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Clinical Interventions in Aging 2014Contradictory results have been reported on the relationship between orthostatic hypotension (OH) and mild cognitive impairment (MCI).
Orthostatic intolerance predicts mild cognitive impairment: incidence of mild cognitive impairment and dementia from the Swedish general population cohort Good Aging in Skåne.
INTRODUCTION
Contradictory results have been reported on the relationship between orthostatic hypotension (OH) and mild cognitive impairment (MCI).
OBJECTIVE
To study the incidence of MCI and dementia and their relationship to OH and subclinical OH with orthostatic symptoms (orthostatic intolerance).
STUDY DESIGN AND SETTING
This study used a prospective general population cohort design and was based on data from the Swedish Good Aging in Skåne study (GÅS-SNAC), they were studied 6 years after baseline of the present study, with the same study protocol at baseline and at follow-up. The study sample comprised 1,480 randomly invited subjects aged 60 to 93 years, and had a participation rate of 82% at follow-up. OH test included assessment of blood pressure and symptoms of OH.
RESULTS
The 6-year incidence of MCI was 8%, increasing from 12.1 to 40.5 per 1,000 person-years for men and 6.9 to 16.9 per 1,000 person-years for women aged 60 to >80 years. The corresponding 6-year incidence of dementia was 8%. Orthostatic intolerance during uprising was related to risk for MCI at follow-up (odds ratio [OR] =1.84 [1.20-2.80][95% CI]), adjusted for age and education independently of blood pressure during testing. After stratification for hypertension (HT), the corresponding age-adjusted OR for MCI in the non-HT group was 1.71 (1.10-2.31) and 1.76 (1.11-2.13) in the HT group. Among controls, the proportion of those with OH was 16%; those with MCI 24%; and those with dementia 31% (age-adjusted OR 1.93 [1.19-3.14]).
CONCLUSION
Not only OH, but also symptoms of OH, seem to be a risk factor for cognitive decline and should be considered in the management of blood pressure among the elderly population.
Topics: Age Factors; Aged; Aged, 80 and over; Aging; Blood Pressure; Cognitive Dysfunction; Dementia; Female; Health Behavior; Humans; Hypotension, Orthostatic; Incidence; Male; Middle Aged; Neuropsychological Tests; Orthostatic Intolerance; Prevalence; Prospective Studies; Risk Factors; Sex Factors; Sweden
PubMed: 25429211
DOI: 10.2147/CIA.S72316 -
Journal of Cardiovascular... Mar 2009POTS is defined as the development of orthostatic symptoms associated with a heart rate (HR) increment >or=30, usually to >or=120 bpm without orthostatic hypotension.... (Review)
Review
INTRODUCTION
POTS is defined as the development of orthostatic symptoms associated with a heart rate (HR) increment >or=30, usually to >or=120 bpm without orthostatic hypotension. Symptoms of orthostatic intolerance are those due to brain hypoperfusion and those due to sympathetic overaction.
METHODS
We provide a review of POTS based primarily on work from the Mayo Clinic.
RESULTS
Females predominate over males by 5:1. Mean age of onset in adults is about 30 years and most patients are between the ages of 20-40 years. Pathophysiologic mechanisms (not mutually exclusive) include peripheral denervation, hypovolemia, venous pooling, beta-receptor supersensitivity, psychologic mechanisms, and presumed impairment of brain stem regulation. Prolonged deconditioning may also interact with these mechanisms to exacerbate symptoms. The evaluation of POTS requires a focused history and examination, followed by tests that should include HUT, some estimation of volume status and preferably some evaluation of peripheral denervation and hyperadrenergic state. All patients with POTS require a high salt diet, copious fluids, and postural training. Many require beta-receptor antagonists in small doses and low-dose vasoconstrictors. Somatic hypervigilance and psychologic factors are involved in a significant proportion of patients.
CONCLUSIONS
POTS is heterogeneous in presentation and mechanisms. Major mechanisms are denervation, hypovolemia, deconditioning, and hyperadrenergic state. Most patients can benefit from a pathophysiologically based regimen of management.
Topics: Humans; Postural Orthostatic Tachycardia Syndrome
PubMed: 19207771
DOI: 10.1111/j.1540-8167.2008.01407.x -
European Heart Journal Jun 2022Unexplained syncope is an important clinical challenge. The influence of age at first syncope on the final syncope diagnosis is not well studied.
AIMS
Unexplained syncope is an important clinical challenge. The influence of age at first syncope on the final syncope diagnosis is not well studied.
METHODS AND RESULTS
Consecutive head-up tilt patients (n = 1928) evaluated for unexplained syncope were stratified into age groups <30, 30-59, and ≥60 years based on age at first syncope. Clinical characteristics and final syncope diagnosis were analysed in relation to age at first syncope and age at investigation. The age at first syncope had a bimodal distribution with peaks at 15 and 70 years. Prodromes (64 vs. 26%, P < 0.001) and vasovagal syncope (VVS, 59 vs. 19%, P < 0.001) were more common in early-onset (<30 years) compared with late-onset (≥60 years) syncope. Orthostatic hypotension (OH, 3 vs. 23%, P < 0.001), carotid sinus syndrome (CSS, 0.6 vs. 9%, P < 0.001), and complex syncope (>1 concurrent diagnosis; 14 vs. 26%, P < 0.001) were more common in late-onset syncope. In patients aged ≥60 years, 12% had early-onset and 70% had late-onset syncope; older age at first syncope was associated with higher odds of OH (+31% per 10-year increase, P < 0.001) and CSS (+26%, P = 0.004). Younger age at first syncope was associated with the presence of prodromes (+23%, P < 0.001) and the diagnoses of VVS (+22%, P < 0.001) and complex syncope (+9%, P = 0.018).
CONCLUSION
In patients with unexplained syncope, first-ever syncope incidence has a bimodal lifetime pattern with peaks at 15 and 70 years. The majority of older patients present only recent syncope; OH and CSS are more common in this group. In patients with early-onset syncope, prodromes, VVS, and complex syncope are more common.
Topics: Humans; Hypotension, Orthostatic; Incidence; Syncope; Syncope, Vasovagal; Tilt-Table Test
PubMed: 35139180
DOI: 10.1093/eurheartj/ehac017 -
Journal of Neurology Feb 2022Postural orthostatic tachycardia syndrome (POTS), a disorder of the autonomic nervous system characterized by a rise in heart rate of at least 30 bpm from supine to... (Review)
Review
Postural orthostatic tachycardia syndrome (POTS), a disorder of the autonomic nervous system characterized by a rise in heart rate of at least 30 bpm from supine to standing position, has been traditionally viewed as a dysfunction of the peripheral nervous system. However, recent studies and evidence from overlapping conditions suggest that in addition to being considered a disorder of the peripheral nervous system, POTS should be viewed also as a central nervous system (CNS) disorder given (1) significant CNS symptom burden in patients with POTS; (2) structural and functional differences found on neuroimaging in patients with POTS and other forms of orthostatic intolerance; (3) evidence of cerebral hypoperfusion and possible alteration in cerebrospinal fluid volume, and (4) positive response to medications targeting the CNS and non-pharmacologic CNS therapies. This review outlines existing evidence of POTS as a CNS disorder and proposes a hypothetical model combining key mechanisms in the pathophysiology of POTS. Redefining POTS as a CNS disorder can lead to new possibilities in pharmacotherapy and non-pharmacologic therapeutic interventions in patents affected by this disabling syndrome.
Topics: Autonomic Nervous System; Central Nervous System Diseases; Heart Rate; Humans; Orthostatic Intolerance; Postural Orthostatic Tachycardia Syndrome
PubMed: 33677650
DOI: 10.1007/s00415-021-10502-z -
American Journal of Hypertension Sep 2016When patients complain of altered consciousness or discomfort in the upright posture, either relieved by recumbency or culminating in syncope, physicians may find... (Review)
Review
When patients complain of altered consciousness or discomfort in the upright posture, either relieved by recumbency or culminating in syncope, physicians may find themselves baffled. There is a wide variety of disorders that cause abnormal regulation of blood pressure and pulse rate in the upright posture. The aim of this focused review is 3-fold. First, to offer a classification (nosology) of these disorders; second, to illuminate the mechanisms that underlie them; and third, to assist the physician in the practical aspects of diagnosis of adult orthostatic hypotension, by extending clinical skills with readily available office technology.
Topics: Humans; Orthostatic Intolerance
PubMed: 27037712
DOI: 10.1093/ajh/hpw023 -
Ugeskrift For Laeger Mar 2014Postural orthostatic tachycardia syndrome (POTS) is a heterogeneous condition of dysautonomia and suspected autoimmunity characterized by abnormal increments in heart... (Review)
Review
Postural orthostatic tachycardia syndrome (POTS) is a heterogeneous condition of dysautonomia and suspected autoimmunity characterized by abnormal increments in heart rate upon assumption of the upright posture accompanied by symptoms of cerebral hypoperfusion and sympathoexcitation. An increase in heart rate equal to or greater than 30 bpm or to levels higher than 120 bpm during a head-up tilt test is the main diagnostic criterion. Management includes both non-pharmacological and pharmacological treatment focusing on stress management, volume expansion and heart rate control.
Topics: Blood Pressure; Female; Heart Rate; Humans; Postural Orthostatic Tachycardia Syndrome; Tilt-Table Test; Young Adult
PubMed: 25350809
DOI: No ID Found -
Exercise and Sport Sciences Reviews Jan 2011Whole-body heating decreases pulmonary capillary wedge pressure and cerebral vascular conductance and causes an inotropic shift in the Frank-Starling curve. Whole-body... (Review)
Review
Whole-body heating decreases pulmonary capillary wedge pressure and cerebral vascular conductance and causes an inotropic shift in the Frank-Starling curve. Whole-body cooling increases pulmonary capillary wedge pressure and cerebral vascular conductance without changing systolic function. These and other data indicate that factors affecting cardiac function may mechanistically contribute to syncope during heat stress and improvements in orthostatic tolerance during cold stress.
Topics: Heart Rate; Heat Stress Disorders; Hot Temperature; Humans; Orthostatic Intolerance; Stroke Volume
PubMed: 21088607
DOI: 10.1097/JES.0b013e318201eed6 -
BMJ (Clinical Research Ed.) Aug 2004
Review
Topics: Cardiac Pacing, Artificial; Cardiovascular Agents; Humans; Syncope, Vasovagal
PubMed: 15297344
DOI: 10.1136/bmj.329.7461.336 -
CMAJ : Canadian Medical Association... Mar 2022
Review
Topics: Heart Rate; Humans; Postural Orthostatic Tachycardia Syndrome
PubMed: 35288409
DOI: 10.1503/cmaj.211373 -
Journal of Translational Medicine May 2021Orthostatic intolerance (OI) is a frequent finding in individuals with myalgic encephalomyelitis /chronic fatigue syndrome (ME/CFS). Published studies have proposed that...
BACKGROUND
Orthostatic intolerance (OI) is a frequent finding in individuals with myalgic encephalomyelitis /chronic fatigue syndrome (ME/CFS). Published studies have proposed that deconditioning is an important pathophysiological mechanism in various forms of OI, including postural orthostatic tachycardia syndrome (POTS), however conflicting opinions exist. Deconditioning can be classified objectively using the predicted peak oxygen consumption (VO) values from cardiopulmonary exercise testing (CPET). Therefore, if deconditioning is an important contributor to OI symptomatology, one would expect a relation between the degree of reduction in peak VOduring CPET and the degree of reduction in CBF during head-up tilt testing (HUT).
METHODS AND RESULTS
In 22 healthy controls and 199 ME/CFS patients were included. Deconditioning was classified by the CPET response as follows: %peak VO ≥ 85% = no deconditioning, %peak VO 65-85% = mild deconditioning, and %peak VO < 65% = severe deconditioning. HC had higher oxygen consumption at the ventilatory threshold and at peak exercise as compared to ME/CFS patients (p ranging between 0.001 and < 0.0001). Although ME/CFS patients had significantly greater CBF reduction than HC (p < 0.0001), there were no differences in CBF reduction among ME/CFS patients with no, mild, or severe deconditioning. We classified the hemodynamic response to HUT into three categories: those with a normal heart rate and blood pressure response, postural orthostatic tachycardia syndrome, or orthostatic hypotension. No difference in the degree of CBF reduction was shown in those three groups.
CONCLUSION
This study shows that in ME/CFS patients orthostatic intolerance is not caused by deconditioning as defined on cardiopulmonary exercise testing. An abnormal high decline in cerebral blood flow during orthostatic stress was present in all ME/CFS patients regardless of their %peak VO results on cardiopulmonary exercise testing.
Topics: Exercise; Fatigue Syndrome, Chronic; Heart Rate; Humans; Orthostatic Intolerance; Postural Orthostatic Tachycardia Syndrome
PubMed: 33947430
DOI: 10.1186/s12967-021-02819-0