Orthostatic hypotension in patients with dementia: clinical features and response to treatment.
OBJECTIVE
To evaluate orthostatic hypotension (OH) prevalence, risk factors, signs and symptoms, and treatment response in patients with dementia.


BACKGROUND
No previous studies had systematically delineated the clinical features of OH in patients with dementia and determined the effects of treatment. Diagnosing this treatable disorder may prevent the severe consequences of falls, syncope, confusion, ischemic brain injury, and death; mortality risk rises with worsening OH. Lesser consequences include skin injuries, sprains, fractures, and subdural hematomas.


METHODS
We reviewed the charts of 188 patients with dementia who had been treated by author D.F., a solo neurologist/neurobehaviorist. About half of the patients had been diagnosed with OH. D.F. had treated the OH until the patients had much improved blood pressure and symptoms, were asymptomatic, or no longer met OH diagnostic criteria. We collected data on diagnoses, blood pressures, and clinical features before and after treatment.


RESULTS
Our patients' most frequent OH signs and symptoms were mental fluctuations (65.6% of patients), excessive sleeping in chairs (29.2%), slow falls without losing consciousness (20.8%), lethargy or fatigue (15.6%), and dizziness (13.5%). All 5 of these signs and symptoms improved significantly with treatment.


CONCLUSIONS
Patients with dementia were less likely to have traditional OH symptoms like dizziness than to have mental fluctuations and confusion, drowsiness, and slow falls. Blaming these problems on worsening dementia and neglecting OH as a potential cause may delay diagnosis and specific treatments that can improve patients' safety, daily function, and quality of life.
*Division of Neurology, Department of Internal Medicine, Riverside Methodist Hospital, Columbus, OH †Ohio Health Research & Innovation Institute, Columbus, OH ‡Hillsboro, OR §Columbus, OH.
Donald L
DL
Freidenberg
Lynn E T
LE
Shaffer
Shawn
S
Macalester
Elizabeth A
EA
Fannin
D017677:Age Distribution; D000368:Aged; D000369:Aged, 80 and over; D000544:Alzheimer Disease / Q000175:diagnosis / Q000453:epidemiology; D018660:Blood Pressure Monitoring, Ambulatory; D002908:Chronic Disease; D015897:Comorbidity; D003704:Dementia / Q000175:diagnosis* / Q000453:epidemiology* / Q000523:psychology; D003937:Diagnosis, Differential; D005260:Female; D006801:Humans; D006973:Hypertension / Q000188:drug therapy / Q000453:epidemiology; D007024:Hypotension, Orthostatic / Q000175:diagnosis* / Q000188:drug therapy / Q000453:epidemiology*; D016015:Logistic Models; D008134:Long-Term Care; D008297:Male; D008875:Middle Aged; D015995:Prevalence; D011788:Quality of Life; D012189:Retrospective Studies; D012307:Risk Factors; D017678:Sex Distribution; D019722:Sphygmomanometers; D016896:Treatment Outcome