title: Cognitive Impairment Is Very Common in Elderly Patients With Syncope and Unexplained Falls.
abstract: OBJECTIVE
  To evaluate the prevalence of cognitive impairment (CI), including mild CI and dementia, in elderly patients with syncope and unexplained falls. In this population, we compared the use of the Mini-Mental State Examination (MMSE) with a cognitive screening test that assesses executive dysfunction typical of subcortical (vascular) CI, that is, the Montreal Cognitive Assessment (MoCA).
  
  
  METHODS
  Observational cohort study.
  
  
  METHODS
  Outpatient fall and syncope clinic.
  
  
  METHODS
  Consecutive patients aged ≥65 years with syncope and unexplained falls without loss of consciousness.
  
  
  METHODS
  Baseline characteristics, functional status, MMSE, MoCA, and magnetic resonance imaging scans of the brain.
  
  
  RESULTS
  prevalence of CI, comparing the MMSE with the MoCA. CI was defined as an MMSE/MoCA score <26.
  
  
  RESULTS
  MMSE/MoCA overall and subdomain scores, Fazekas and medial temporal lobe atrophy scores.
  
  
  RESULTS
  We included 200 patients, mean age 79.5 (standard deviation 6.6) years (Syncope Group: n = 101; Fall Group: n = 99). Prevalence of CI was 16.8% (MMSE) versus 60.4% (MoCA) in the Syncope Group (P < .001) and 16.8% (MMSE) versus 56.6% (MoCA) in the Fall Group (P < .001). Prevalence of CI did not differ between the Syncope Group and Fall Group with either method. Executive dysfunction was present in both groups.
  
  
  CONCLUSIONS
  CI is as common in elderly patients with syncope as it is in patients with unexplained falls, with an overall prevalence of 58%. The MMSE fails as a screening instrument for CI in these patients, because it does not assess executive function. Therefore, we recommend the MoCA for cognitive screening in older patients with syncope and unexplained falls.
authors.affiliation: Department of Geriatric Medicine, Northwest Clinics, Alkmaar, the Netherlands.
authors.forename: Susanne C
authors.initials: SC
authors.lastname: de Ruiter
authors.affiliation: Department of Geriatric Medicine, Northwest Clinics, Alkmaar, the Netherlands.
authors.forename: Jos F M
authors.initials: JFM
authors.lastname: de Jonghe
authors.affiliation: Department of Cardiology, Northwest Clinics, Alkmaar, the Netherlands.
authors.forename: Tjeerd
authors.initials: T
authors.lastname: Germans
authors.affiliation: Department of Cardiology, Northwest Clinics, Alkmaar, the Netherlands.
authors.forename: Jaap H
authors.initials: JH
authors.lastname: Ruiter
authors.affiliation: Department of Geriatric Medicine, Northwest Clinics, Alkmaar, the Netherlands. Electronic address: r.w.m.m.jansen@nwz.nl.
authors.forename: René W M M
authors.initials: RWMM
authors.lastname: Jansen
mesh_terms: D000058:Accidental Falls; D000368:Aged; D060825:Cognitive Dysfunction / Q000453:epidemiology*; D015331:Cohort Studies; D015897:Comorbidity; D005260:Female; D006801:Humans; D008297:Male; D008609:Mental Status Schedule; D009426:Netherlands / Q000453:epidemiology; D013575:Syncope
keywords: Syncope; cognitive disorder; fall; mini-mental state examination; montreal cognitive assessment