One-Dimensional Statistical Parametric Mapping Identifies Impaired Orthostatic Cerebrovascular and Cardiovascular Response in Frailty Index

Abstract

Background Orthostasis is a potent physiological stressor which adapts with age. The age-related accumulation of health deficits in multiple physiological systems may impair the physiological response to orthostasis and lead to negative health outcomes such as falls, depression, and cognitive decline. Research to date has focused on changes with orthostasis at prespecified intervals of time, without consideration for whole signal approaches. Methods One-dimensional statistical parametric mapping identified regions in time of significant association between variables of interest using a general linear model. Frailty index operationalized accumulated health and social deficits using 32-items from a computer-assisted interview. This study examined the association of frailty index on blood pressure, heart rate, and cerebral oxygenation during an orthostatic test in a sample of 2742 adults aged 50 or older from The Irish Longitudinal Study on Ageing. Results Frailty index was seen to be negatively associated with cerebral oxygenation changes from baseline over a period of 7 seconds (p = .036). Heart rate and systolic blood pressure were positively and negatively associated with frailty index over periods of 17 seconds (p = .001) and 10 seconds (p = .015), respectively. Conclusions Statistical parametric mapping demonstrated these significant regions of cerebral oxygenation during orthostasis provide indirect evidence of impaired autoregulation associated with frailty. Statistical parametric mapping also replicated prior relationships in heart rate and systolic blood pressure associated with a higher frailty index. These findings highlight the utility of 1-dimensional statistical parametric modeling in identifying significant regions of interest in physiological recordings.

Increased multimorbidity is associated with impaired cerebral and peripheral hemodynamic stabilization during active standing

“…Capturing a broader range of morbidities may have masked underlying differences in cardiovascular multimorbidity, which may ultimately be the driver of the observed BP differences. Last, our finding of impaired BP and HR recovery with multimorbidity agrees with previous studies investigating frailty indices, 5,13,[33][34][35] suggesting that our multimorbidity scale captures key frailty factors contributing toward peripheral circulation impairment, and is likely an appropriate surrogate for frailty in the context of falls and syncope patients. Furthermore, we have found the strongest associations during the recovery period (30 s), which encourages the use of newly developed definitions such as delayed BP recovery 1 over more classic definitions such as initial OH or classical OH.…”

“…In males, similar but weaker trends may support a similar hypothesis, but the alternative hypothesis may also apply. Maguire et al identified differences in TSI between males and females during the first 30 s after standing, 13 and Jedrzejczyk-Spaho et al found lower values of TSI during a HUT in females than in males in their cohort of patients with suspected syncope. 27 Interestingly, resting cerebral perfusion is known to be higher in healthy females, 36 with CA often preserved in this cohort.…”

“…This change is clinically relevant, given that a 5%–10% TSI drop is associated with presyncope or loss of consciousness 26 . Maguire et al similarly reported impaired cerebral oxygenation recovery with increasing levels of frailty (measured as an index of morbidities and ADL deficits) at 20–27 s after standing in a population sample of community‐dwelling adults (mean(SD): 64.4(7.7) years) 13 . In a large study of patients undergoing head‐up tilting (median(IQR): 40 (35) years), Jedrzejczyk‐Spaho et al also demonstrated that having multiple comorbidities was associated with larger TSI drops 27 …”

Analysis of systolic and diastolic blood pressure variability in frail, pre-frail, and non-frail elderly patients: The relationship between frailty syndrome and blood pressure variability in the elderly

“…Relevant trials have shown that there is no significant benefit from strict blood pressure control in the elderly and that aggressive blood pressure control should be avoided even more in debilitated patients. [41] Our study concluded that the worse the overall health status of the elderly, the greater the blood pressure variability. Therefore, geriatricians should regulate blood pressure in elderly frail patients not only by lowering excessive blood pressure, but also by using long-acting, combination drugs to reduce blood pressure variability, and new anti-hypertensive drugs with blood pressure stabilizing effects are urgently needed.…”

Frailty and cerebrovascular disease: Concepts and clinical implications for stroke medicine

“…Crucially, central and peripheral vascular hemodynamic changes occur in response to ageing, and frailty is associated with impaired cerebral autoregulation. 41 Distinguishing pathological disease states from ''healthy'' ageing is paramount for the development of effective interventions. For example, age is negatively correlated with penumbral volume (but not core volume) in individuals undergoing CT perfusion in the hyperacute stroke setting.…”