title: Etiology of Syncope and Unexplained Falls in Elderly Adults with Dementia: Syncope and Dementia (SYD) Study.
abstract: To investigate the etiology of transient loss of consciousness (T-LOC) suspected to be syncope and unexplained falls in elderly adults with dementia.
  
  
  
  Prospective, observational, multicenter study.
  
  
  
  Acute care wards, syncope units or centers for the diagnosis of dementia.
  
  
  
  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.
  
  
  
  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.
  
  
  
  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.
  
  
  
  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.
authors.affiliation: Syncope Unit, Geriatric Cardiology and Medicine, University of Florence and Azienda Ospedaliero Universitaria Careggi, Florence, Italy.
authors.forename: Andrea
authors.initials: A
authors.lastname: Ungar
authors.affiliation: Centro di Valutazione e Ricerca Gerontologica, University of Modena and Reggio Emilia, Modena, Italy.
authors.forename: Chiara
authors.initials: C
authors.lastname: Mussi
authors.affiliation: Syncope Unit, Geriatric Cardiology and Medicine, University of Florence and Azienda Ospedaliero Universitaria Careggi, Florence, Italy.
authors.forename: Alice
authors.initials: A
authors.lastname: Ceccofiglio
authors.affiliation: Department of Health Sciences, University of Milano Bicocca, Milan, Italy.|Acute Geriatric Unit, San Gerardo Hospital, Monza, Italy.|Milan Center for Neuroscience, Milan, Italy.
authors.forename: Giuseppe
authors.initials: G
authors.lastname: Bellelli
authors.affiliation: Medicine and Geriatric Unit, Spedali Civili, Brescia, Italy.
authors.forename: Franco
authors.initials: F
authors.lastname: Nicosia
authors.affiliation: Struttura Complessa a Direzione Universitaria, Geriatria e Malattie Metaboliche dell'Osso, Città della Salute e della Scienza-Molinette, Torino, Italy.
authors.forename: Mario
authors.initials: M
authors.lastname: Bo
authors.affiliation: Geriatric Department, SS. Trinità Hospital, Cagliari, Italy.
authors.forename: Daniela
authors.initials: D
authors.lastname: Riccio
authors.affiliation: Department of Geriatrics, Neurosciences and Orthopedics, Catholic University of the Sacred Heart, Rome, Italy.
authors.forename: Anna Maria
authors.initials: AM
authors.lastname: Martone
authors.affiliation: Department of Translational Medical Sciences, University of Naples Federico II, Naples, Italy.
authors.forename: Livia
authors.initials: L
authors.lastname: Guadagno
authors.affiliation: Geriatric Unit, Santa Chiara Hospital, Trento, Italy.
authors.forename: Gabriele
authors.initials: G
authors.lastname: Noro
authors.affiliation: Centro di Valutazione e Ricerca Gerontologica, University of Modena and Reggio Emilia, Modena, Italy.
authors.forename: Giulia
authors.initials: G
authors.lastname: Ghidoni
authors.affiliation: Syncope Unit, Geriatric Cardiology and Medicine, University of Florence and Azienda Ospedaliero Universitaria Careggi, Florence, Italy.
authors.forename: Martina
authors.initials: M
authors.lastname: Rafanelli
authors.affiliation: Syncope Unit, Geriatric Cardiology and Medicine, University of Florence and Azienda Ospedaliero Universitaria Careggi, Florence, Italy.
authors.forename: Niccolò
authors.initials: N
authors.lastname: Marchionni
authors.affiliation: Department of Translational Medical Sciences, University of Naples Federico II, Naples, Italy.
authors.forename: Pasquale
authors.initials: P
authors.lastname: Abete
mesh_terms: D000058:Accidental Falls / Q000706:statistics & numerical data*; D000368:Aged; D000369:Aged, 80 and over; D000544:Alzheimer Disease / Q000150:complications* / Q000453:epidemiology*; D003430:Cross-Sectional Studies; D003937:Diagnosis, Differential; D005260:Female; D016330:Frail Elderly; D019983:Guideline Adherence; D006801:Humans; D007024:Hypotension, Orthostatic / Q000150:complications / Q000175:diagnosis / Q000453:epidemiology; D007558:Italy; D008297:Male; D054971:Orthostatic Intolerance / Q000150:complications / Q000175:diagnosis / Q000453:epidemiology; D011446:Prospective Studies; D012307:Risk Factors; D013575:Syncope / Q000453:epidemiology* / Q000209:etiology*
keywords: dementia; falls; syncope; transient loss of consciousness