Orthostatic hypotension in dementia with Lewy bodies: a meta-analysis of prospective studies

Işık, Ahmet Turan; Dost, Fatma Sena; Yavuz, İdil; Öntan, Mehmet Selman; Bulut, Esra Ateş; Kaya, Derya

doi:10.1007/s10286-023-00933-1

Cited by 5 publications

(9 citation statements)

References 51 publications

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“…When it comes to dysautonomia, which is likely to be an early marker of DLB, OH is often the rst to come to mind. A recent meta-analysis reported OH in 50.8% of DLB patients, [14] which is considerably higher than both patients with AD (28%) [3] and non-demented older adults (17.9%). [5] Many studies in patients with DLB have reported that OH may be closely related to cognitive impairment, even an important predictor of cognitive outcomes, and chronic hypoxia may link to neurodegenerative mechanisms.…”

Section: Discussionmentioning

confidence: 93%

“…Considering both DLB-related negative health outcomes, [9,13,21,29] and adverse events and complications related to OH and PPH, as signs of dysautonomia, it is clear that the prevention of such outcomes is indispensable to ensure better management of DLB. [8, 9,14] Although delayed OH was signi cantly higher in DLB patients than in control, this difference between the groups disappeared after the adjustment. Indeed, a higher frequency is an expected outcome, as delayed OH is likely to be an early and milder form of OH in such patients.…”

Section: Discussionmentioning

confidence: 94%

“…[12] It is not only one of the supportive clinical features of the DLB but also leads to complexity in the management of patients and increases disease burden. [13] Although there is much evidence of how important OH is in DLB patients clinically, [14] other postprandial and postural blood pressure changes in DLB, such as, postprandial hypotension (PPH), orthostatic hypertension (OHT) and supine hypertension (HT), in such patients have not been studied in detail yet. Therefore, the study aimed to show the prevalence of blood pressure changes in DLB patients.…”

Section: Introductionmentioning

confidence: 99%

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Postprandial Hypotension Is More Common Than Orthostatic Hypotension In Older Adults With Dementia With Lewy Bodies: A Cross-Sectional Study

Işık

Öntan

Dost

et al. 2023

Preprint

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Purpose Dysautonomia is one of the supportive clinical features in dementia with Lewy bodies (DLB). This study aimed to investigate the prevalence of postural and postprandial blood pressure changes as a sign of dysautonomia in DLB patients. Methods The study group comprised 125 patients with DLB (76 females; mean age 78.4 ± 7.1 years) and 126 controls (89 females; mean age 74.5 ± 6.8 years). Postprandial blood pressure changes were assessed by ambulatory 24-hour blood pressure monitorization. Postural blood pressure changes were assessed via the head-up tilt table test. Results The frequency of postprandial hypotension (PPH), orthostatic hypotension (OH), and delayed OH was higher in patients with DLB compared to controls (89.4% vs 50.8%; p < 0.001, 45.5% vs 28.6%; p = 0.006, and 13.3% vs 5.6%; p = 0.045, respectively); whereas the frequency of supine hypertension (HT), and orthostatic hypertension (OHT) was similar. However, supine HT in non-hypertensive participants was higher in DLB patients than in controls (n = 45, 48.9% vs n = 37, 27%; p = 0.043). PPH and OH were independently associated with DLB (odds ratio [OR]:10.52 confidence interval [CI]%95 3.11–35.61; p < 0.00, and OR:1.96 CI%95 1.05–3.69; p = 0.035, respectively) after adjustment for age, the number of drugs, anti-psychotics, antiparkinsonian drugs, angiotensin receptor blockers, and beta blockers. Conclusion The study demonstrated that PPH was the most common type of dysautonomia, followed by OH and supine HT in older patients with DLB Given the potential complications of postural blood pressure changes and PPH in such patients, autonomic dysfunction should be evaluated in the follow-up of DLB.

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Section: Discussionmentioning

confidence: 93%

Section: Discussionmentioning

confidence: 94%

Section: Introductionmentioning

confidence: 99%

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Postprandial Hypotension Is More Common Than Orthostatic Hypotension In Older Adults With Dementia With Lewy Bodies: A Cross-Sectional Study

Işık

Öntan

Dost

et al. 2023

Preprint

Self Cite

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“…The study protocol, which includes the definition of research questions, description of the search strategy, criteria for inclusion and exclusion of studies, approach to assessing bias risk, and the plan for meta‐analytic synthesis, has previously been published on PROSPERO under the registration number CRD42022327390 17 …”

Section: Methodsmentioning

confidence: 99%

Primitive reflexes and dementia in older adults: a meta‐analysis of observational and cohort studies

Altunkalem Seydi,

Kaya,

Yavuz

et al. 2024

Psychogeriatrics

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Primitive reflexes (PRs) are clinical signs that indicate diffuse cerebral dysfunction and frontal lesions. We aimed to present a comprehensive analysis of the prevalence and risk of PRs in patients with dementia. English‐language articles published from January 1990 to April 2021 were searched in PubMed, ScienceDirect, Cochrane, and Web of Science with keywords. The titles and abstracts of the identified articles were screened to identify potentially relevant papers. Odds ratios and risk ratios were extracted with 95% confidence intervals and combined using the random‐effects model after logarithmic transformation. The prevalence in dementia patients was also combined using the random‐effects model. This meta‐analysis involved 29 studies. The snout reflex (48% of cases) was the most prevalent. It was found that the risk of PRs in individuals with dementia was significantly elevated, ranging from 13.94 to 16.38 times higher than in healthy controls. The grasp reflex exhibited the highest risk for dementia. This meta‐analysis showed that the prevalence and the risk of PRs is high in older patients with dementia. Therefore, PRs, especially the grasp reflex, should be carefully assessed as a part of routine physical examination in the diagnostic process for dementia.

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“…Besides MIBG myocardial scintigraphy, the usefulness of cardiovascular function assessments, such as measurements of orthostatic blood pressure 17,18 and heart rate variability (HRV), 19–21 for the diagnosis of DLB have been reported. We reported impaired ventilatory response to hypercapnia (VRH) in DLB, 22 and further studies have reported dysfunction and disorder of respiratory systems of patients with DLB 23–25 …”

Section: Introductionmentioning

confidence: 99%

Autonomic dysfunction in dementia with Lewy bodies: Focusing on cardiovascular and respiratory dysfunction

Mizukami

2023

PCN Reports

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Dementia with Lewy bodies (DLB) is the second most common cause of dementia after Alzheimer's disease. The disease is characterized by many Lewy bodies appearing in the patient's cerebrum. DLB frequently presents with a variety of autonomic symptoms from the early or prodromal stages of the disease, and these are listed as supportive features in the diagnostic criteria. As several useful assessment methods for evaluating autonomic function in DLB have been reported, this review will focus on cardiovascular and respiratory dysfunction and its assessments. Cardiovascular disorders, such as orthostatic hypotension and abnormal heart rate variability, have been reported in DLB patients. Decreased myocardial uptake by metaiodobenzylguanidine myocardial scintigraphy has been added as an indicative biomarker for DLB in the 2017 revision of the diagnostic criteria. We have reported reduced ventilatory response to hypercapnia, abnormal respiratory rhythm, and high frequency of sleep‐disordered breathing as abnormalities of the respiratory regulatory system associated with DLB. Since autonomic dysfunction is highly prevalent in DLB from the early or prodromal phase of the disease and is associated with reduced activities of daily living and quality of life, the evaluation of autonomic dysfunction is also useful in the differential diagnosis of DLB from Alzheimer's disease. There are fewer studies on the respiratory regulatory system than on the cardiovascular system, thus further research is needed to explore its role in DLB.

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Orthostatic hypotension in dementia with Lewy bodies: a meta-analysis of prospective studies

Cited by 5 publications

References 51 publications

Postprandial Hypotension Is More Common Than Orthostatic Hypotension In Older Adults With Dementia With Lewy Bodies: A Cross-Sectional Study

Postprandial Hypotension Is More Common Than Orthostatic Hypotension In Older Adults With Dementia With Lewy Bodies: A Cross-Sectional Study

Primitive reflexes and dementia in older adults: a meta‐analysis of observational and cohort studies

Autonomic dysfunction in dementia with Lewy bodies: Focusing on cardiovascular and respiratory dysfunction

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