The period of hypotension following orthostatic challenge is prolonged in dementia with Lewy bodies

• Published in: International journal of geriatric psychiatry Vol. 23; no. 2; pp. 192 - 198
• Main Authors: Andersson, M., Hansson, O., Minthon, L., Ballard, C.G., Londos, E.
• Format: Journal Article
• Language: English
• Published: Chichester, UK John Wiley & Sons, Ltd 01.02.2008; Wiley; Wiley Subscription Services, Inc
• Subjects: Aged; Alzheimer Disease - complications; Alzheimer Disease - psychology; Alzheimer's disease; Arterial hypertension. Arterial hypotension; Biological and medical sciences; Blood and lymphatic vessels; Blood pressure; Cardiology. Vascular system; Case-Control Studies; Chi-Square Distribution; Clinical manifestations. Epidemiology. Investigative techniques. Etiology; Clinical Medicine; Dementia; Female; Fundamental and applied biological sciences. Psychology; Geriatric psychiatry; Geriatrics; Humans; hypotension; Hypotension, Orthostatic - complications; Hypotension, Orthostatic - psychology; Klinisk medicin; Lewy bodies; Lewy body disease; Lewy Body Disease - complications; Lewy Body Disease - psychology; Male; Medical and Health Sciences; Medical sciences; Medicin och hälsovetenskap; Neurologi; Neurology; Neuropsychological Tests; Older people; orthostatic; orthostatic hypotension; Psychoanalysis; Psychology. Psychoanalysis. Psychiatry; Psychopathology. Psychiatry; Pulse; Statistics, Nonparametric; Time; Human; orthostatic hypotension; Nervous system diseases; Lewy body disease; Cardiovascular disease; Cerebral disorder; Senile dementia; Postural hypotension; Gerontology; Arterial hypotension; Diseases of the autonomic nervous system; Central nervous system disease; Arterial pressure; dementia; Degenerative disease; Blood pressure; Hemodynamics; Elderly; Lewy body; Geriatrics; Prolonged
• ISSN: 0885-6230; 1099-1166; 1099-1166
• DOI: 10.1002/gps.1861

Objectives To determine whether orthostatic hypotension (OH) is more common in patients with dementia than in older people without cognitive impairment and to identify key differences in the profile of the orthostatic response and the pulse drive during orthostatic challenge between Alzheimer's disease (AD) and dementia with Lewy bodies (DLB). Methods The orthostatic response was evaluated in 235 patients with AD, 52 patients with DLB and 62 elderly controls. The blood pressure and pulse rate were measured in supine position, immediately after standing up and after 1, 3, 5 and 10 min of standing. OH was defined as a reduction of systolic blood pressure (SBP) of at least 20 mm Hg or a reduction of diastolic blood pressure (DBP) of at least 10 mm Hg. Results OH occurred in 69% of the DLB patients and in 42% of the AD patients, but only in 13% of the controls (p < 0.001 controls vs AD and controls vs DLB, p = 0.001 AD vs DLB) The DLB patients had a greater drop in SBP than the other study groups during orthostatic challenge and had a more prolonged period of orthostasis. The pulse drive on orthostatic challenge was similar in between groups. However, in the DLB group it was not adequate to restore the blood pressure to supine values. Conclusions Patients with DLB react different to orthostatic challenge than patients with AD or controls, with important clinical implications for key disease symptoms and treatment. Copyright © 2007 John Wiley & Sons, Ltd.