Andrea Ungar1, Chiara Mussi2, Alice Ceccofiglio1, Giuseppe Bellelli3,4,5, Franco Nicosia6, Mario Bo7, Daniela Riccio8, Anna Maria Martone9, Livia Guadagno10, Gabriele Noro11, Giulia Ghidoni2, Martina Rafanelli1, Niccolò Marchionni1, Pasquale Abete10. 1. Syncope Unit, Geriatric Cardiology and Medicine, University of Florence and Azienda Ospedaliero Universitaria Careggi, Florence, Italy. 2. Centro di Valutazione e Ricerca Gerontologica, University of Modena and Reggio Emilia, Modena, Italy. 3. Department of Health Sciences, University of Milano Bicocca, Milan, Italy. 4. Acute Geriatric Unit, San Gerardo Hospital, Monza, Italy. 5. Milan Center for Neuroscience, Milan, Italy. 6. Medicine and Geriatric Unit, Spedali Civili, Brescia, Italy. 7. Struttura Complessa a Direzione Universitaria, Geriatria e Malattie Metaboliche dell'Osso, Città della Salute e della Scienza-Molinette, Torino, Italy. 8. Geriatric Department, SS. Trinità Hospital, Cagliari, Italy. 9. Department of Geriatrics, Neurosciences and Orthopedics, Catholic University of the Sacred Heart, Rome, Italy. 10. Department of Translational Medical Sciences, University of Naples Federico II, Naples, Italy. 11. Geriatric Unit, Santa Chiara Hospital, Trento, Italy.
Abstract
OBJECTIVES: To investigate the etiology of transient loss of consciousness (T-LOC) suspected to be syncope and unexplained falls in elderly adults with dementia. DESIGN: Prospective, observational, multicenter study. SETTING: Acute care wards, syncope units or centers for the diagnosis of dementia. PARTICIPANTS: Individuals aged 65 and older with a diagnosis of dementia and one or more episodes of T-LOC of a suspected syncopal nature or unexplained falls during the previous 3 months were enrolled. MEASUREMENTS: The causes of T-LOC suspected to be syncope and unexplained falls were evaluated using a simplified protocol based on European Society of Cardiology guidelines. RESULTS: Of 357 individuals enrolled, 181 (50.7%) had been referred for T-LOC suspected to be syncope, 166 (46.5%) for unexplained falls, and 10 (2.8%) for both. An initially suspected diagnosis of syncope was confirmed in 158 (87.3%), and syncope was identified as the cause of the event in 75 (45.2%) of those referred for unexplained falls. Orthostatic hypotension was the cause of the event in 117 of 242 (48.3%) participants with a final diagnosis of syncope. CONCLUSION: The simplified syncope diagnostic protocol can be used in elderly people with dementia referred for suspected syncope or unexplained falls. Unexplained falls may mask a diagnosis of syncope or pseudosyncope in almost 50% of cases. Given the high prevalence of orthostatic syncope in participants (~50%), a systematic reappraisal of drugs potentially responsible for orthostatic hypotension is warranted.
OBJECTIVES: To investigate the etiology of transient loss of consciousness (T-LOC) suspected to be syncope and unexplained falls in elderly adults with dementia. DESIGN: Prospective, observational, multicenter study. SETTING: Acute care wards, syncope units or centers for the diagnosis of dementia. PARTICIPANTS: Individuals aged 65 and older with a diagnosis of dementia and one or more episodes of T-LOC of a suspected syncopal nature or unexplained falls during the previous 3 months were enrolled. MEASUREMENTS: The causes of T-LOC suspected to be syncope and unexplained falls were evaluated using a simplified protocol based on European Society of Cardiology guidelines. RESULTS: Of 357 individuals enrolled, 181 (50.7%) had been referred for T-LOC suspected to be syncope, 166 (46.5%) for unexplained falls, and 10 (2.8%) for both. An initially suspected diagnosis of syncope was confirmed in 158 (87.3%), and syncope was identified as the cause of the event in 75 (45.2%) of those referred for unexplained falls. Orthostatic hypotension was the cause of the event in 117 of 242 (48.3%) participants with a final diagnosis of syncope. CONCLUSION: The simplified syncope diagnostic protocol can be used in elderly people with dementia referred for suspected syncope or unexplained falls. Unexplained falls may mask a diagnosis of syncope or pseudosyncope in almost 50% of cases. Given the high prevalence of orthostatic syncope in participants (~50%), a systematic reappraisal of drugs potentially responsible for orthostatic hypotension is warranted.
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