of Pediatrics, Mayo Clinic
| | - Michael H Silber
- From the Mayo Center for Sleep Medicine (C.A.A., S.J.M., G.M.T., L.L.-V., J.C.F., T.R.G., E.P.S., J.T.J., M.R.K., T.F., E.J.O., D.J.S., T.J.M., M.J., M.L., J.L.M., M.T.-P., D.Z.C., M.H.S., E.K.S.L.), Department of Neurology; Mayo Center for Sleep Medicine (S.J.M., G.M.T., L.L.-V., J.C.F., T.R.G., E.P.S., J.T.J., M.R.K., T.F., D.J.S., T.J.M., M.J., M.L., J.L.M., M.T.-P., D.Z.C., M.H.S., E.K.S.L.),; Department of Neurology (F.A., H.B., J.G.-R., R.S., W.S., B.F.B.); Department of Radiology (K.K.); Department of Cardiovascular Medicine (N.C., V.K.S.); Department of Medicine (J.L.K.); and Mayo Center for Sleep Medicine (C.A.M.), Department of Pediatrics, Mayo Clinic
| | - Erik K St Louis
- From the Mayo Center for Sleep Medicine (C.A.A., S.J.M., G.M.T., L.L.-V., J.C.F., T.R.G., E.P.S., J.T.J., M.R.K., T.F., E.J.O., D.J.S., T.J.M., M.J., M.L., J.L.M., M.T.-P., D.Z.C., M.H.S., E.K.S.L.), Department of Neurology; Mayo Center for Sleep Medicine (S.J.M., G.M.T., L.L.-V., J.C.F., T.R.G., E.P.S., J.T.J., M.R.K., T.F., D.J.S., T.J.M., M.J., M.L., J.L.M., M.T.-P., D.Z.C., M.H.S., E.K.S.L.),; Department of Neurology (F.A., H.B., J.G.-R., R.S., W.S., B.F.B.); Department of Radiology (K.K.); Department of Cardiovascular Medicine (N.C., V.K.S.); Department of Medicine (J.L.K.); and Mayo Center for Sleep Medicine (C.A.M.), Department of Pediatrics, Mayo Clinic
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Hailu W, Tesfaye T, Derseh L, Hailu A, Clarfield AM. Prevalence of orthostatic hypotension and associated factors among older people with hypertension in Northern Ethiopia. BMC Geriatr 2024; 24:928. [PMID: 39528998 PMCID: PMC11552219 DOI: 10.1186/s12877-024-05519-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/31/2024] [Accepted: 10/25/2024] [Indexed: 11/16/2024] Open
Abstract
BACKGROUND The prevalence of hypertension increases with age, and older people with this condition are at increased risk of developing orthostatic hypotension (OH) due to age-related changes in blood pressure regulation mechanisms as well as prescribed medications. OH increases the risk of falls, often with subsequent fractures as well as other morbidity and even mortality. The prevalence and characteristics of OH in older people with hypertension in Low-Income Countries have not been well characterized. This study aims to determine the prevalence of OH and associated factors among older people with hypertension in northern Ethiopia. METHOD A hospital-based cross-sectional study was conducted using a convenience sample of patients aged 60 years and older with hypertension receiving pharmacotherapy and followed up at the University of Gondar Hospital, Ethiopia. Blood pressure (BP) was measured in the supine position, and after 3 min of standing; the level of BP drop (> 20/10) was used to define measured OH. Data regarding symptoms of OH were also collected using the Orthostatic Hypotension Questionnaire (OHQ). The data were entered into Microsoft Excel version 2016 and exported to SPSS version 20 for statistical analysis. Logistic regression analysis was conducted to assess the factors associated with OH. RESULTS A total of 240 participants were included, with a mean age of 68.8 ± 7.1 years. The prevalence of OH was 23.8% (CI: 21.5%, 26.1%). Of the medications used, calcium channel blocker (CCBs) treatment was strongly associated with OH (AOR = 2.03[95%CI = 1.08-3.8]). Two-thirds (61.4%) of participants with measured OH experienced relevant symptoms of OH. CONCLUSION There was a high prevalence of OH among older patients with hypertension attending a tertiary care hospital in Gondar, with one in four affected. The use of CCBs was identified as an independent risk factor for OH. Most patients with OH experienced relevant symptoms, so monitoring this condition in this group may help prevent adverse consequences.
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Affiliation(s)
- Workagegnehu Hailu
- Department of Internal Medicine, College of Medicine and Health Sciences, University of Gondar, Gondar, Ethiopia.
| | - Tsebaot Tesfaye
- Department of Internal Medicine, College of Medicine and Health Sciences, University of Gondar, Gondar, Ethiopia
| | - Lemma Derseh
- Department of Epidemiology and Biostatistics, College of Medicine and Health Sciences, University of Gondar, Gondar, Ethiopia
| | - Awraris Hailu
- College of Health Sciences, Debre Berhan University, Debre Berhan, Ethiopia
| | - A Mark Clarfield
- Faculty of Health Sciences, Ben-Gurion University of the Negev, Israel and McGill University, Montréal, Canada
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Petriceks AH, Appel LJ, Miller ER, Mitchell CM, Schrack JA, Wanigatunga AA, Michos ED, Christenson RH, Rebuck H, Juraschek SP. Associations of Hypertension and Orthostatic Hypotension With Subclinical Cardiovascular Disease. J Gerontol A Biol Sci Med Sci 2024; 79:glae234. [PMID: 39292998 PMCID: PMC11561395 DOI: 10.1093/gerona/glae234] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/16/2024] [Indexed: 09/20/2024] Open
Abstract
BACKGROUND Orthostatic hypotension is associated with cardiovascular disease. It remains unclear if low standing blood pressure or high seated blood pressure is responsible for this association. We compared associations of orthostatic hypotension and hypertension with high-sensitivity cardiac troponin I and N-terminal pro-B-type natriuretic peptide. METHODS We performed a secondary analysis of the Study to Understand Fall Reduction and Vitamin D in You, a randomized controlled trial funded by the National Institute on Aging, between July 2015 and May 2019. Participants were community-dwelling adults, 70 years or older. Blood tests for high-sensitivity cardiac troponin I and N-terminal pro-B-type natriuretic peptide were drawn at visits concurrent with blood pressure measurements. Secondary analysis occurred in 2023. We determined associations between blood pressure phenotypes and cardiac biomarkers. RESULTS Of 674 participants (mean age 76.5 ± 5.4 years, 43% female, 17.2% Black race), 29.1% had prior cardiovascular disease. Participants with seated hypertension had 10.1% greater high-sensitivity cardiac troponin I (95% confidence interval = 3.8-16.9) and 11.0% greater N-terminal pro-B-type natriuretic peptide (4.0-18.6) than those without seated hypertension. Participants with standing hypertension had 8.6% (2.7-14.9) greater high-sensitivity cardiac troponin I and 11.8% greater N-terminal pro-B-type natriuretic peptide (5.1-18.9) than those without standing hypertension. Hypotensive phenotypes were not associated with either biomarker. CONCLUSIONS Both seated and standing hypertension were associated with greater high-sensitivity cardiac troponin I and N-terminal pro-B-type natriuretic peptide, but hypotensive phenotypes were not. Hypoperfusion may not be the principal mechanism behind subclinical cardiac injury among older adults with orthostatic hypotension.
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Affiliation(s)
- Aldis H Petriceks
- Division of General Medicine, Department of Medicine, Beth Israel Deaconess Medical Center, Boston, Massachusetts, USA
- Harvard Medical School, Boston, Massachusetts, USA
| | - Lawrence J Appel
- Department of General Internal Medicine, The Johns Hopkins University School of Medicine, Baltimore, Maryland, USA
- Bloomberg School of Public Health, Johns Hopkins University, Baltimore, Maryland, USA
| | - Edgar R Miller
- Department of General Internal Medicine, The Johns Hopkins University School of Medicine, Baltimore, Maryland, USA
- Bloomberg School of Public Health, Johns Hopkins University, Baltimore, Maryland, USA
| | - Christine M Mitchell
- Bloomberg School of Public Health, Johns Hopkins University, Baltimore, Maryland, USA
| | - Jennifer A Schrack
- Bloomberg School of Public Health, Johns Hopkins University, Baltimore, Maryland, USA
| | - Amal A Wanigatunga
- Bloomberg School of Public Health, Johns Hopkins University, Baltimore, Maryland, USA
| | - Erin D Michos
- Department of General Internal Medicine, The Johns Hopkins University School of Medicine, Baltimore, Maryland, USA
- Bloomberg School of Public Health, Johns Hopkins University, Baltimore, Maryland, USA
| | - Robert H Christenson
- Department of Pathology, University of Maryland School of Medicine, Baltimore, Maryland, USA
| | - Heather Rebuck
- Department of Pathology, University of Maryland School of Medicine, Baltimore, Maryland, USA
| | - Stephen P Juraschek
- Division of General Medicine, Department of Medicine, Beth Israel Deaconess Medical Center, Boston, Massachusetts, USA
- Harvard Medical School, Boston, Massachusetts, USA
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15
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Kim N, Han J, Kang H. The Effect of a Biofeedback-Based Integrated Intervention for Older Adults with Orthostatic Hypotension: A Secondary Analysis on Psychological Health Outcomes in a Non-Randomized Pilot Trial. Healthcare (Basel) 2024; 12:2143. [PMID: 39517355 PMCID: PMC11545707 DOI: 10.3390/healthcare12212143] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/30/2024] [Revised: 10/21/2024] [Accepted: 10/25/2024] [Indexed: 11/16/2024] Open
Abstract
BACKGROUND/OBJECTIVES Aging-related physical changes and dysfunctions in the autonomic nervous system (ANS) often lead to orthostatic hypotension (OH) in older adults. OH negatively impacts both the physical and psychological well-being of those affected. Previous studies have demonstrated that the biofeedback-based integrated program (BBIP), a multicomponent intervention focused on heart rate variability biofeedback, effectively improves OH, as well as symptoms related to ANS function. This substudy aims to examine the effects of the BBIP on psychological health outcomes among community-dwelling older adults with OH. METHODS This study employed a non-randomized controlled trial design with a convenience sampling strategy. A total of 51 older adults with OH were recruited from two senior welfare centers and randomly assigned to either the intervention group (n = 27) or the control group (n = 24). The intervention group participated in a 12-week BBIP, which included weekly biofeedback sessions and group education on lifestyle modification to alleviate OH. Telephone counseling was also provided to promote compliance. RESULTS The intervention group showed significant improvements in health-related quality of life, depression, anxiety, and fall efficacy after the 12-week BBIP, whereas the control group exhibited no significant changes. There was a significant reduction in the percentage of participants in the intervention group reporting problems in all five dimensions of the EQ-5D (mobility, self-care, usual activities, pain/discomfort, and anxiety/depression). CONCLUSIONS The BBIP was effective in improving the psychological health outcomes of older adults with OH. Future studies should explore the long-term effects of the BBIP using a larger sample size and a randomized controlled trial design.
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Affiliation(s)
- Nahyun Kim
- College of Nursing, Keimyung University, Daegu 42601, Republic of Korea;
| | - Jeonghwa Han
- Department of Nursing, Kyungwoon University, Gumi 39160, Republic of Korea;
| | - Hyunwook Kang
- College of Nursing, Kangwon National University, Chuncheon 24341, Republic of Korea
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16
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Kocyigit SE, Ates Bulut E, Aydin AE, Dost FS, Kaya D, Isik AT. The relationship between cognitive frailty, physical frailty and malnutrition in Turkish older adults. Nutrition 2024; 126:112504. [PMID: 39142070 DOI: 10.1016/j.nut.2024.112504] [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: 03/14/2024] [Revised: 05/09/2024] [Accepted: 05/26/2024] [Indexed: 08/16/2024]
Abstract
OBJECTIVE The aim of this study was to assess the relationship between cognitive and physical frailty and malnutrition in older adults. METHODS The study was cross-sectional and observational. A total of 992 patients who applied to the geriatric outpatient clinic between January 2018 and December 2022 were included in the study. All patients underwent comprehensive geriatric assessment. Demographic characteristics, geriatric syndromes, comorbidities, and laboratory parameters were recorded. Fried's Frailty Scale was used to determine physical frailty. The Mini Nutritional Assessment Short Form was performed to determine nutritional status. Cognitive frailty was defined as the coexistence of physical frailty and mild cognitive impairment. RESULTS Of 992 patients participating in the study, 66% were female, and the mean age was 73.2 ± 7.4. The rate of physical frailty was 13.4%, and 96 patients were cognitively frail. Malnutrition rates were 18.8%, 12.5%, and 2.2% in the cognitive frailty, physical frailty, and healthy control groups, respectively. The healthy control group had a lower median age, fewer geriatric syndromes (excluding orthostatic hypotension), and lower rates of diabetes and hypertension than the frailty groups. The frequency of malnutrition was similar in the cognitive and physical frailty groups. The cognitive frailty group had higher median age, sarcopenia rate, and Timed Up and Go duration; were less likely to be female; and showed lower albumin, mobility, and functionality scores than the physical frailty group (P < 0.05). After adjusting for demographic characteristics, comorbidities, geriatric syndromes, and laboratory parameters, cognitive frailty showed a stronger relationship with malnutrition (odds ratio 1.96, confidence interval 1.13-5.04, P = 0.04). CONCLUSIONS Cognitive and physical frailty were found to be associated with malnutrition in older adults. Even after accounting for confounding factors, it appears that cognitive frailty is more closely related to nutritional status than physical frailty.
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Affiliation(s)
| | - Esra Ates Bulut
- Department of Geriatric Medicine, Adana City Training and Research Hospital, Adana, Turkey
| | - Ali Ekrem Aydin
- Department of Geriatric Medicine, Ondokuz Mayis University, Samsun, Turkey
| | - Fatma Sena Dost
- Department of Geriatric Medicine, Darica Farabi Training and Research Hospital, Kocaeli, Turkey
| | - Derya Kaya
- Unit for Aging Brain and Dementia, Department of Geriatric Medicine, Faculty of Medicine, Dokuz Eylul University, Izmir, Turkey
| | - Ahmet Turan Isik
- Unit for Aging Brain and Dementia, Department of Geriatric Medicine, Faculty of Medicine, Dokuz Eylul University, Izmir, Turkey.
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Yi H, Tang W, Shen Y, Tan L, Zeng F, Yang S. Orthostatic intolerance during early mobilization following thoracoscopic lung resection: a prospective observational study. BMC Surg 2024; 24:265. [PMID: 39285467 PMCID: PMC11403817 DOI: 10.1186/s12893-024-02556-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/17/2024] [Accepted: 09/03/2024] [Indexed: 09/22/2024] Open
Abstract
BACKGROUND Early postoperative mobilization is important for enhanced recovery but can be hindered by orthostatic intolerance. However, study on postoperative orthostatic intolerance in thoracoscopic lung resection is limited. Thus, this investigation aims to examine the prevalence and variables contributing to orthostatic intolerance on the first day following thoracoscopic lung cancer resection. METHODS A prospective observational study was conducted from February 01 to May 05, 2023, at the First Affiliated Hospital of Chongqing Medical University. Typically, 215 subjects subjected to thoracoscopic lung resection were enrolled in this study. Their general information, disease, and treatment information were collected, and the occurrence of orthostatic intolerance was recorded. RESULTS Typically, 64 patients (29.77%) demonstrated orthostatic intolerance during early mobilization, and 43.75% failed to walk. The prevalence of nausea, dizziness, and impaired vision was 60.94%, 92.19%, and 25.00%, respectively, and no patient experienced syncope. The factors shown to be independently linked with orthostatic intolerance were being female (OR = 2.98, 1.53 to 5.82) and high pain level during sitting (OR = 2.69, 1.79 to 4.04). Individuals with orthostatic intolerance had a longer postoperative hospital stay with a mean of 5.42 days against 4.25 days (p = 0.003). CONCLUSIONS Orthostatic intolerance was prevalent following thoracoscopic lung cancer resection and affected patients' capability to mobilize and prolonged postoperative hospitalization. Being female and having high pain levels during sitting were identified as independent factors for orthostatic intolerance. This suggests that more emphasis should be given to risky patients, and for these groups, we may optimize pain management to adjust the risk of emerging orthostatic intolerance, facilitating early mobilization and early postoperative rehabilitation.
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Affiliation(s)
- Hongjie Yi
- Department of Cardiothoracic Surgery, The First Affiliated Hospital of Chongqing Medical University, Chongqing, China
| | - Wenfeng Tang
- Department of Nursing, The First Affiliated Hospital of Chongqing Medical University, No.1, Youyi Road, Yuzhong District, Chongqing, 400016, China.
| | - Ying Shen
- Department of Cardiothoracic Surgery, The First Affiliated Hospital of Chongqing Medical University, Chongqing, China
| | - Li Tan
- Department of Cardiothoracic Surgery, The First Affiliated Hospital of Chongqing Medical University, Chongqing, China
| | - Fanshu Zeng
- Department of Nursing, The First Affiliated Hospital of Chongqing Medical University, No.1, Youyi Road, Yuzhong District, Chongqing, 400016, China
| | - Siqi Yang
- Department of Nursing, The First Affiliated Hospital of Chongqing Medical University, No.1, Youyi Road, Yuzhong District, Chongqing, 400016, China
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Guo Y, Lin T, Lin N, Lin H. Effectiveness analysis of deceleration capacity and traditional heart rate variability in diagnosing vasovagal syncope. Front Cardiovasc Med 2024; 11:1333684. [PMID: 39290211 PMCID: PMC11405235 DOI: 10.3389/fcvm.2024.1333684] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/05/2023] [Accepted: 08/13/2024] [Indexed: 09/19/2024] Open
Abstract
Background Vasovagal syncope (VVS) is a prevalent medical condition with a lack of efficient methods for its detection. Aim This study aimed to explore an objective clinical indicator in diagnosing VVS. Methods The retrospective analysis involved clinical data of 243 syncope patients from 1 June 2020 to 31 July 2023. Among them, 108 patients had a negative result in the tilt test (TTT), while the remaining 135 patients had a positive result in the TTT. Relevant statistical methods were utilized to examine the correlation between VVS and different indicators of heart rate variability. Results After screening, 354 patients being considered for VVS were evaluated, resulting in a final sample size of 243. Sex, age, deceleration capacity (DC), and standard deviation of all normal-to-normal intervals (SDNNs) were the variables that showed statistical significance between the TTT(-) group and the TTT(+) group. Independent risk factors identified by multivariate logistic regression were DC [odds ratio (OR) 1.710, 95% confidence interval (CI) 1.388-2.106, P < 0.001] and SDNN (OR 1.033, 95% CI 1.018-1.049, P < 0.001). Comparing the groups, receiver operating characteristic analysis revealed a notable distinction in both DC and SDNN [the respective areas under the curve were 0.789 (95% CI 0.730-0.848) and 0.702 (95% CI 0.637-0.767); the cutoff values were 7.15 and 131.42; P < 0.001, respectively]. Conclusion In summary, DC can function as an impartial and easily accessible clinical marker for differentiating VVS. A value exceeding 7.15 ms might suggest a higher likelihood of syncope.
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Affiliation(s)
- Yongzhe Guo
- Department of Cardiology, Fujian Heart Medical Center, Fujian Institute of Coronary Heart Disease, Fujian Medical University Union Hospital, Fuzhou, China
| | - Tao Lin
- Department of Epidemiology, School of Public Health, Fujian Medical University, Fuzhou, China
| | - Nanyu Lin
- Department of Cardiology, Fujian Heart Medical Center, Fujian Institute of Coronary Heart Disease, Fujian Medical University Union Hospital, Fuzhou, China
| | - Huizhong Lin
- Department of Cardiology, Fujian Heart Medical Center, Fujian Institute of Coronary Heart Disease, Fujian Medical University Union Hospital, Fuzhou, China
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Maia TFLD, Magalhães PAF, Santos DTS, de Brito Gomes JL, Schwingel PA, de Freitas Brito A. Current Concepts in Early Mobilization of Critically Ill Patients Within the Context of Neurologic Pathology. Neurocrit Care 2024; 41:272-284. [PMID: 38396279 DOI: 10.1007/s12028-023-01934-8] [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: 01/11/2023] [Accepted: 12/27/2023] [Indexed: 02/25/2024]
Abstract
Neurocritical patients (NCPs) in the intensive care unit (ICU) rapidly progress to respiratory and peripheral muscle dysfunctions, which significantly impact morbidity and death. Early mobilization in NCPs to decrease the incidence of ICU-acquired weakness has been showing rapid growth, although pertinent literature is still scarce. With this review, we summarize and discuss current concepts in early mobilization of critically ill patients within the context of neurologic pathology in NCPs. A narrative synthesis of literature was undertaken trying to answer the following questions: How do the respiratory and musculoskeletal systems in NCPs behave? Which metabolic biomarkers influence physiological responses in NCPs? Which considerations should be taken when prescribing exercises in neurocritically ill patients? The present review detected safety, feasibility, and beneficial response for early mobilization in NCPs, given successes in other critically ill populations and many smaller intervention trials in neurocritical care. However, precautions should be taken to elect the patient for early care, as well as monitoring signs that indicate interruption for intervention, as worse outcomes were associated with very early mobilization in acute stroke trials.
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Affiliation(s)
- Thaís Ferreira Lopes Diniz Maia
- Post Graduation Program in Rehabilitation and Functional Performance, Universidade de Pernambuco, BR 203, Km 2, s/n, Vila Eduardo, 56, Petrolina, Pernambuco, 328-900, Brazil.
| | - Paulo André Freire Magalhães
- Post Graduation Program in Rehabilitation and Functional Performance, Universidade de Pernambuco, BR 203, Km 2, s/n, Vila Eduardo, 56, Petrolina, Pernambuco, 328-900, Brazil
| | - Dasdores Tatiana Silva Santos
- Post Graduation Program in Rehabilitation and Functional Performance, Universidade de Pernambuco, BR 203, Km 2, s/n, Vila Eduardo, 56, Petrolina, Pernambuco, 328-900, Brazil
| | - Jorge Luiz de Brito Gomes
- Post Graduation Program in Rehabilitation and Functional Performance, Universidade de Pernambuco, BR 203, Km 2, s/n, Vila Eduardo, 56, Petrolina, Pernambuco, 328-900, Brazil
| | - Paulo Adriano Schwingel
- Post Graduation Program in Rehabilitation and Functional Performance, Universidade de Pernambuco, BR 203, Km 2, s/n, Vila Eduardo, 56, Petrolina, Pernambuco, 328-900, Brazil
| | - Aline de Freitas Brito
- Post Graduation Program in Rehabilitation and Functional Performance, Universidade de Pernambuco, BR 203, Km 2, s/n, Vila Eduardo, 56, Petrolina, Pernambuco, 328-900, Brazil
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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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21
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Rutten VC, Al CM, Festen S, Zuiverloon TCM, Boormans JL, Polinder-Bos HA. Selecting the right treatment: Health outcome priorities in older patients with bladder cancer. J Geriatr Oncol 2024; 15:101811. [PMID: 38896950 DOI: 10.1016/j.jgo.2024.101811] [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: 02/22/2024] [Revised: 04/09/2024] [Accepted: 05/28/2024] [Indexed: 06/21/2024]
Abstract
INTRODUCTION Selecting the appropriate treatment for older patients with non-muscle invasive (NMIBC) or muscle-invasive bladder cancer (MIBC) is challenging due to smoking-related comorbidities, treatment toxicity, and an increased risk of adverse health outcomes. Considering patient preferences prior to treatment is therefore crucial. Here, we aimed to identify the health outcome priorities of older patients with high-risk NMIBC (HR-NMIBC) or MIBC. MATERIALS AND METHODS Patients aged 70 years or older or at risk for frailty, diagnosed with HR-NMIBC or MIBC without distant metastases, were referred for a comprehensive geriatric assessment (CGA). The CGA consisted of an interview, physical examination, and several tests to examine physical, cognitive, functional, and social status. Quality of life was assessed using EQ5D and EORTC QLQ-C30 questionnaires. Health outcome priorities were discussed using the Outcome Prioritization Tool (OPT) and associations between health outcome priorities and CGA-determinants and quality of life were studied. RESULTS Of 146 patients (14 HR-NMIBC, 132 MIBC), OPT data was available for 139. Life extension was most often prioritized (44%), closely followed by preserving independence (40%). Reducing pain (7%) and other symptoms (9%) were less often prioritized. Patients prioritizing life extension had fewer musculoskeletal problems than patients prioritizing reducing pain or other symptoms (p = 0.02). Patients at risk of or suffering from malnutrition more frequently selected reducing pain or other symptoms as their health outcome priority (p = 0.004). For all other CGA-determinants and quality of life, there were no significant differences between groups based on health outcome priorities. DISCUSSION In older patients with HR-NMIBC and MIBC, life extension and preserving independence are the most common health outcomes priorities. CGA-determinants and quality of life are generally not associated with the prioritization of health outcomes. As health outcome priorities cannot be predicted by CGA-determinants or quality of life, it is crucial to discuss health outcome priorities with patients to promote shared decision-making.
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Affiliation(s)
- Vera C Rutten
- Department of Urology, Erasmus MC Cancer Institute, Rotterdam, the Netherlands.
| | - Cornelia M Al
- Division of Geriatric Medicine, Department of Internal Medicine, Erasmus MC University Medical Center, Rotterdam, the Netherlands
| | - Suzanne Festen
- University of Groningen, University Center for Geriatric Medicine, University Medical Center Groningen, Groningen, the Netherlands
| | | | - Joost L Boormans
- Department of Urology, Erasmus MC Cancer Institute, Rotterdam, the Netherlands
| | - Harmke A Polinder-Bos
- Division of Geriatric Medicine, Department of Internal Medicine, Erasmus MC University Medical Center, Rotterdam, the Netherlands
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22
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Kocyigit SE, Katipoglu B. Hypomagnesemia may be related to frailty, gait and balance problems, and basic activities of daily living in older adults. Acta Clin Belg 2024; 79:160-167. [PMID: 38849991 DOI: 10.1080/17843286.2024.2364143] [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: 05/02/2024] [Accepted: 06/01/2024] [Indexed: 06/09/2024]
Abstract
OBJECTIVES The study aims to investigate the relationship between hypomagnesemia, preclinical hypomagnesemia, and normomagnesemia as along with geriatric syndrome and comprehensive geriatric parameters(CGA). METHODS 217 patients who applied to the geriatric clinic between November 2022 and December 2023 were included in the study. All patients underwent CGA. Patients were categorized into three groups: Magnesium (Mg) level ≤ 1.5 mg/dL, Mg level 1.5-1.8 mg/dL, and Mg level > 1.8 mg/dL. These three groups were compared in terms of demographic characteristics, comorbidities, CGA parameters, and geriatric syndromes. Regression analyses was conducted for significant parameters, adjusting for confounders. RESULTS 74.9% of all participants were female, with an average age of 76.5 ± 6.6 years. The frequency of hypomagnesemia was 14.2%. Demographic characteristics and medication use, including proton pump inhibitors and diuretics, were similar in these three groups. While the FRIED frailty scale and the duration of the timed-up-and-go test were higher in the hypomagnesemia group, the Basic Activities Daily of Living (ADLs) and the Tinetti-POMA(performance-oriented mobility assessment) scores were lower in the hypomagnesemia group. When normomagnesemia was accepted as the reference category, FRIED frailty scale, Basic ADLs, and POMA score were more significant in the hypomagnesemia group (p = 0.025, p = 0.013 and p = 0.011,respectively), but there was no significance in the preclinical hypomagnesemia group regardless of the covariates. CONCLUSION Hypomagnesemia, particularly serum Mg levels below 1.5 mg/dL, may be associated with frailty, basic ADLs, gait, and balance tests. In geriatric practice, patients with hypomagnesemia should be evaluated in terms of the risk of the mentioned disorders.
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Affiliation(s)
- Suleyman Emre Kocyigit
- Department of Geriatric Medicine, Balikesir University Medicine of Faculty, Balikesir, Turkey
| | - Bilal Katipoglu
- Department of Geriatric Medicine, Ataturk City Training and Research Hospital, Balikesir, Turkey
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Ito S, Maki Y, Hatsuda N. Delayed Diagnosis of Spinal Cord Injury in a Patient With Intellectual Disability: A Case Report. Cureus 2024; 16:e59588. [PMID: 38827009 PMCID: PMC11144419 DOI: 10.7759/cureus.59588] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 05/03/2024] [Indexed: 06/04/2024] Open
Abstract
Spinal cord injury (SCI) can cause neurogenic shock accompanied by bradycardia and hypotension. If no preceding traumatic episodes are apparent and the neurological examination is complicated by the patient's intellectual disability, SCI is likely to be overlooked. A 63-year-old man with intellectual disability presented to our hospital. The patient had fallen on the floor; however, no apparent head or neck trauma was observed. The patient returned home after confirming the absence of intracranial hematoma on computed tomography. However, the patient was re-admitted because of hypotension and bradycardia, and sick sinus syndrome was suspected. As the manifestations were motor weakness in the extremities and urinary retention, screening spinal magnetic resonance imaging revealed cervical cord injury and spondylosis. Cervical SCI related to a fall was suspected. Cervical decompression surgery and rehabilitation therapy contributed to the improved patient status. Herein, we report a case of intellectual disability in which SCI was initially overlooked. No severe preceding traumatic episode or intellectual disability of the patient could have led to overlooking SCI in our case. Clinicians should be cautious about this rare condition.
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Affiliation(s)
- Sayaka Ito
- Neurosurgery, Kohka Public Hospital, Kohka, JPN
| | - Yoshinori Maki
- Neurosurgery, Hikone Chuo Hospital, Hikone, JPN
- Rehabilitation, Hikari Hospital, Otsu, JPN
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24
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Kaplan S. Prevalence of multiple system atrophy: A literature review. Rev Neurol (Paris) 2024; 180:438-450. [PMID: 38453600 DOI: 10.1016/j.neurol.2023.11.013] [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: 04/14/2023] [Revised: 09/19/2023] [Accepted: 11/28/2023] [Indexed: 03/09/2024]
Abstract
INTRODUCTION This paper aims to provide a literature overview on multiple system atrophy (MSA) prevalence in European and other pan-European populations. METHODS A literature search (PubMed, EMBASE) was performed through 2022 to identify published studies on MSA prevalence in European countries. Of these search results, titles and abstracts were screened for relevance. A standardized assessment tool was used for systematically data extraction and comparison. For studies where only the incidence rate was reported, MSA prevalence was derived based on the incidence and duration of disease. RESULTS A total of 24 studies conducted in 14 countries and published between 1995 and 2022 were identified. The prevalence of MSA was reported in 18 (75%) studies and was derived from six (25%) incidence studies. These studies were mainly prospective population-based studies or multi-center studies from specific regions or specialty clinical settings. Two earlier studies in Germany and the Netherlands were conducted using door-to-door design. The time period of evaluation of prevalence ranged from 1990 to 2018. The crude prevalence of MSA ranged from 0.5/100,000 in Spain to 17/100,000 in Japan. Age-specific prevalence rates were provided in five studies, and the reported age ranges varied. The gender-specific crude prevalence was estimated as 2.75/100,000 for men and 1.19/100.000 for women. The derived prevalence was higher (ranging from 0.7-18.9/100,000) than studies where the prevalence was reported. CONCLUSION The variations observed in MSA prevalence may result from differences in age distributions of the study populations, study methodology, diagnostic criteria and case assessment strategies of MSA. Thus, the comparability of these studies is limited.
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Affiliation(s)
- S Kaplan
- Teva Pharmaceutical Industries Ltd, 12, Hatrufa St, Netanya, Israel.
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25
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Prakash S, Gupta R, Raval MM, Tibrewal C. Serotonin syndrome presenting as acute dizziness with supine hypertension and orthostatic hypotension. BMJ Case Rep 2024; 17:e260229. [PMID: 38627042 PMCID: PMC11029266 DOI: 10.1136/bcr-2024-260229] [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] [Indexed: 04/19/2024] Open
Abstract
Serotonin syndrome (SS) is a drug-induced clinical syndrome characterised by a combination of cognitive, neuromuscular and autonomic dysfunctions. The symptoms may include mild non-specific symptoms such as tremors and diarrhoea to coma and sudden death. Herein, we describe a case of SS in which acute dizziness was associated with supine hypertension and orthostatic hypotension. A man in his mid-30s had a 10-month history of anxiety, depression and chronic tension-type headache. He had been on amitriptyline (25 mg daily) and sertraline (50 mg daily). Increment of sertraline (75 mg daily) and amitriptyline (75 mg daily) and the addition of tramadol led to the development of acute severe dizziness. Physical examinations demonstrate supine hypertension and orthostatic hypotension. He also met the diagnostic criteria of SS. The administration of cyproheptadine provided a complete response to dizziness, supine hypertension, orthostatic hypotension and other clinical features of SS.
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Affiliation(s)
- Sanjay Prakash
- Neurolgy, SBKS Medical Institute and Research Centre, Vadodara, India
| | - Ravisha Gupta
- Medicine, Smt BK Shah Medical Institute & Research Centre, Waghodia, Gujarat, India
| | - Maitree M Raval
- Medicine, Smt BK Shah Medical Institute & Research Centre, Waghodia, Gujarat, India
| | - Charu Tibrewal
- Medicine, The Gujarat Research & Medical Institute, Ahmedabad, Gujarat, India
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Hu J, Chi J, Cai H, Wu N, Li P, Huang Y, Lin C, Lai Y, Huang J, Li W, Su P, Li M, Lin Z, Xu L. Effect of orthostatic hypotension on long-term prognosis of elderly patients with stable coronary artery disease: a retrospective cohort study. Front Cardiovasc Med 2024; 11:1342379. [PMID: 38682102 PMCID: PMC11048043 DOI: 10.3389/fcvm.2024.1342379] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/21/2023] [Accepted: 03/25/2024] [Indexed: 05/01/2024] Open
Abstract
Background The long-term prognosis of patients with stable coronary artery disease (CAD) combined with orthostatic hypotension (OH) has rarely been reported. This research was designed to examine whether OH increases the risk of all-cause mortality and cardiovascular death among patients with stable CAD. Methods We retrospectively analyzed retired military personnel over 65 years of age who were hospitalized at the General Hospital of Southern Theater Command of the Chinese People's Liberation Army between March and July 2010. A total of 924 patients with stable CAD were included, among whom 263 had OH. The risk of all-cause mortality and cardiovascular death in OH and non-OH groups were analyzed with the Cox proportional hazards models, and restricted cubic spline plots were utilized for subgroup analyses. Furthermore, competing risk models were applied for sensitivity analyses. Results The median age of the patients was 82.00 (80.00-85.00) years. Over 159 months of follow-up, the loss to follow-up rate was 2.27%, and all-cause mortality was observed in 574 (63.57%) patients, including 184 with OH. Moreover, cardiovascular death occurred in 127 patients (13.73%), with 58 cases associated with OH. Although the relationship between OH and all-cause mortality was non-significant [body mass index (BMI) < 25 group, adjusted hazard ratio (HR) = 1.10 with a 95% confidence interval (CI): 0.82-1.40; BMI ≥ 25 group, adjusted HR = 1.30, 95% CI: 0.98-1.70], it was independently related to a growing risk of cardiovascular death (adjusted HR = 1.80, 95% CI: 1.20-2.60). This finding was further validated by using a competing risk model (subdistribution HR = 1.74, 95% CI: 1.22-2.49). Moreover, age, low-density lipoprotein cholesterol, and frequency of hospital admissions were identified as risk factors of cardiovascular death among patients with OH (P < 0.05). Conclusion Our study, based on retired military personnel with stable CAD, found that OH led to a significantly higher risk of cardiovascular death, but it was not noticeably associated with all-cause mortality on long-term prognosis.
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Affiliation(s)
- Jiaman Hu
- Department of Geriatric Cardiology & Branch of National Clinical Research Center for Geriatric Diseases & Guangzhou Key Laboratory of Cardiac Rehabilitation, General Hospital of Southern Theater Command, Guangzhou, China
- School of Public Health, Guangdong Pharmaceutical University, Guangzhou, China
| | - Jianing Chi
- The First School of Clinical Medicine, Southern Medical University, Guangzhou, China
| | - Hua Cai
- Graduate School, Guangzhou University of Chinese Medicine, Guangzhou, China
| | - Ningxia Wu
- Graduate School, Guangzhou University of Chinese Medicine, Guangzhou, China
| | - Pengfei Li
- Department of Geriatric Cardiology & Branch of National Clinical Research Center for Geriatric Diseases & Guangzhou Key Laboratory of Cardiac Rehabilitation, General Hospital of Southern Theater Command, Guangzhou, China
| | - Yuekang Huang
- Department of Geriatric Cardiology & Branch of National Clinical Research Center for Geriatric Diseases & Guangzhou Key Laboratory of Cardiac Rehabilitation, General Hospital of Southern Theater Command, Guangzhou, China
| | - Cailong Lin
- Department of Geriatric Cardiology & Branch of National Clinical Research Center for Geriatric Diseases & Guangzhou Key Laboratory of Cardiac Rehabilitation, General Hospital of Southern Theater Command, Guangzhou, China
| | - Yingying Lai
- Department of Geriatric Cardiology & Branch of National Clinical Research Center for Geriatric Diseases & Guangzhou Key Laboratory of Cardiac Rehabilitation, General Hospital of Southern Theater Command, Guangzhou, China
| | - Jianyu Huang
- Department of Geriatric Cardiology & Branch of National Clinical Research Center for Geriatric Diseases & Guangzhou Key Laboratory of Cardiac Rehabilitation, General Hospital of Southern Theater Command, Guangzhou, China
| | - Weihua Li
- Department of Geriatric Cardiology & Branch of National Clinical Research Center for Geriatric Diseases & Guangzhou Key Laboratory of Cardiac Rehabilitation, General Hospital of Southern Theater Command, Guangzhou, China
| | - Peng Su
- Department of Geriatric Cardiology & Branch of National Clinical Research Center for Geriatric Diseases & Guangzhou Key Laboratory of Cardiac Rehabilitation, General Hospital of Southern Theater Command, Guangzhou, China
| | - Min Li
- Department of Geriatric Cardiology & Branch of National Clinical Research Center for Geriatric Diseases & Guangzhou Key Laboratory of Cardiac Rehabilitation, General Hospital of Southern Theater Command, Guangzhou, China
| | - Zhongqiu Lin
- The Sixth Affiliated Hospital, School of Medicine, South China University of Technology, Foshan, China
| | - Lin Xu
- Department of Geriatric Cardiology & Branch of National Clinical Research Center for Geriatric Diseases & Guangzhou Key Laboratory of Cardiac Rehabilitation, General Hospital of Southern Theater Command, Guangzhou, China
- School of Public Health, Guangdong Pharmaceutical University, Guangzhou, China
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Hristovska AM, Andersen LB, Uldall-Hansen B, Kehlet H, Troelsen A, Gromov K, Foss NB. Postoperative orthostatic intolerance following fast-track unicompartmental knee arthroplasty: incidence and hemodynamics-a prospective observational cohort study. J Orthop Surg Res 2024; 19:214. [PMID: 38561817 PMCID: PMC10983746 DOI: 10.1186/s13018-024-04639-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/11/2023] [Accepted: 02/21/2024] [Indexed: 04/04/2024] Open
Abstract
BACKGROUND Early postoperative mobilization is essential for early functional recovery but can be inhibited by postoperative orthostatic intolerance (OI). Postoperative OI is common after major surgery, such as total knee arthroplasty (TKA). However, limited data are available after less extensive surgery, such as unicompartmental knee arthroplasty (UKA). We, therefore, investigated the incidence of OI as well as cardiovascular and tissue oxygenation responses during early mobilization after UKA. METHODS This prospective single-centre observational study included 32 patients undergoing primary UKA. Incidence of OI and cardiovascular and tissue oxygenation responses during mobilization were evaluated preoperatively, at 6 and 24 h after surgery. Perioperative fluid balance, bleeding, surgery duration, postoperative hemoglobin, pain during mobilization and opioid usage were recorded. RESULTS During mobilization at 6 h after surgery, 4 (14%, 95%CI 4-33%) patients experienced OI; however, no patients terminated the mobilization procedure prematurely. Dizziness and feeling of heat were the most common symptoms. OI was associated with attenuated systolic and mean arterial blood pressure responses in the sitting position (all p < 0.05). At 24 h after surgery, 24 (75%) patients had already been discharged, including three of the four patients with early OI. Only five patients were available for measurements, two of whom experienced OI; one terminated the mobilization procedure due to intolerable symptoms. We observed no statistically significant differences in perioperative fluid balance, bleeding, surgery duration, postoperative hemoglobin, pain, or opioid usage between orthostatic intolerant and tolerant patients. CONCLUSIONS The incidence of orthostatic intolerance after fast-track unicompartmental knee arthroplasty is low (~ 15%) and is associated with decreased orthostatic pressure responses. Compared to the previously described orthostatic intolerance incidence of ~ 40% following total knee arthroplasty, early orthostatic intolerance is uncommon after unicompartmental knee arthroplasty, suggesting a procedure-specific component. TRIAL REGISTRATION Prospectively registered at ClinicalTrials.gov; registration number: NCT04195360, registration date: 13.12.2019.
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Affiliation(s)
- Ana-Marija Hristovska
- Department of Anesthesiology and Intensive Care, Copenhagen University Hospital Hvidovre, Kettegård Alle 30, 2650, Hvidovre, Copenhagen, Denmark.
| | - Louise B Andersen
- Department of Anesthesiology and Intensive Care, Copenhagen University Hospital Hvidovre, Kettegård Alle 30, 2650, Hvidovre, Copenhagen, Denmark
| | - Bodil Uldall-Hansen
- Department of Anesthesiology and Intensive Care, Copenhagen University Hospital Hvidovre, Kettegård Alle 30, 2650, Hvidovre, Copenhagen, Denmark
| | - Henrik Kehlet
- Section of Surgical Pathophysiology, Copenhagen University Hospital Rigshospitalet, Copenhagen, Denmark
| | - Anders Troelsen
- Department of Orthopedic Surgery, Copenhagen University Hospital Hvidovre, Copenhagen, Denmark
| | - Kirill Gromov
- Department of Orthopedic Surgery, Copenhagen University Hospital Hvidovre, Copenhagen, Denmark
| | - Nicolai B Foss
- Department of Anesthesiology and Intensive Care, Copenhagen University Hospital Hvidovre, Kettegård Alle 30, 2650, Hvidovre, Copenhagen, Denmark
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Alnasser Alsukhni R, Vichayanrat E, Koay S, Davis LM, Ingle G, McNamara P, Panicker JN, Bhatia KP, Mathias C, Bomanji J, Iodice V. Abnormal dopamine transporter imaging in pure autonomic failure: a potential biomarker of central nervous system involvement. Eur J Neurol 2024; 31:e16169. [PMID: 38085264 PMCID: PMC11235633 DOI: 10.1111/ene.16169] [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: 07/06/2023] [Revised: 10/21/2023] [Accepted: 11/14/2023] [Indexed: 02/09/2024]
Abstract
BACKGROUND AND PURPOSE Pure autonomic failure (PAF) is a rare progressive neurodegenerative disease characterized by neurogenic orthostatic hypotension at presentation, without other neurological abnormalities. Some patients may develop other central neurological features indicative of multiple system atrophy or a Lewy body disorder. There are currently no biomarkers to assess possible central nervous system involvement in probable PAF at an early stage. A possibility is to evaluate the nigrostriatal dopaminergic degeneration by imaging of dopamine transporter with DaTscan brain imaging. The objective was to evaluate subclinical central nervous system involvement using DaTscan in PAF. METHODS We retreospectively reviewed pure autonomic failure patients who were evaluated at the Autonomic Unit between January 2015 and August 2021 and underwent comprehensive autonomic assessment, neurological examination, brain magnetic resonance imaging and DaTscan imaging. DaTscan imaging was performed if patients presented with atypical features which did not meet the criteria for Parkinson's disease or multiple system atrophy or other atypical parkinsonism. RESULTS In this cohort, the median age was 49.5 years at disease onset, 57.5 years at presentation, and the median disease duration was 7.5 years. Five of 10 patients had an abnormal DaTscan without neurological features meeting the criteria of an alternative diagnosis. Patients with abnormal DaTscan were predominantly males, had shorter disease duration and had more severe genitourinary symptoms. DISCUSSION Degeneration of nigrostriatal dopaminergic neurons measured using DaTscan imaging can present in patients with PAF without concurrent signs indicating progression to widespread α-synucleinopathy. It is advocated that DaTscan imaging should be considered as part of the workup of patients with emerging autonomic failure who are considered to have PAF.
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Affiliation(s)
| | | | - Shiwen Koay
- Autonomic UnitNational Hospital for Neurology and NeurosurgeryLondonUK
| | - Laura May Davis
- Institute of Nuclear MedicineUCLH NHS Foundation TrustLondonUK
| | - Gordon Ingle
- Autonomic UnitNational Hospital for Neurology and NeurosurgeryLondonUK
| | - Patricia McNamara
- Autonomic UnitNational Hospital for Neurology and NeurosurgeryLondonUK
| | - Jalesh N. Panicker
- UCL Queen Square Institute of Neurology, Faculty of Brain SciencesUniversity College LondonLondonUK
- Department of Uro‐NeurologyNational Hospital for Neurology and NeurosurgeryLondonUK
| | - Kailash P. Bhatia
- Department of Clinical and Movement Neurosciences, UCL Queen Square Institute of NeurologyUniversity College LondonLondonUK
| | - Christopher Mathias
- UCL Queen Square Institute of Neurology, Faculty of Brain SciencesUniversity College LondonLondonUK
| | - Jamshed Bomanji
- Institute of Nuclear MedicineUCLH NHS Foundation TrustLondonUK
| | - Valeria Iodice
- Autonomic UnitNational Hospital for Neurology and NeurosurgeryLondonUK
- UCL Queen Square Institute of Neurology, Faculty of Brain SciencesUniversity College LondonLondonUK
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El-Mhadi S, Mouine N, Benjelloun H, Aboudrar S, El Bakkali M. Primary autonomic failure: a complex case of orthostatic hypotension in a hypertensive elderly patient. Eur Heart J Case Rep 2024; 8:ytae073. [PMID: 38419751 PMCID: PMC10901262 DOI: 10.1093/ehjcr/ytae073] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/14/2023] [Revised: 01/24/2024] [Accepted: 02/02/2024] [Indexed: 03/02/2024]
Abstract
Background Primary autonomic failure (PAF) or Bradbury Eggleston syndrome is a neurodegenerative disorder of the autonomic nervous system characterized by orthostatic hypotension. Case summary We report the case of a 76-year-old patient with a history of hypertension, who presented with exercise-induced fatigue. He exhibited systolic hypertension and resting bradycardia in the supine position, with orthostatic hypotension without reactive tachycardia, suggesting dysautonomia. Neurological examination was unremarkable. The patient underwent cardiovascular autonomic testing, revealing evidence of beta-sympathetic deficiency associated with neurogenic orthostatic hypotension. Causes of secondary dysautonomia were excluded. The patient was diagnosed with PAF. Even if managing the combination of supine hypertension and orthostatic hypotension was challenging, significant improvements in functional and haemodynamic status were observed with a personalized management approach. Discussion Throughout this case report, we emphasize the critical need for an evaluation of autonomic function and blood pressure's dynamics in hypertensive patients experiencing orthostatic symptoms, enabling the implementation of tailored therapeutic strategies.
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Affiliation(s)
- Samah El-Mhadi
- Cardiology A Department, Ibn Sina University Hospital Center, Rabat, Morocco
| | - Najat Mouine
- Department of Cardiology, Mohammed V Military Hospital, Rabat, Morocco
| | - Halima Benjelloun
- Cardiology A Department, Ibn Sina University Hospital Center, Rabat, Morocco
| | - Souad Aboudrar
- Exercise physiology and autonomic nervous system team, Laboratory of Physiology, Mohammed V University, Rabat, Morocco
| | - Mustapha El Bakkali
- Exercise physiology and autonomic nervous system team, Laboratory of Physiology, Mohammed V University, Rabat, Morocco
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Novak P, Systrom DM, Marciano SP, Knief A, Felsenstein D, Giannetti MP, Hamilton MJ, Nicoloro-SantaBarbara J, Saco TV, Castells M, Farhad K, Pilgrim DM, Mullally WJ. Mismatch between subjective and objective dysautonomia. Sci Rep 2024; 14:2513. [PMID: 38291116 PMCID: PMC10828385 DOI: 10.1038/s41598-024-52368-x] [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: 08/08/2023] [Accepted: 01/17/2024] [Indexed: 02/01/2024] Open
Abstract
Autonomic symptom questionnaires are frequently used to assess dysautonomia. It is unknown whether subjective dysautonomia obtained from autonomic questionnaires correlates with objective dysautonomia measured by quantitative autonomic testing. The objective of our study was to determine correlations between subjective and objective measures of dysautonomia. This was a retrospective cross-sectional study conducted at Brigham and Women's Faulkner Hospital Autonomic Laboratory between 2017 and 2023 evaluating the patients who completed autonomic testing. Analyses included validated autonomic questionnaires [Survey of Autonomic Symptoms (SAS), Composite Autonomic Symptom Score 31 (Compass-31)] and standardized autonomic tests (Valsalva maneuver, deep breathing, sudomotor, and tilt test). The autonomic testing results were graded by a Quantitative scale for grading of cardiovascular reflexes, sudomotor tests and skin biopsies (QASAT), and Composite Autonomic Severity Score (CASS). Autonomic testing, QASAT, CASS, and SAS were obtained in 2627 patients, and Compass-31 in 564 patients. The correlation was strong between subjective instruments (SAS vs. Compass-31, r = 0.74, p < 0.001) and between objective instruments (QASAT vs. CASS, r = 0.81, p < 0.001). There were no correlations between SAS and QASAT nor between Compass-31 and CASS. There continued to be no correlations between subjective and objective instruments for selected diagnoses (post-acute sequelae of COVID-19, n = 61; postural tachycardia syndrome, 211; peripheral autonomic neuropathy, 463; myalgic encephalomyelitis/chronic fatigue syndrome, 95; preload failure, 120; post-treatment Lyme disease syndrome, 163; hypermobile Ehlers-Danlos syndrome, 213; neurogenic orthostatic hypotension, 86; diabetes type II, 71, mast cell activation syndrome, 172; hereditary alpha tryptasemia, 45). The lack of correlation between subjective and objective instruments highlights the limitations of the commonly used questionnaires with some patients overestimating and some underestimating true autonomic deficit. The diagnosis-independent subjective-objective mismatch further signifies the unmet need for reliable screening surveys. Patients who overestimate the symptom burden may represent a population with idiosyncratic autonomic-like symptomatology, which needs further study. At this time, the use of autonomic questionnaires as a replacement of autonomic testing cannot be recommended.
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Affiliation(s)
- Peter Novak
- Autonomic Laboratory, Department of Neurology, Brigham and Women's Hospital, Boston, MA, USA.
- Department of Neurology, Brigham and Women's Faulkner Hospital, Boston, MA, USA.
- Harvard Medical School, Boston, MA, USA.
| | - David M Systrom
- Harvard Medical School, Boston, MA, USA
- Department of Medicine, Pulmonary and Critical Care, Brigham and Women's Hospital, Boston, MA, USA
| | - Sadie P Marciano
- Department of Neurology, Brigham and Women's Faulkner Hospital, Boston, MA, USA
| | - Alexandra Knief
- Department of Neurology, Brigham and Women's Faulkner Hospital, Boston, MA, USA
| | - Donna Felsenstein
- Harvard Medical School, Boston, MA, USA
- Department of Infectious Disease and Medicine, Massachusetts General Hospital, Boston, MA, USA
| | - Matthew P Giannetti
- Harvard Medical School, Boston, MA, USA
- Department of Medicine, Mastocytosis Center, Brigham and Women's Hospital, Boston, MA, USA
| | - Matthew J Hamilton
- Harvard Medical School, Boston, MA, USA
- Department of Medicine, Mastocytosis Center, Brigham and Women's Hospital, Boston, MA, USA
| | | | - Tara V Saco
- Harvard Medical School, Boston, MA, USA
- Department of Medicine, Mastocytosis Center, Brigham and Women's Hospital, Boston, MA, USA
| | - Mariana Castells
- Harvard Medical School, Boston, MA, USA
- Department of Medicine, Mastocytosis Center, Brigham and Women's Hospital, Boston, MA, USA
| | - Khosro Farhad
- Harvard Medical School, Boston, MA, USA
- Department of Neurology, Massachusetts General Hospital, Boston, MA, USA
| | - David M Pilgrim
- Department of Neurology, Brigham and Women's Faulkner Hospital, Boston, MA, USA
- Harvard Medical School, Boston, MA, USA
| | - William J Mullally
- Department of Neurology, Brigham and Women's Faulkner Hospital, Boston, MA, USA
- Harvard Medical School, Boston, MA, USA
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Okkels N, Horsager J, Fedorova TD, Knudsen K, Skjærbæk C, Andersen KB, Labrador-Espinosa M, Vestergaard K, Mortensen JK, Klit H, Møller M, Danielsen EH, Johnsen EL, Bekan G, Hansen KV, Munk OL, Damholdt MF, Kjeldsen PL, Hansen AK, Gottrup H, Grothe MJ, Borghammer P. Impaired cholinergic integrity of the colon and pancreas in dementia with Lewy bodies. Brain 2024; 147:255-266. [PMID: 37975822 DOI: 10.1093/brain/awad391] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/01/2023] [Revised: 09/20/2023] [Accepted: 10/28/2023] [Indexed: 11/19/2023] Open
Abstract
Dementia with Lewy bodies is characterized by a high burden of autonomic dysfunction and Lewy pathology in peripheral organs and components of the sympathetic and parasympathetic nervous system. Parasympathetic terminals may be quantified with 18F-fluoroetoxybenzovesamicol, a PET tracer that binds to the vesicular acetylcholine transporter in cholinergic presynaptic terminals. Parasympathetic imaging may be useful for diagnostics, improving our understanding of autonomic dysfunction and for clarifying the spatiotemporal relationship of neuronal degeneration in prodromal disease. Therefore, we aimed to investigate the cholinergic parasympathetic integrity in peripheral organs and central autonomic regions of subjects with dementia with Lewy bodies and its association with subjective and objective measures of autonomic dysfunction. We hypothesized that organs with known parasympathetic innervation, especially the pancreas and colon, would have impaired cholinergic integrity. To achieve these aims, we conducted a cross-sectional comparison study including 23 newly diagnosed non-diabetic subjects with dementia with Lewy bodies (74 ± 6 years, 83% male) and 21 elderly control subjects (74 ± 6 years, 67% male). We obtained whole-body images to quantify PET uptake in peripheral organs and brain images to quantify PET uptake in regions of the brainstem and hypothalamus. Autonomic dysfunction was assessed with questionnaires and measurements of orthostatic blood pressure. Subjects with dementia with Lewy bodies displayed reduced cholinergic tracer uptake in the pancreas (32% reduction, P = 0.0003) and colon (19% reduction, P = 0.0048), but not in organs with little or no parasympathetic innervation. Tracer uptake in a region of the medulla oblongata overlapping the dorsal motor nucleus of the vagus correlated with autonomic symptoms (rs = -0.54, P = 0.0077) and changes in orthostatic blood pressure (rs = 0.76, P < 0.0001). Tracer uptake in the pedunculopontine region correlated with autonomic symptoms (rs = -0.52, P = 0.0104) and a measure of non-motor symptoms (rs = -0.47, P = 0.0230). In conclusion, our findings provide the first imaging-based evidence of impaired cholinergic integrity of the pancreas and colon in dementia with Lewy bodies. The observed changes may reflect parasympathetic denervation, implying that this process is initiated well before the point of diagnosis. The findings also support that cholinergic denervation in the brainstem contributes to dysautonomia.
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Affiliation(s)
- Niels Okkels
- Department of Nuclear Medicine and PET, Aarhus University Hospital, 8200 Aarhus N, Denmark
- Department of Clinical Medicine, Aarhus University, 8000 Aarhus C, Denmark
- Department of Neurology, Aarhus University Hospital, 8200 Aarhus N, Denmark
| | - Jacob Horsager
- Department of Nuclear Medicine and PET, Aarhus University Hospital, 8200 Aarhus N, Denmark
- Department of Clinical Medicine, Aarhus University, 8000 Aarhus C, Denmark
| | - Tatyana D Fedorova
- Department of Nuclear Medicine and PET, Aarhus University Hospital, 8200 Aarhus N, Denmark
- Department of Clinical Medicine, Aarhus University, 8000 Aarhus C, Denmark
| | - Karoline Knudsen
- Department of Nuclear Medicine and PET, Aarhus University Hospital, 8200 Aarhus N, Denmark
| | - Casper Skjærbæk
- Department of Nuclear Medicine and PET, Aarhus University Hospital, 8200 Aarhus N, Denmark
- Department of Clinical Medicine, Aarhus University, 8000 Aarhus C, Denmark
| | - Katrine B Andersen
- Department of Nuclear Medicine and PET, Aarhus University Hospital, 8200 Aarhus N, Denmark
- Department of Clinical Medicine, Aarhus University, 8000 Aarhus C, Denmark
| | - Miguel Labrador-Espinosa
- Unidad de Trastornos del Movimiento, Servicio de Neurología y Neurofisiología Clínica, Instituto de Biomedicina de Sevilla (IBiS), Hospital Universitario Virgen del Rocío/CSIC/Universidad de Sevilla, 41013 Seville, Spain
- Centro de Investigación Biomédica en Red Sobre Enfermedades Neurodegenerativas (CIBERNED), Instituto de Salud Carlos III, 28029 Madrid, Spain
| | | | - Janne K Mortensen
- Department of Clinical Medicine, Aarhus University, 8000 Aarhus C, Denmark
- Department of Neurology, Aarhus University Hospital, 8200 Aarhus N, Denmark
| | - Henriette Klit
- Department of Neurology, Aarhus University Hospital, 8200 Aarhus N, Denmark
| | - Mette Møller
- Department of Neurology, Aarhus University Hospital, 8200 Aarhus N, Denmark
| | - Erik H Danielsen
- Department of Neurology, Aarhus University Hospital, 8200 Aarhus N, Denmark
| | - Erik L Johnsen
- Department of Neurology, Aarhus University Hospital, 8200 Aarhus N, Denmark
| | - Goran Bekan
- Department of Neurology, Regionshospitalet Gødstrup, 7400 Herning, Denmark
| | - Kim V Hansen
- Department of Nuclear Medicine and PET, Aarhus University Hospital, 8200 Aarhus N, Denmark
| | - Ole L Munk
- Department of Nuclear Medicine and PET, Aarhus University Hospital, 8200 Aarhus N, Denmark
| | - Malene F Damholdt
- Department of Clinical Medicine, Aarhus University, 8000 Aarhus C, Denmark
| | - Pernille L Kjeldsen
- Department of Nuclear Medicine and PET, Aarhus University Hospital, 8200 Aarhus N, Denmark
- Department of Clinical Medicine, Aarhus University, 8000 Aarhus C, Denmark
- Department of Neurology, Aalborg University Hospital, 9000 Aalborg, Denmark
| | - Allan K Hansen
- Department of Nuclear Medicine and PET, Aarhus University Hospital, 8200 Aarhus N, Denmark
- Department of Nuclear Medicine, Aalborg University Hospital, 9000 Aalborg, Denmark
| | - Hanne Gottrup
- Department of Neurology, Aarhus University Hospital, 8200 Aarhus N, Denmark
| | - Michel J Grothe
- Unidad de Trastornos del Movimiento, Servicio de Neurología y Neurofisiología Clínica, Instituto de Biomedicina de Sevilla (IBiS), Hospital Universitario Virgen del Rocío/CSIC/Universidad de Sevilla, 41013 Seville, Spain
- Centro de Investigación Biomédica en Red Sobre Enfermedades Neurodegenerativas (CIBERNED), Instituto de Salud Carlos III, 28029 Madrid, Spain
| | - Per Borghammer
- Department of Nuclear Medicine and PET, Aarhus University Hospital, 8200 Aarhus N, Denmark
- Department of Clinical Medicine, Aarhus University, 8000 Aarhus C, Denmark
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Zhang J, Gao X, Ma B, Liu L, Gao H. Synchronous Bilateral Brachial Blood Pressure Measurements Increased Orthostatic Hypotension Detection in the Elderly. Curr Hypertens Rev 2024; 20:57-63. [PMID: 38155470 DOI: 10.2174/0115734021269751231204114902] [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: 07/27/2023] [Revised: 09/26/2023] [Accepted: 10/25/2023] [Indexed: 12/30/2023]
Abstract
BACKGROUND Orthostatic hypotension (OH) is a common clinical sign, but its detection rate is low, and it is difficult to repeat because there is no standardized screening method available. AIM This study aimed to establish a method for detecting blood pressure and assess whether it could increase the OH detection rate in the elderly. METHODS From May to October, 2022, 178 patients with symptomatic OH and 286 subjects with asymptomatic OH were selected. BP from the bilateral brachial artery was measured using two electronic sphygmomanometers on both arms at the same time, in the order of supine, sitting, and standing at 0-3 min. OH should meet 20/10 mmHg, standing BP minus sitting BP. The OH detection rates were calculated and compared. The symptomatic OH group was more often older, slimmer, had lower ADL scores, and contained fewer smokers (all P< 0.05). RESULTS The detection rate of the symptomatic OH group using the modified method was 59.55%, which was higher than that of the routine method (34.83% vs. 59.55%, P<0.05). The detection rate using the modified method in the OH group with asymptomatic OH was 20.63%, which was higher than that of the routine method (20.63% vs. 5.59%, P< 0.01). CONCLUSION Synchronous measurement of bilateral brachial artery BP in supine, sitting, and standing positions increased the detection rate of OH in the elderly.
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Affiliation(s)
- Jianying Zhang
- Department of Neurology, The Affiliated Hospital of Qingdao Binhai University, 266404, Qingdao, Shandong, China
| | - Xia Gao
- Department of Acupuncture, Affiliated Qingdao Central Hospital of Qingdao University, Qingdao Cancer Hospital, 266042, Qingdao, Shandong, China
| | - Benxu Ma
- Department of Acupuncture, Affiliated Qingdao Central Hospital of Qingdao University, Qingdao Cancer Hospital, 266042, Qingdao, Shandong, China
| | - Lili Liu
- Department of Pathology, Affiliated Qingdao Central Hospital of Qingdao University, Qingdao Cancer Hospital, 266042, Qingdao, Shandong, China
| | - Huanmin Gao
- Department of Neurology, The Affiliated Hospital of Qingdao Binhai University, 266404, Qingdao, Shandong, China
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Pavy-Le Traon A, Foubert-Samier A, Fabbri M. An overview on pure autonomic failure. Rev Neurol (Paris) 2024; 180:94-100. [PMID: 38129276 DOI: 10.1016/j.neurol.2023.11.003] [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: 10/31/2023] [Accepted: 11/28/2023] [Indexed: 12/23/2023]
Abstract
Pure autonomic failure (PAF) is a neurodegenerative disease affecting the sympathetic component of the autonomic nervous system and presenting as orthostatic hypotension (OH). It is a rare, sporadic disease of adults. Although OH is the primary symptom, the autonomic dysfunction may be more generalised, leading to genitourinary and intestinal dysfunction and sweating disorders. Autonomic symptoms in PAF may be similar to those observed in other autonomic neuropathies that need to be ruled out. PAF belongs to the group of α synucleinopathies and is characterised by predominant peripheral deposition of α-synuclein in autonomic ganglia and nerves. However, in a significant number of cases, PAF may convert into another synucleinopathy with central nervous system involvement with varying prognosis: Parkinson's disease (PD), multiple system atrophy (MSA), or dementia with Lewy bodies (DLB). The clinical features, the main differential diagnoses, the risk factors for "phenoconversion" to another synucleinopathy as well as an overview of treatment will be discussed.
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Affiliation(s)
- A Pavy-Le Traon
- Neurology department, French reference center for Multiple System Atrophy, CHU de Toulouse, Toulouse, France; I2MC Institute-Inserm U1297, Toulouse, France
| | - A Foubert-Samier
- Bordeaux University, Inserm, Bordeaux Population Health Research Center, UMR1219, Bordeaux, France; Neurodegenerative Diseases Neurology Department, CHU de Bordeaux, IMNc, CRMR AMS, Bordeaux, France; Bordeaux University, CNRS, IMN, UMR 5293, Bordeaux, France
| | - M Fabbri
- Neurology department, French reference center for Multiple System Atrophy, CHU de Toulouse, Toulouse, France; Department of Clinical Pharmacology and Neurosciences, Toulouse Parkinson Expert Centre, Toulouse NeuroToul Center of Excellence in Neurodegeneration (COEN), French NS-Park/F-CRIN Network, University of Toulouse 3, CHU of Toulouse, Inserm, Toulouse, France
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Strumia M, Vidal JS, Cestac P, Sallerin B, Hanon O, Rouch L. Orthostatic hypotension and orthostatic hypertension are both associated with lower cognitive function: The S.AGES cohort. J Am Geriatr Soc 2023; 71:3721-3730. [PMID: 37655948 DOI: 10.1111/jgs.18571] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/21/2022] [Revised: 05/22/2023] [Accepted: 07/02/2023] [Indexed: 09/02/2023]
Abstract
BACKGROUND Blood pressure (BP) postural changes, both orthostatic hypotension (OHYPO) and orthostatic hypertension (OHYPER) are common in older adults. Few studies have investigated their association with cognition, particularly for OHYPER, an emerging cardiovascular risk factor. We aimed to assess the association between OHYPO, OHYPER and cognition in non-institutionalized older subjects. METHODS The S.AGES (Sujets ÂGES, Aged Subjects) cohort followed every 6 months for 3 years non-institutionalized subjects aged ≥65 years without dementia at inclusion, in France. OHYPO and OHYPER were respectively defined as a fall or an increase of ≥20 mmHg in systolic BP and/or ≥10 mmHg in diastolic BP after standing from a sitting position. Cognition was assessed using the Mini-Mental State Examination (MMSE). Linear mixed models were used for the analyses. RESULTS Among the 3170 subjects included (mean age 78 years, 56% women), 209 (6.5%) had OHYPO and 226 (7.1%) had OHYPER at baseline. After adjustment for demographics, cardiovascular risk factors and disease, seated SBP/DBP and BP lowering treatment, mean MMSE was 0.52 point lower in participants with OHYPER compared to those with normal BP postural changes (β adjusted [95% CI] = -0.52 [-0.96; -0.09], p = 0.02) and 0.50 point lower in participants with OHYPO compared to those with normal BP postural changes (β adjusted [95% CI] = -0.50 [-0.95; -0.06], p = 0.03). Sensitivity analyses showed a dose-response relationship between OHYPO and cognition. CONCLUSION Although the absolute differences in MMSE were small, both OHYPO and OHYPER were associated with lower cognition. Orthostatic BP measurements could help identify patients with risk of cognitive impairment. Further studies are needed to assess whether controlling orthostatic BP could be a promising interventional target in preserving cognition among older adults.
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Affiliation(s)
- M Strumia
- Maintain Aging Research Team, CERPOP, Université de Toulouse, Inserm, Université Paul Sabatier, Toulouse, France
- Département de pharmacie Clinique, pôle gériatrie, Centre Hospitalier Universitaire de Toulouse, Toulouse, France
| | - J S Vidal
- EA 4468, Université de Paris, Paris, France
- Service de gériatrie, Hôpital Broca, AP-HP, Hôpitaux Universitaires Paris Centre, Paris, France
| | - P Cestac
- Maintain Aging Research Team, CERPOP, Université de Toulouse, Inserm, Université Paul Sabatier, Toulouse, France
- Département de pharmacie Clinique, pôle gériatrie, Centre Hospitalier Universitaire de Toulouse, Toulouse, France
| | - B Sallerin
- Département de pharmacie Clinique, pôle gériatrie, Centre Hospitalier Universitaire de Toulouse, Toulouse, France
- RESTORE UMR 1301, Inserm 5070, CNRS EFS, équipe FLAMES, Université Paul Sabatier, Toulouse, France
| | - O Hanon
- EA 4468, Université de Paris, Paris, France
- Service de gériatrie, Hôpital Broca, AP-HP, Hôpitaux Universitaires Paris Centre, Paris, France
| | - L Rouch
- Maintain Aging Research Team, CERPOP, Université de Toulouse, Inserm, Université Paul Sabatier, Toulouse, France
- Département de pharmacie Clinique, pôle gériatrie, Centre Hospitalier Universitaire de Toulouse, Toulouse, France
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Petriceks AH, Appel LJ, Miller ER, Mitchell CM, Schrack JA, Mukamal KJ, Lipsitz LA, Wanigatunga AA, Plante TB, Michos ED, Juraschek SP. Timing of orthostatic hypotension and its relationship with falls in older adults. J Am Geriatr Soc 2023; 71:3711-3720. [PMID: 37668347 PMCID: PMC10842425 DOI: 10.1111/jgs.18573] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/07/2023] [Revised: 06/22/2023] [Accepted: 07/01/2023] [Indexed: 09/06/2023]
Abstract
BACKGROUND There is inconsistent evidence on the optimal time after standing to assess for orthostatic hypotension. We determined the prevalence of orthostatic hypotension at different time points after standing in a population of older adults, as well as fall risk and symptoms associated with orthostatic hypotension. METHODS We performed a secondary analysis of the Study to Understand Fall Reduction and Vitamin D in You (STURDY), a randomized clinical trial funded by the National Institute on Aging, testing the effect of differing vitamin D3 doses on fall risk in older adults. STURDY occurred between July 2015 and May 2019. Secondary analysis occurred in 2022. Participants were community-dwelling adults, 70 years or older. In the orthostatic hypotension assessment, participants stood upright from supine position and underwent six standing blood pressure measurements (M1-M6) in two clusters of three measurements (immediately and 3 min after standing). Cox proportional hazard models were used to examine the relationship between orthostatic hypotension at each measurement and subsequent falls. Participants were followed until the earlier of their 24-month visit or study completion. RESULTS Orthostatic hypotension occurred in 32% of assessments at M1, and only 16% at M5 and M6. Orthostatic hypotension from average immediate (M1-3) and average delayed (M4-6) measurements, respectively, predicted higher fall risk (M1-3 = 1.65 [1.08, 2.52]; M4-6 = 1.73 [1.03, 2.91]) (hazard ratio [95% confidence interval]). However, among individual measurements, only orthostatic hypotension at M5 (1.84 [1.16, 2.93]) and M6 (1.85 [1.17, 2.91]) predicted higher fall risk. Participants with orthostatic hypotension at M1 (3.07 [1.48, 6.38]) and M2 (3.72 [1.72, 8.03]) were more likely to have reported orthostatic symptoms. CONCLUSIONS Orthostatic hypotension was most prevalent and symptomatic immediately within 1-2 min after standing, but more informative for fall risk after 4.5 min. Clinicians may consider both intervals when assessing for orthostatic hypotension.
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Affiliation(s)
- Aldis H. Petriceks
- Harvard Medical School, Boston, Massachusetts, USA
- Columbia University Mailman School of Public Health, New York, New York, USA
| | - Lawrence J. Appel
- The Johns Hopkins University School of Medicine, Baltimore, Maryland, USA
- The Welch Center for Prevention, Epidemiology and Clinical Research, Johns Hopkins University, Baltimore, Maryland, USA
- Bloomberg School of Public Health, Johns Hopkins University, Baltimore, Maryland, USA
| | - Edgar R. Miller
- The Johns Hopkins University School of Medicine, Baltimore, Maryland, USA
- The Welch Center for Prevention, Epidemiology and Clinical Research, Johns Hopkins University, Baltimore, Maryland, USA
- Bloomberg School of Public Health, Johns Hopkins University, Baltimore, Maryland, USA
| | - Christine M. Mitchell
- Bloomberg School of Public Health, Johns Hopkins University, Baltimore, Maryland, USA
| | - Jennifer A. Schrack
- Bloomberg School of Public Health, Johns Hopkins University, Baltimore, Maryland, USA
| | - Kenneth J. Mukamal
- Harvard Medical School, Boston, Massachusetts, USA
- Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, Massachusetts, USA
| | - Lewis A. Lipsitz
- Harvard Medical School, Boston, Massachusetts, USA
- Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, Massachusetts, USA
- Hinda and Arthur Marcus Institute for Aging Research, Hebrew SeniorLife, Boston, Massachusetts, USA
| | - Amal A. Wanigatunga
- Bloomberg School of Public Health, Johns Hopkins University, Baltimore, Maryland, USA
| | - Timothy B. Plante
- The Welch Center for Prevention, Epidemiology and Clinical Research, Johns Hopkins University, Baltimore, Maryland, USA
- Larner College of Medicine at the University of Vermont, Burlington, Vermont, USA
| | - Erin D. Michos
- The Johns Hopkins University School of Medicine, Baltimore, Maryland, USA
- Bloomberg School of Public Health, Johns Hopkins University, Baltimore, Maryland, USA
| | - Stephen P. Juraschek
- Harvard Medical School, Boston, Massachusetts, USA
- Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, Massachusetts, USA
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Earle WB, Kondo JK, Kendrick KN, Turkson-Ocran RA, Ngo L, Cluett JL, Mukamal KJ, Daya Malek N, Selvin E, Lutsey PL, Coresh J, Juraschek SP. Association of Supine Hypertension Versus Standing Hypotension With Adverse Events Among Middle-Aged Adults. Hypertension 2023; 80:2437-2446. [PMID: 37646155 PMCID: PMC10640713 DOI: 10.1161/hypertensionaha.123.21215] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/13/2023] [Accepted: 08/10/2023] [Indexed: 09/01/2023]
Abstract
BACKGROUND Management of orthostatic hypotension (OH) prioritizes prevention of standing hypotension, sometimes at the expense of supine hypertension. It is unclear whether supine hypertension is associated with adverse outcomes relative to standing hypotension. OBJECTIVES To compare the long-term clinical consequences of supine hypertension and standing hypotension among middle-aged adults with and without OH. METHODS The ARIC study (Atherosclerosis Risk in Communities) measured supine and standing blood pressure (BP) in adults aged 45 to 64 years, without neurogenic OH, between 1987 and 1989. We defined OH as a positional drop in systolic BP ≥20 mm Hg or diastolic BP ≥10 mm Hg, supine hypertension as supine BP≥140/≥90 mm Hg, and standing hypotension as standing BP≤105/≤65 mm Hg. Participants were followed for >30 years. We used Cox regression models to examine associations with cardiovascular disease events, all-cause mortality, falls, and syncope. RESULTS Of 12 489 participants (55% female, 26% Black, mean age 54 years, SD 6), 4.4% had OH. Among those without OH (N=11 943), 19% had supine hypertension and 21% had standing hypotension, while among those with OH (N=546), 58% had supine hypertension and 38% had standing hypotension. Associations with outcomes did not differ by OH status (P-interactions >0.25). Supine hypertension was associated with heart failure (hazard ratio, 1.83 [95% CI, 1.68-1.99]), falls (hazard ratio, 1.12 [95% CI, 1.02-1.22]), and all-cause mortality (hazard ratio, 1.45 [95% CI, 1.37-1.54]), while standing hypotension was only significantly associated with mortality (hazard ratio, 1.06 [95% CI, 1.00-1.14]). CONCLUSIONS Supine hypertension was associated with higher risk of adverse events than standing hypotension, regardless of OH status. This challenges conventional OH management, which prioritizes standing hypotension over supine hypertension.
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Affiliation(s)
- William B Earle
- Department of Medicine, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA (W.B.E., J.K.K., K.N.K., R.-A.T.-O., L.N., J.L.C., K.J.M., S.P.J.)
| | - Jordan K Kondo
- Department of Medicine, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA (W.B.E., J.K.K., K.N.K., R.-A.T.-O., L.N., J.L.C., K.J.M., S.P.J.)
| | - Karla N Kendrick
- Department of Medicine, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA (W.B.E., J.K.K., K.N.K., R.-A.T.-O., L.N., J.L.C., K.J.M., S.P.J.)
| | - Ruth-Alma Turkson-Ocran
- Department of Medicine, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA (W.B.E., J.K.K., K.N.K., R.-A.T.-O., L.N., J.L.C., K.J.M., S.P.J.)
| | - Long Ngo
- Department of Medicine, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA (W.B.E., J.K.K., K.N.K., R.-A.T.-O., L.N., J.L.C., K.J.M., S.P.J.)
| | - Jennifer L Cluett
- Department of Medicine, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA (W.B.E., J.K.K., K.N.K., R.-A.T.-O., L.N., J.L.C., K.J.M., S.P.J.)
| | - Kenneth J Mukamal
- Department of Medicine, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA (W.B.E., J.K.K., K.N.K., R.-A.T.-O., L.N., J.L.C., K.J.M., S.P.J.)
| | - Natalie Daya Malek
- Department of Epidemiology and the Welch Center for Prevention, Epidemiology and Clinical Research, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD (N.D.M., E.S., J.C.)
| | - Elizabeth Selvin
- Department of Epidemiology and the Welch Center for Prevention, Epidemiology and Clinical Research, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD (N.D.M., E.S., J.C.)
| | - Pamela L Lutsey
- Division of Epidemiology and Community Health, University of Minnesota, Minneapolis, MN (P.L.L.)
| | - Josef Coresh
- Department of Epidemiology and the Welch Center for Prevention, Epidemiology and Clinical Research, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD (N.D.M., E.S., J.C.)
| | - Stephen P Juraschek
- Department of Medicine, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA (W.B.E., J.K.K., K.N.K., R.-A.T.-O., L.N., J.L.C., K.J.M., S.P.J.)
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Wiersinga JHI, Rhodius-Meester HFM, Wolters FJ, Trappenburg MC, Lemstra AW, Barkhof F, Peters MJL, van der Flier WM, Muller M. Orthostatic hypotension and its association with cerebral small vessel disease in a memory clinic population. J Hypertens 2023; 41:1738-1744. [PMID: 37589676 DOI: 10.1097/hjh.0000000000003525] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 08/18/2023]
Abstract
BACKGROUND Orthostatic hypotension (OH), an impaired blood pressure (BP) response to postural change, has been associated with cognitive decline and dementia, possibly through cerebral small vessel disease (CSVD). We hypothesized that longer duration of BP drop and a larger BP drop is associated with increased risk of CSVD. METHODS This cross-sectional study included 3971 memory clinic patients (mean age 68 years, 45% female, 42% subjective cognitive complaints, 17% mild cognitive impairment, 41% dementia) from the Amsterdam Ageing Cohort and Amsterdam Dementia Cohort. Early OH (EOH) was defined as a drop in BP of ±20 mmHg systolic and/or 10 mmHg diastolic only at 1 min after standing, and delayed/prolonged OH (DPOH) at 1 and/or 3 min after standing. Presence of CSVD [white matter hyperintensities (WMH), lacunes, microbleeds] was assessed with MRI ( n = 3584) or CT brain (n = 389). RESULTS The prevalence of early OH was 9% and of delayed/prolonged OH 18%. Age- and sex-adjusted logistic regression analyses showed that delayed/prolonged OH, but not early OH, was significantly associated with a higher burden of WMH (OR, 95%CI: 1.21, 1.00-1.46) and lacunes (OR, 95%CI 1.34, 1.06-1.69), but not microbleeds (OR, 95%CI 1.22, 0.89-1.67). When adjusting for supine SBP, these associations attenuated (ORs, 95%CI for WMH 1.04, 0.85-1.27; for lacunes 1.21, 0.91-1.62; for microbleeds 0.95, 0.68-1.31). A larger drop in SBP was associated with increased risk of WMH and microbleeds, however, when adjusted for supine SBP, this effect diminished. CONCLUSIONS Among memory clinic patients, DPOH is more common than EOH. While longer duration and larger magnitude of BP drop coincided with a higher burden of CSVD, these associations were largely explained by high supine BP.
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Affiliation(s)
- Julia H I Wiersinga
- Amsterdam UMC location Vrije Universiteit Amsterdam, Department of Internal Medicine section Geriatrics
- Amsterdam Cardiovascular Sciences, Atherosclerosis & Ischemic Syndromes
| | - Hanneke F M Rhodius-Meester
- Amsterdam UMC location Vrije Universiteit Amsterdam, Department of Internal Medicine section Geriatrics
- Amsterdam UMC location Vrije Universiteit Amsterdam, Alzheimer Center Amsterdam & Department of Neurology, Amsterdam, The Netherlands
- Oslo University Hospital, Department of Geriatric Medicine, Ullevål, Oslo, Norway
| | - Frank J Wolters
- Erasmus Medical Center, Department of Epidemiology, Rotterdam
- Erasmus Medical Center, Departments of Radiology & Nuclear Medicine and Alzheimer Center Erasmus MC, Rotterdam, The Netherlands
| | - Marijke C Trappenburg
- Amsterdam UMC location Vrije Universiteit Amsterdam, Department of Internal Medicine section Geriatrics
- Amstelland Hospital, Department of Internal Medicine section Geriatrics, Amstelveen
- Amsterdam UMC location Vrije Universiteit Amsterdam, Department of Radiology, Amsterdam, The Netherlands
| | - Afina W Lemstra
- Amsterdam UMC location Vrije Universiteit Amsterdam, Alzheimer Center Amsterdam & Department of Neurology, Amsterdam, The Netherlands
| | - Frederik Barkhof
- Amsterdam UMC location Vrije Universiteit Amsterdam, Alzheimer Center Amsterdam & Department of Neurology, Amsterdam, The Netherlands
- Centre for Medical Image Computing, Department of Medical Physics and Biomedical Engineering, University College London, London, UK
- Amsterdam Neuroscience, Neurodegeneration, Brain Imaging, Amsterdam
| | - Mike J L Peters
- UMC Utrecht, University of Utrecht, Department of Internal Medicine section Geriatrics, Utrecht
| | - Wiesje M van der Flier
- Amsterdam UMC location Vrije Universiteit Amsterdam, Alzheimer Center Amsterdam & Department of Neurology, Amsterdam, The Netherlands
- Amsterdam Neuroscience, Neurodegeneration, Brain Imaging, Amsterdam
- Amsterdam UMC location Vrije Universiteit Amsterdam, Department of Epidemiology and Biostatistics, Amsterdam
| | - Majon Muller
- Amsterdam UMC location Vrije Universiteit Amsterdam, Department of Internal Medicine section Geriatrics
- Amsterdam Cardiovascular Sciences, Atherosclerosis & Ischemic Syndromes
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van der Stam AH, Shmuely S, de Vries NM, Bloem BR, Thijs RD. The Impact of Head-Up Tilt Sleeping on Orthostatic Tolerance: A Scoping Review. BIOLOGY 2023; 12:1108. [PMID: 37626994 PMCID: PMC10452159 DOI: 10.3390/biology12081108] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/11/2023] [Revised: 07/31/2023] [Accepted: 08/03/2023] [Indexed: 08/27/2023]
Abstract
To systematically summarize the evidence of head-up tilt sleeping (HUTS) on orthostatic tolerance, we conducted a systematic, predefined search in PubMed, OVID Embase, Cochrane and Web of Science. We included studies assessing the effect of HUTS on orthostatic tolerance and other cardiovascular measures and rated the quality with the American Academy of Neurology risk of bias tool. We included 10 studies (n = 185) in four groups: orthostatic hypotension (OH; 6 studies, n = 103), vasovagal syncope (1 study, n = 12), nocturnal angina pectoris (1 study, n = 10) and healthy subjects (2 studies, n = 58). HUTS duration varied (1 day-4 months) with variable inclinations (5°-15°). In two of six OH studies, HUTS significantly improved standing systolic blood pressure. Orthostatic tolerance was consistently enhanced in OH studies with higher angles (≥12°), in 2 out of 3 with smaller angles (5°) but also in one studying horizontal sleeping. In vasovagal syncope, HUTS significantly augmented resilience to extreme orthostatic stress. One study was rated as a class II risk of bias, one of Class II/III and eight of Class IV. The evidence favouring HUTS to improve orthostatic tolerance is weak due to variable interventions, populations, small samples and a high risk of bias. Despite this, we found some physiological signs suggesting a beneficial effect.
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Affiliation(s)
- Amber H. van der Stam
- Department of Neurology, Donders Institute for Brain Cognition and Behavior, Radboud University Medical Center, 6500 HB Nijmegen, The Netherlands; (A.H.v.d.S.); (S.S.); (N.M.d.V.); (B.R.B.)
| | - Sharon Shmuely
- Department of Neurology, Donders Institute for Brain Cognition and Behavior, Radboud University Medical Center, 6500 HB Nijmegen, The Netherlands; (A.H.v.d.S.); (S.S.); (N.M.d.V.); (B.R.B.)
| | - Nienke M. de Vries
- Department of Neurology, Donders Institute for Brain Cognition and Behavior, Radboud University Medical Center, 6500 HB Nijmegen, The Netherlands; (A.H.v.d.S.); (S.S.); (N.M.d.V.); (B.R.B.)
| | - Bastiaan R. Bloem
- Department of Neurology, Donders Institute for Brain Cognition and Behavior, Radboud University Medical Center, 6500 HB Nijmegen, The Netherlands; (A.H.v.d.S.); (S.S.); (N.M.d.V.); (B.R.B.)
| | - Roland D. Thijs
- Department of Neurology, Leiden University Medical Centre, 2300 RC Leiden, The Netherlands
- Stichting Epilepsie Instellingen Nederland, 2130 AM Hoofddorp, The Netherlands
- UCL Queen Square Institute of Neurology, University College London, London WC1N 1PJ, UK
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Inui H, Sakamoto T, Ueda K, Ito T, Kitahara T. Volume ratio and distribution rate in patients with orthostatic vertigo/dizziness using MR imaging: a comparison with vertiginous diseases. Acta Otolaryngol 2023; 143:631-635. [PMID: 37537926 DOI: 10.1080/00016489.2023.2238760] [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: 05/16/2023] [Accepted: 07/11/2023] [Indexed: 08/05/2023]
Abstract
BACKGROUND Orthostatic dizziness/vertigo (ODV) is characterized by lightheadedness owing to postural changes. AIMS/OBJECTIVES To measure the endolymphatic space (ELS)/total fluid space (TFS) volume ratio and the distribution rate of endolymphatic fluid (ELF) of patients with ODV and compare them with those of control subjects (CS). MATERIALS AND METHODS This study included 22 patients (44 ears) with ODV and 52 controls (104 ears, CS). The ELS/TFS volume ratio (%) and distribution rate (%) of the inner ear components were measured using 3-dimensional magnetic resonance imaging. RESULTS In the ODV group, the mean ELS/TFS volume ratios of the cochlea, vestibule, and semi-circular canals (SCCs) were 12.1%, 18.6%, and 18.1%, respectively; the mean ELS distribution rates for the cochlea, vestibule, and SCCs were 27.3%, 26.2%, and 46.6%, respectively. The ELS distribution rate of the vestibule was significantly lower (p < .01) and the ELS distribution rate of the SCCs was significantly higher in the ODV than in the CS group (p < .01). CONCLUSIONS AND SIGNIFICANCE The ELS distribution rate in the vestibule + SCCs among patients with ODV did not differ from that in the CS; ELF in the vestibule moved to the SCCs, and a large amount of ELF was distributed only in the SCCs.
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Affiliation(s)
| | | | - Keita Ueda
- Department of Otorhinolaryngology-Head and Neck Surgery, Nara Medical University, Kashihara, Nara, Japan
| | - Taeko Ito
- Department of Otorhinolaryngology-Head and Neck Surgery, Nara Medical University, Kashihara, Nara, Japan
| | - Tadashi Kitahara
- Department of Otorhinolaryngology-Head and Neck Surgery, Nara Medical University, Kashihara, Nara, Japan
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Abubakar M, Prasad R, Salim SS, Basavaraju D, Khan M, Lateef IK, Furqan A, Raza S, Gupta I, Singla D, Adil H, Naeem A. Orthostatic Hypotension in Benign Prostatic Hyperplasia Patients and Its Association With Alpha-1 Antagonist Use: A Comprehensive Literature Review. Cureus 2023; 15:e44097. [PMID: 37750139 PMCID: PMC10518119 DOI: 10.7759/cureus.44097] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 08/25/2023] [Indexed: 09/27/2023] Open
Abstract
Orthostatic hypotension (OH) is frequently observed in benign prostatic hyperplasia (BPH) patients undergoing alpha-1 adrenergic antagonist (A1AA) therapy. While previous studies have acknowledged the prevalence of OH in BPH patients on A1AAs, limited data exist on ranking the safety of different A1AAs. This comprehensive review explores the underlying mechanisms of OH, examines numerous factors influencing its development, and provides insights into effective treatment strategies such as hydration, gradual postural changes, leg exercises, compression stockings, and tilt-table training for BPH management. The review highlights the significance of individualized care, interdisciplinary collaboration, and further research to optimize A1AA treatment, improve patient outcomes, and enhance quality of life.
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Affiliation(s)
- Muhammad Abubakar
- Department of Internal Medicine, Siddique Sadiq Memorial Trust Hospital, Gujranwala, PAK
- Department of Internal Medicine, Ameer-ud-Din Medical College, Lahore General Hospital, Lahore, PAK
| | - Rachna Prasad
- Department of Internal Medicine, Stanley Medical College, Chennai, IND
| | - Siffat S Salim
- Department of Surgery, Holy Family Red Crescent Medical College Hospital, Dhaka, BGD
| | - Deepak Basavaraju
- Department of Internal Medicine, Mysore Medical College and Research Institute, Mysore, IND
| | - Munazza Khan
- Department of Internal Medicine, Medical University Pleven, Pleven, BGR
| | - Ibrahim K Lateef
- Department of Internal Medicine, Medical University Pleven, Pleven, BGR
| | - Ahmad Furqan
- Department of Internal Medicine, Lahore Medical and Dental College, Lahore, PAK
| | - Saud Raza
- Department of Internal Medicine, Ameer-ud-Din Medical College, Lahore General Hospital, Lahore, PAK
| | - Ishita Gupta
- Department of Internal Medicine, Dr. Baba Saheb Ambedkar Medical College and Hospital, New Delhi, IND
| | - Deepak Singla
- Department of Internal Medicine, Government Medical College, Patiala, Patiala, IND
| | - Hira Adil
- Department of Community Medicine, Khyber Girls Medical College, Peshawar, PAK
| | - Ather Naeem
- Department of Cardiology, Punjab Institute of Cardiology, Lahore, PAK
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Torres RD, Rashed H, Mathur P, Castillo C, Abell T, Terson de Paleville DGL. Autogenic biofeedback training improves autonomic responses in a participant with cervical motor complete spinal cord injury- case report. Spinal Cord Ser Cases 2023; 9:31. [PMID: 37438337 PMCID: PMC10338546 DOI: 10.1038/s41394-023-00593-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/06/2022] [Revised: 06/27/2023] [Accepted: 07/04/2023] [Indexed: 07/14/2023] Open
Abstract
STUDY DESIGN Single-subject case design OBJECTIVE: To evaluate the Autogenic Feedback Training Exercise (AFTE) on autonomic nervous system responses. INTRODUCTION AFTE combines specific autogenic exercises with biofeedback of multiple physiological responses. Originally developed by the National Aeronautics and Space Administration (NASA), AFTE is used to improve post-flight orthostatic intolerance and motion sickness in astronauts. Individuals with cervical or upper thoracic spinal cord injury (SCI) often present symptoms of autonomic dysfunction similar to astronauts. We hypothesize that AFTE challenges nervous system baroreflex, gastric and vascular responses often impaired after SCI. METHODS Using a modified AFTE protocol, we trained a hypotensive female participant with cervical motor complete (C5/6-AIS A) SCI, and a male non-injured control participant (NI) and measured blood pressure (BP), heart rate (HR), gastric electrical activity, and microvascular blood volume before, during and after AFTE. The participants were instructed to complete breathing and imagery exercises to help facilitate relaxation. Subsequently, they were instructed to use stressful imagery and breathing exercises during arousal trials. RESULTS Both participants completed 8 sessions of approximately 45 min each. Microvascular blood volume decreased 23% (SCI) and 54% (NI) from the beginning to the end of the stimulation cycles. The participant with SCI became progressively more normotensive and improved levels of gastric electrical activity, while the NI participant's changes in HR, gastric electrical activity, and BP were negligible. CONCLUSIONS AFTE may offer a novel non-pharmacologic intervention to minimize symptoms of dysautonomia in people with SCI.
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Affiliation(s)
- Rachel D Torres
- Interdisciplinary Program in Translational Neuroscience, University of Louisville, Louisville, KY, USA
| | - Hani Rashed
- Division of Gastroenterology, Hepatology & Nutrition, Vanderbilt University Medical Center, Nashville, TN, USA
| | - Prateek Mathur
- Division of Gastroenterology, Hepatology and Nutrition, University of Louisville, Louisville, KY, USA
| | - Camilo Castillo
- Division of Physical Medicine and Rehabilitation, University of Louisville, Louisville, KY, USA
| | - Thomas Abell
- Division of Gastroenterology, Hepatology and Nutrition, University of Louisville, Louisville, KY, USA
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Su D, Zhang X, Su Y, Chan P, Xu E. Effects of different levodopa doses on blood pressure in older patients with early and middle stages of Parkinson's disease. Heliyon 2023; 9:e17876. [PMID: 37483692 PMCID: PMC10362309 DOI: 10.1016/j.heliyon.2023.e17876] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/25/2022] [Revised: 05/03/2023] [Accepted: 06/29/2023] [Indexed: 07/25/2023] Open
Abstract
Objective Levodopa is the first-line treatment for patients with Parkinson's disease (PD). However, only a few studies have focused on the tolerance of this drug in older patients with PD in the early and middle stages. Therefore, this study aimed to explore the effects of different levodopa doses on blood pressure (BP) in this subpopulation. Methods This cohort analysis enrolled 83 patients. The levodopa challenge test was used to evaluate drug responsiveness. After at least 12 h following anti-PD drug discontinuation, patients' BPs were measured in a lying position, after 1 min standing, and after 3 min standing, in "off state" and best "on state." Results BP in the 250 mg and 375 mg levodopa/benserazide groups decreased significantly in the lying and standing positions. The 3-min standing-position systolic BP was significantly influenced by the dose of levodopa/benserazide. However, no statistical change was observed in the 125 mg group. The postural-mediated systolic BP disparity was significant at 3 min in the upright position. Nineteen (incidence, 22.9%) and Twenty-five patients (incidence, 30.1%) developed complications of orthostatic hypotension (OH) in the "off state" and best "on state," respectively. Mild cognitive impairment was a risk factor for OH occurrence in the "off state." The OH occurrence in the best "on state" was associated with OH in the "off state" and urinary incontinence. Conclusion Our findings suggest that 250 mg or more of levodopa/benserazide could significantly reduce BP and orthostatic effect in older patients with PD in the early and middle stages. Therefore, they should routinely monitor their BP. Trial registration number ChiCTR2200055707.
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Affiliation(s)
- Dan Su
- Department of Geriatrics, Liangxiang Hospital of Beijing Fangshan District, Beijing 102400, China
- National Clinical Research Center for Geriatric Disorders, Xuanwu Hospital of Capital Medical University, Beijing 100053, China
| | - Xiaojun Zhang
- Department of Geriatrics, Occupational Disease Prevention and Control Institute of Chemical Industry, Beijing 100093, China
| | - Yanling Su
- Department of Geriatrics, Liangxiang Hospital of Beijing Fangshan District, Beijing 102400, China
| | - Piu Chan
- National Clinical Research Center for Geriatric Disorders, Xuanwu Hospital of Capital Medical University, Beijing 100053, China
- Clinical Center for Parkinson's Disease, Parkinson Disease Center of Beijing Institute for Brain Disorders, Beijing 100053, China
| | - Erhe Xu
- Department of Neurology, Xuanwu Hospital of Capital Medical University, Beijing 100053, China
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Zhang L, Hou Y, Wei Q, Ou R, Liu K, Lin J, Yang T, Xiao Y, Zhao B, Shang H. Diagnostic utility of movement disorder society criteria for multiple system atrophy. Front Aging Neurosci 2023; 15:1200563. [PMID: 37396656 PMCID: PMC10310919 DOI: 10.3389/fnagi.2023.1200563] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/05/2023] [Accepted: 05/26/2023] [Indexed: 07/04/2023] Open
Abstract
Background The 2008 criteria for the diagnosis of multiple system atrophy (MSA) has been widely used for more than 10 years, but the sensitivity is low, particularly for patients in the early stage. Recently, a new MSA diagnostic criteria was developed. Objective The objective of the study was to assess and compare the diagnostic utility of the new movement disorder society (MDS) MSA criteria with the 2008 MSA criteria. Methods This study included patients diagnosed with MSA between January 2016 and October 2021. All patients underwent regular face-to-face or telephonic follow-ups every year until October 2022. A total of 587 patients (309 males and 278 females) were retrospectively reviewed to compare the diagnostic accuracy of the MDS MSA criteria to that of the 2008 MSA criteria (determined by the proportion of patients categorized as established or probable MSA). Autopsy is the gold standard diagnosis of MSA, which is not available in clinical practice. Thus, we applied the 2008 MSA criteria at the last review as the reference standard. Results The sensitivity of the MDS MSA criteria (93.2%, 95% CI = 90.5-95.2%) was significantly higher than that of the 2008 MSA criteria (83.5%, 95% CI = 79.8-86.6%) (P < 0.001). Additionally, the sensitivity of the MDS MSA criteria was maintained robustly across different subgroups, defined by diagnostic subtype, disease duration, and the type of symptom[s] at onset. Importantly, the specificities were not significantly different between the MDS MSA criteria and the 2008 MSA criteria (P > 0.05). Conclusion The present study demonstrated that the MDS MSA criteria exhibited good diagnostic utility for MSA. The new MDS MSA criteria should be considered as a useful diagnostic tool for clinical practice and future therapeutic trials.
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Sainbhi AS, Vakitbilir N, Gomez A, Stein KY, Froese L, Zeiler FA. Non-Invasive Mapping of Cerebral Autoregulation Using Near-Infrared Spectroscopy: A Study Protocol. Methods Protoc 2023; 6:58. [PMID: 37368002 DOI: 10.3390/mps6030058] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/17/2023] [Revised: 05/18/2023] [Accepted: 06/06/2023] [Indexed: 06/28/2023] Open
Abstract
The ability of cerebral vessels to maintain a fairly constant cerebral blood flow is referred to as cerebral autoregulation (CA). Using near-infrared spectroscopy (NIRS) paired with arterial blood pressure (ABP) monitoring, continuous CA can be assessed non-invasively. Recent advances in NIRS technology can help improve the understanding of continuously assessed CA in humans with high spatial and temporal resolutions. We describe a study protocol for creating a new wearable and portable imaging system that derives CA maps of the entire brain with high sampling rates at each point. The first objective is to evaluate the CA mapping system's performance during various perturbations using a block-trial design in 50 healthy volunteers. The second objective is to explore the impact of age and sex on regional disparities in CA using static recording and perturbation testing in 200 healthy volunteers. Using entirely non-invasive NIRS and ABP systems, we hope to prove the feasibility of deriving CA maps of the entire brain with high spatial and temporal resolutions. The development of this imaging system could potentially revolutionize the way we monitor brain physiology in humans since it would allow for an entirely non-invasive continuous assessment of regional differences in CA and improve our understanding of the impact of the aging process on cerebral vessel function.
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Affiliation(s)
- Amanjyot Singh Sainbhi
- Department of Biomedical Engineering, Price Faculty of Engineering, University of Manitoba, Winnipeg, MB R3T 5V6, Canada
| | - Nuray Vakitbilir
- Department of Biomedical Engineering, Price Faculty of Engineering, University of Manitoba, Winnipeg, MB R3T 5V6, Canada
| | - Alwyn Gomez
- Section of Neurosurgery, Department of Surgery, Rady Faculty of Health Sciences, University of Manitoba, Winnipeg, MB R3A 1R9, Canada
- Department of Human Anatomy and Cell Science, Rady Faculty of Health Sciences, University of Manitoba, Winnipeg, MB R3E 0J9, Canada
| | - Kevin Y Stein
- Department of Biomedical Engineering, Price Faculty of Engineering, University of Manitoba, Winnipeg, MB R3T 5V6, Canada
| | - Logan Froese
- Department of Biomedical Engineering, Price Faculty of Engineering, University of Manitoba, Winnipeg, MB R3T 5V6, Canada
| | - Frederick A Zeiler
- Department of Biomedical Engineering, Price Faculty of Engineering, University of Manitoba, Winnipeg, MB R3T 5V6, Canada
- Section of Neurosurgery, Department of Surgery, Rady Faculty of Health Sciences, University of Manitoba, Winnipeg, MB R3A 1R9, Canada
- Department of Human Anatomy and Cell Science, Rady Faculty of Health Sciences, University of Manitoba, Winnipeg, MB R3E 0J9, Canada
- Centre on Aging, University of Manitoba, Winnipeg, MB R3T 2N2, Canada
- Division of Anaesthesia, Department of Medicine, Addenbrooke's Hospital, University of Cambridge, Cambridge CB2 0QQ, UK
- Department of Clinical Neuroscience, Karolinska Institutet, 171 77 Stockholm, Sweden
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Huang B, Chau SWH, Liu Y, Chan JWY, Wang J, Ma SL, Zhang J, Chan PKS, Yeoh YK, Chen Z, Zhou L, Wong SH, Mok VCT, To KF, Lai HM, Ng S, Trenkwalder C, Chan FKL, Wing YK. Gut microbiome dysbiosis across early Parkinson's disease, REM sleep behavior disorder and their first-degree relatives. Nat Commun 2023; 14:2501. [PMID: 37130861 PMCID: PMC10154387 DOI: 10.1038/s41467-023-38248-4] [Citation(s) in RCA: 66] [Impact Index Per Article: 33.0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/29/2022] [Accepted: 04/21/2023] [Indexed: 05/04/2023] Open
Abstract
The microbiota-gut-brain axis has been suggested to play an important role in Parkinson's disease (PD). Here we performed a cross-sectional study to profile gut microbiota across early PD, REM sleep behavior disorder (RBD), first-degree relatives of RBD (RBD-FDR), and healthy controls, which could reflect the gut-brain staging model of PD. We show gut microbiota compositions are significantly altered in early PD and RBD compared with control and RBD-FDR. Depletion of butyrate-producing bacteria and enrichment of pro-inflammatory Collinsella have already emerged in RBD and RBD-FDR after controlling potential confounders including antidepressants, osmotic laxatives, and bowel movement frequency. Random forest modelling identifies 12 microbial markers that are effective to distinguish RBD from control. These findings suggest that PD-like gut dysbiosis occurs at the prodromal stages of PD when RBD develops and starts to emerge in the younger RBD-FDR subjects. The study will have etiological and diagnostic implications.
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Affiliation(s)
- Bei Huang
- Li Chiu Kong Family Sleep Assessment Unit, Department of Psychiatry, Faculty of Medicine, The Chinese University of Hong Kong, Hong Kong SAR, China
- Department of Psychiatry, Faculty of Medicine, The Chinese University of Hong Kong, Hong Kong SAR, China
| | - Steven W H Chau
- Li Chiu Kong Family Sleep Assessment Unit, Department of Psychiatry, Faculty of Medicine, The Chinese University of Hong Kong, Hong Kong SAR, China
- Department of Psychiatry, Faculty of Medicine, The Chinese University of Hong Kong, Hong Kong SAR, China
| | - Yaping Liu
- Li Chiu Kong Family Sleep Assessment Unit, Department of Psychiatry, Faculty of Medicine, The Chinese University of Hong Kong, Hong Kong SAR, China
- Department of Psychiatry, Faculty of Medicine, The Chinese University of Hong Kong, Hong Kong SAR, China
- Center for Sleep and Circadian Medicine, The Affiliated Brain Hospital of Guangzhou Medical University, Guangzhou, Guangdong, China
| | - Joey W Y Chan
- Li Chiu Kong Family Sleep Assessment Unit, Department of Psychiatry, Faculty of Medicine, The Chinese University of Hong Kong, Hong Kong SAR, China
- Department of Psychiatry, Faculty of Medicine, The Chinese University of Hong Kong, Hong Kong SAR, China
| | - Jing Wang
- Li Chiu Kong Family Sleep Assessment Unit, Department of Psychiatry, Faculty of Medicine, The Chinese University of Hong Kong, Hong Kong SAR, China
- Department of Psychiatry, Faculty of Medicine, The Chinese University of Hong Kong, Hong Kong SAR, China
- Center for Sleep and Circadian Medicine, The Affiliated Brain Hospital of Guangzhou Medical University, Guangzhou, Guangdong, China
| | - Suk Ling Ma
- Department of Psychiatry, Faculty of Medicine, The Chinese University of Hong Kong, Hong Kong SAR, China
| | - Jihui Zhang
- Li Chiu Kong Family Sleep Assessment Unit, Department of Psychiatry, Faculty of Medicine, The Chinese University of Hong Kong, Hong Kong SAR, China
- Department of Psychiatry, Faculty of Medicine, The Chinese University of Hong Kong, Hong Kong SAR, China
- Center for Sleep and Circadian Medicine, The Affiliated Brain Hospital of Guangzhou Medical University, Guangzhou, Guangdong, China
| | - Paul K S Chan
- Department of Microbiology, Faculty of Medicine, The Chinese University of Hong Kong, Hong Kong SAR, China
- Centre for Gut Microbiota Research, Faculty of Medicine, The Chinese University of Hong Kong, Hong Kong SAR, China
| | - Yun Kit Yeoh
- Department of Microbiology, Faculty of Medicine, The Chinese University of Hong Kong, Hong Kong SAR, China
| | - Zigui Chen
- Department of Microbiology, Faculty of Medicine, The Chinese University of Hong Kong, Hong Kong SAR, China
- Centre for Gut Microbiota Research, Faculty of Medicine, The Chinese University of Hong Kong, Hong Kong SAR, China
| | - Li Zhou
- Li Chiu Kong Family Sleep Assessment Unit, Department of Psychiatry, Faculty of Medicine, The Chinese University of Hong Kong, Hong Kong SAR, China
- Department of Psychiatry, Faculty of Medicine, The Chinese University of Hong Kong, Hong Kong SAR, China
| | - Sunny Hei Wong
- Institute of Digestive Disease, State Key Laboratory of Digestive Disease, Faculty of Medicine, The Chinese University of Hong Kong, Hong Kong SAR, China
- Department of Medicine and Therapeutics, Faculty of Medicine, The Chinese University of Hong Kong, Hong Kong SAR, China
- Centre for Microbiome Medicine, Lee Kong Chian School of Medicine, Nanyang Technological University, Singapore, Singapore
| | - Vincent C T Mok
- Department of Medicine and Therapeutics, Faculty of Medicine, The Chinese University of Hong Kong, Hong Kong SAR, China
- Li Ka Shing Institute of Health Sciences, Faculty of Medicine, The Chinese University of Hong Kong, Shatin, Hong Kong, China
- Margaret K.L. Cheung Research Centre for Management of Parkinsonism, Department of Medicine and Therapeutics, Faculty of Medicine, The Chinese University of Hong Kong, Hong Kong SAR, China
| | - Ka Fai To
- Centre for Gut Microbiota Research, Faculty of Medicine, The Chinese University of Hong Kong, Hong Kong SAR, China
- Institute of Digestive Disease, State Key Laboratory of Digestive Disease, Faculty of Medicine, The Chinese University of Hong Kong, Hong Kong SAR, China
- Department of Anatomical and Cellular Pathology, Faculty of Medicine, The Chinese University of Hong Kong, Hong Kong SAR, China
| | - Hei Ming Lai
- Department of Psychiatry, Faculty of Medicine, The Chinese University of Hong Kong, Hong Kong SAR, China
- Department of Medicine and Therapeutics, Faculty of Medicine, The Chinese University of Hong Kong, Hong Kong SAR, China
- Li Ka Shing Institute of Health Sciences, Faculty of Medicine, The Chinese University of Hong Kong, Shatin, Hong Kong, China
| | - Simon Ng
- Centre for Gut Microbiota Research, Faculty of Medicine, The Chinese University of Hong Kong, Hong Kong SAR, China
- Institute of Digestive Disease, State Key Laboratory of Digestive Disease, Faculty of Medicine, The Chinese University of Hong Kong, Hong Kong SAR, China
- Department of Surgery, Faculty of Medicine, The Chinese University of Hong Kong, Hong Kong SAR, China
| | - Claudia Trenkwalder
- Clinic for Neurosurgery, University Medical Center, Georg August University Göttingen, Göttingen, Germany
- Center of Parkinsonism and Movement Disorders, Paracelsus-Elena Hospital, Kassel, Germany
| | - Francis K L Chan
- Centre for Gut Microbiota Research, Faculty of Medicine, The Chinese University of Hong Kong, Hong Kong SAR, China
- Institute of Digestive Disease, State Key Laboratory of Digestive Disease, Faculty of Medicine, The Chinese University of Hong Kong, Hong Kong SAR, China
- Department of Medicine and Therapeutics, Faculty of Medicine, The Chinese University of Hong Kong, Hong Kong SAR, China
- Li Ka Shing Institute of Health Sciences, Faculty of Medicine, The Chinese University of Hong Kong, Shatin, Hong Kong, China
| | - Yun Kwok Wing
- Li Chiu Kong Family Sleep Assessment Unit, Department of Psychiatry, Faculty of Medicine, The Chinese University of Hong Kong, Hong Kong SAR, China.
- Department of Psychiatry, Faculty of Medicine, The Chinese University of Hong Kong, Hong Kong SAR, China.
- Centre for Gut Microbiota Research, Faculty of Medicine, The Chinese University of Hong Kong, Hong Kong SAR, China.
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de Azevedo Vieira ARS, Porto-Dantas LB, do Prado Romani FA, Carvalho PS, Pop-Busui R, Pedrosa HC. Autonomic neuropathic symptoms in patients with diabetes: practical tools for screening in daily routine. Diabetol Metab Syndr 2023; 15:83. [PMID: 37101234 PMCID: PMC10130803 DOI: 10.1186/s13098-023-01036-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/30/2022] [Accepted: 03/22/2023] [Indexed: 04/28/2023] Open
Abstract
BACKGROUND Diabetic autonomic neuropathy (DAN) is a frequent complication in people with diabetes whose screening is often neglected. This study aimed to evaluate DAN through practical tools in people with diabetes in a referral center for diabetes treatment. METHODS DAN symptoms and severity were assessed using the Survey of Autonomic Symptoms (SAS) via digital application (app) in patients attended from June 1, 2021, to November 12, 2021. SAS scoring for DAN was performed using established validated cutoffs. The adhesive with cobalt salt color indicator (Neuropad™) was used as a measure of sudomotor dysfunction. Demographical and clinical data were also collected. RESULTS Data from 109 participants, 66.9% T2DM, 73.4% female, with a median age of 54.00 (± 20.00) years, were analyzed. Symptomatic DAN was present in 69.7% of participants and was associated with older age (p = 0.002), higher HbA1c (p = 0.043), higher abdominal circumference (p = 0.019), higher BMI (p = 0.013), more likely to have metabolic syndrome (MS) with a 10-fold increased risk, and more frequent association with diabetic peripheral neuropathy (p = 0.005). Sudomotor dysfunction was found in 65 participants with positive Neuropad™ detected in 63.1% of them. CONCLUSION The use of SAS through an app proved to be a practical and easy-to-use instrument to document symptoms of DAN in busy clinical practice. The high frequency of symptoms draws attention to the importance of screening this underdiagnosed diabetes complication. The risk factors and comorbidities associated with symptomatic DAN highlight the patients' phenotypes linked to MS that should be targeted for DAN evaluations in larger samples in the community.
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Affiliation(s)
- Ana Raquel Souza de Azevedo Vieira
- Unit of Endocrinology of the Regional Hospital of Taguatinga and Research Center of the Foundation for Education and Research in Health Sciences, Secretariat of Health of the Federal District, Brasilia, Brazil
| | - Lara Benigno Porto-Dantas
- Unit of Endocrinology of the Regional Hospital of Taguatinga and Research Center of the Foundation for Education and Research in Health Sciences, Secretariat of Health of the Federal District, Brasilia, Brazil.
| | - Flaviene Alves do Prado Romani
- Unit of Endocrinology of the Regional Hospital of Taguatinga and Research Center of the Foundation for Education and Research in Health Sciences, Secretariat of Health of the Federal District, Brasilia, Brazil
| | - Patrícia Souza Carvalho
- Unit of Endocrinology of the Regional Hospital of Taguatinga and Research Center of the Foundation for Education and Research in Health Sciences, Secretariat of Health of the Federal District, Brasilia, Brazil
| | - Rodica Pop-Busui
- Division of Metabolism, Endocrinology & Diabetes, Department of Internal Medicine, University of Michigan, Ann Arbor, MI, USA
| | - Hermelinda Cordeiro Pedrosa
- Division of Metabolism, Endocrinology & Diabetes, Department of Internal Medicine, University of Michigan, Ann Arbor, MI, USA
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Loureiro D, Bilbao R, Bordet S, Grasso L, Otero-Losada M, Capani F, Ponzo OJ, Perez-Lloret S. A systematic review and meta-analysis on the association between orthostatic hypotension and mild cognitive impairment and dementia in Parkinson's disease. Neurol Sci 2023; 44:1211-1222. [PMID: 36542202 DOI: 10.1007/s10072-022-06537-3] [Citation(s) in RCA: 7] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/21/2022] [Accepted: 11/26/2022] [Indexed: 12/24/2022]
Abstract
BACKGROUND Cognitive impairment is a frequent disabling feature of Parkinson's disease (PD). Orthostatic hypotension (OH) is treatable and may be a risk factor for cognitive impairment. OBJECTIVE We conducted a systematic review and meta-analysis to examine the relationship between OH with PD-associated minimal cognitive impairment (PD-MCI) and dementia (PDD) and assess the mitigating effects of potential confounding factors. METHODS Observational studies published in English, Spanish, French, or Portuguese up to January 2022 were searched for in PubMed, EBSCO, and SciELO databases. The primary aim of this study was to revise the association between OH with PD-MCI and PDD. Alongside, we assessed OH as related to cognitive rating scales. Fixed and random models were fitted. Meta-regression was used to assess the mitigating effects of confounding variables. RESULTS We identified 18 studies that reported OH association with PDD or PD-MCI, 15 of them reporting OH association with cognitive rating scales. OH was significantly associated with PDD/PD-MCI (OR, 95% CI: 3.31, 2.16-5.08; k = 18, n = 2251; p < 0.01). OH association with PDD (4.64, 2.68-8.02; k = 13, n = 1194; p < 0.01) was stronger than with PD-MCI (1.82, 0.92-3.58; k = 5, n = 1056; p = NS). The association between OH and PD-MCI/PDD was stronger in studies with a higher proportion of women and in those with a lower frequency of supine hypertension. Global cognition rating scale scores were lower in patients with OH (SMD, 95% CI: - 0.55, - 0.83/ - 0.26; k = 12, n = 1427; p < 0.01). CONCLUSIONS Orthostatic hypotension shows as a significant risk factor for cognitive impairment in PD, especially in women and patients not suffering from hypertension.
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Affiliation(s)
- Débora Loureiro
- Departamento de Fisiología, Facultad de Medicina, Universidad de Buenos Aires (UBA), Buenos Aires, Argentina
| | - Rodrigo Bilbao
- Departamento de Fisiología, Facultad de Medicina, Universidad de Buenos Aires (UBA), Buenos Aires, Argentina
| | - Sofía Bordet
- Centro de Altos Estudios en Ciencias Humanas y de la Salud, Universidad Abierta Interamericana, Consejo Nacional de Investigaciones Científicas y Técnicas, CACEIHS, UAI-CONICET, Buenos Aires, Argentina
- Centro de Investigaciones en Psicología y Psicopedagogía, Facultad de Psicología y Psicopedagogía, Pontificia Universidad Católica Argentina, CIPP, UCA, Buenos Aires, Argentina
| | - Lina Grasso
- Centro de Investigaciones en Psicología y Psicopedagogía, Facultad de Psicología y Psicopedagogía, Pontificia Universidad Católica Argentina, CIPP, UCA, Buenos Aires, Argentina
| | - Matilde Otero-Losada
- Centro de Altos Estudios en Ciencias Humanas y de la Salud, Universidad Abierta Interamericana, Consejo Nacional de Investigaciones Científicas y Técnicas, CACEIHS, UAI-CONICET, Buenos Aires, Argentina
| | - Francisco Capani
- Centro de Altos Estudios en Ciencias Humanas y de la Salud, Universidad Abierta Interamericana, Consejo Nacional de Investigaciones Científicas y Técnicas, CACEIHS, UAI-CONICET, Buenos Aires, Argentina
- Instituto de Ciencias Biomédicas, Facultad de Ciencias de la Salud, Universidad Autónoma de Chile, Santiago, Chile
| | - Osvaldo J Ponzo
- Departamento de Fisiología, Facultad de Medicina, Universidad de Buenos Aires (UBA), Buenos Aires, Argentina
| | - Santiago Perez-Lloret
- Departamento de Fisiología, Facultad de Medicina, Universidad de Buenos Aires (UBA), Buenos Aires, Argentina.
- Observatorio de Salud Pública, Pontificia Universidad Católica Argentina, Consejo Nacional de Investigaciones Científicas y Técnicas, Av. Alicia Moreau de Justo 1300, C1107, Buenos Aires, Argentina.
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Su D, Su Y, Xu B, Chhetri JK, Chan P. Age as a risk factor for orthostatic hypotension induced by the levodopa challenge test in patients with Parkinson's disease: Results from a single-center trial. Medicine (Baltimore) 2023; 102:e33161. [PMID: 36862872 PMCID: PMC9981374 DOI: 10.1097/md.0000000000033161] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 03/04/2023] Open
Abstract
BACKGROUND Hypotension can occur in patients receiving levodopa (L-dopa) treatment for parkinsonism. However, only few studies have focused on the characteristics of orthostatic hypotension (OH) induced by the L-dopa challenge test (LCT). This study aimed to investigate the characteristics and influencing factors of LCT-induced OH in a relatively large sample of patients with Parkinson's disease (PD). METHODS Seventy-eight patients with PD without a previous diagnosis of OH underwent the LCT. Blood pressure (BP) in the supine and standing positions was measured before and 2 hours after the LCT. If diagnosed with OH, the patients' BP was monitored again 3 hours after the LCT. The clinical features and demographics of the patients were analyzed. RESULTS Eight patients were diagnosed with OH 2 hours after the LCT (median dose of 375 mg L-dopa/benserazide; incidence = 10.3%). One patient without symptoms had OH 3 hours after the LCT. Compared with patients without OH, patients with OH had lower 1- and 3-minutes standing systolic BP and 1-minute standing diastolic BP at baseline and 2 hours after the LCT. Patients in the OH group were of older age (65.31 ± 4.17 years vs 59.74 ± 5.55years) and had lower Montreal Cognitive Assessment scores (17.5 vs 24) and higher L-dopa/benserazide levels (375 [250, 500] mg vs 250 [125, 500] mg). Older age markedly increased the odds of having LCT-induced OH (odds ratio, 1.451; 95% confidence interval, 1.055-1.995; P = .022). CONCLUSIONS LCT increased the odds of OH in non-OH PD, causing symptomatic OH in 10.3% of patients in our study, thereby raising safety concerns. Increase in age was observed to be a risk factor for LCT-induced OH in PD patients. A study with a larger sample size is warranted to confirm our results. TRIAL REGISTRATION NUMBER Clinical Trials Registry under ChiCTR2200055707. DATE OF REGISTRATION January 16, 2022.
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Affiliation(s)
- Dan Su
- Department of Geriatrics, Liangxiang Hospital of Beijing Fangshan District, Beijing, China
- National Clinical Research Center for Geriatric Diseases, Xuanwu Hospital of Capital Medical University, Beijing, China
| | - Yanling Su
- Department of Geriatrics, Liangxiang Hospital of Beijing Fangshan District, Beijing, China
| | - Baolei Xu
- National Clinical Research Center for Geriatric Diseases, Xuanwu Hospital of Capital Medical University, Beijing, China
| | - Jagadish K. Chhetri
- National Clinical Research Center for Geriatric Diseases, Xuanwu Hospital of Capital Medical University, Beijing, China
- *Correspondence: Jagadish K. Chhetri, National Clinical Research Center for Geriatric Diseases, Xuanwu Hospital of Capital Medical University, Beijing 100053, China (e-mail: )
| | - Piu Chan
- National Clinical Research Center for Geriatric Diseases, Xuanwu Hospital of Capital Medical University, Beijing, China
- Department of Neurology, Neurobiology and Geriatrics, Xuanwu Hospital of Capital Medical University, Beijing Institute of Geriatrics, Beijing, China
- Clinical Center for Parkinson’s Disease, Parkinson Disease Center of Beijing Institute for Brain Disorders, Beijing, China
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The circadian rhythm of arterial blood pressure in Alzheimer's disease and vascular dementia. Acta Neurol Belg 2023; 123:129-137. [PMID: 34043211 DOI: 10.1007/s13760-021-01664-8] [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: 11/06/2020] [Accepted: 03/26/2021] [Indexed: 10/21/2022]
Abstract
Hypertension is considered a risk factor for stroke and dementia. Ambulatory blood pressure monitoring (ABPM) is a useful tool in the diagnosis and treatment of hypertension. This study aimed to evaluate blood pressure using ABPM, in 30 Alzheimer's disease (AD) patients and 30 vascular dementia (VaD) patients in comparison with 30 healthy controls. BP was recorded every 15 min from 6 AM to 10 PM, and every 30 min from 10 PM to 6 AM. Mean systolic (SBP) and diastolic (DBP) blood pressure during daytime, nighttime, diurnal index, pulse pressure, and heart rate were extracted from the ABPM recordings. VaD patients presented higher SBP values compared to AD patients and healthy controls. DBP values in the AD group were the lowest, while VaD patients presented the highest DBP values, including day and nighttime. Mean arterial pressure values were also the highest in the VaD group, while AD patients had similar values with the control group. The VaD patients presented the lowest systolic diurnal index compared to AD patients and controls. The mean pulse pressure and nighttime pulse pressure values were higher in both groups of dementia patients when compared with the control group. Increased SBP, pulse pressure, and alteration in the circadian pattern with the highest incidence of the non-dipper and reverse dipper patterns were found in patients with dementia when compared with the healthy elderly. Also, decreased values of DBP were found in AD patients, especially during the night period.
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Variability of blood pressure response to orthostatism and reproducibility of orthostatic hypotension in hospitalized patients with acute ischemic stroke. Blood Press Monit 2023; 28:47-51. [PMID: 36606479 DOI: 10.1097/mbp.0000000000000627] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/07/2023]
Abstract
OBJECTIVE Orthostatic hypotension (OH) which diagnosis is based on the measurement of the blood pressure response to orthostatism (BPRO) is a common condition associated with adverse cerebrovascular and cognitive prognosis. It is likely that the single measurement might underestimate the true prevalence of OH. This study investigated the prevalence and reproducibility of the diagnosis of OH and related risk factors in hospitalized acute ischemic stroke (AIS) patients with multiple measurements. MATERIALS AND METHODS This study was a prospective cohort analysis of consecutive AIS patients admitted to the hospital. A total of 211 patients were included. BPRO was assessed five times at the same time on different days. RESULTS OH was found in 33 cases (15.6%) in the initial set of measurements of the first day. A cumulative diagnosis of OH after five BPRO tests was found in 75 cases (35.5%). The reproducibility of the diagnosis of OH was mild or poor. In patients with a cumulative diagnosis of OH, 29 (38.7%) patients had orthostatic hypertension (OHTN). In multivariate analysis, the Fazekas scale (odds radio = 1.28, 95% confidence interval (CI), 1.04-1.59, P = 0.023) and extracranial carotid stenosis (≥70%) (odds radio = 3.64, 95% CI, 1.19-11.13, P = 0.023) were independent risk factors for OH. CONCLUSION The reproducibility of OH is poor and the concurrent appearance of OH and OHTN is common in hospitalized AIS patients. Multiple measurements should be taken in hospitalized AIS patients when screening for OH especially patients with higher Fazekas scale and extracranial carotid stenosis (≥70%).
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