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2.
Ann Emerg Med ; 76(6): 730-738, 2020 12.
Artigo em Inglês | MEDLINE | ID: mdl-33010956

RESUMO

STUDY OBJECTIVE: Falls are a major cause of mortality and morbidity in adults aged 65 years and older and a common chief complaint in the emergency department (ED). However, the rate of missed opportunities to diagnose and intervene in modifiable fall-risk factors in the ED is unknown. We hypothesize that although ED providers (defined as ED attendings, residents, and advanced care providers) excel at assessing and ruling out injury, they miss the opportunity to identify a large portion of the modifiable risk factors that contribute to a patient's fall. Our objective is to quantify the number of missed opportunities to identify and reduce fall-risk factors in older adult ED patients presenting after a fall. METHODS: This secondary analysis used data from a prospective cohort study of older patients at a single academic urban ED. The original study investigated the standard ED evaluation after a fall in older adults. All patients in the original study had a falls evaluation conducted at their ED visit by trained research assistants; this served as the standard fall evaluation. We reviewed the charts of study patients and identified modifiable fall-risk factors. We then determined the number of missed opportunities to intervene in these risk factors during the ED encounter; the primary outcome was the percentage of missed opportunities to identify risk factors in older ED patients who fell. RESULTS: We found that of the 400 patient charts reviewed, 349 patients had a modifiable risk factor for falling. Of those patients with known modifiable risk factors, the ED team missed identifying the factors in 335 patients (96%). The most commonly missed fall-risk factors were visual acuity (147/154; 96%) and the use of high-risk medications (245/259;95%). Gait abnormalities had the lowest rates of missed modifiable risk factors, at 56% of patients (109/196). When a modifiable risk factor was identified and intervened in, it was most commonly done in the ED observation unit by a physician or physical therapist, and often consisted of an outpatient referral or primary care physician follow-up. CONCLUSION: Providers frequently fail to identify and intervene in modifiable fall-risk factors in older adult patients presenting to the ED after a fall; this is a missed opportunity. Addressing the risk factors that contributed to the fall during a fall-related ED visit may minimize fall risk and promote safer mobility.


Assuntos
Acidentes por Quedas/prevenção & controle , Acidentes por Quedas/estatística & dados numéricos , Serviço Hospitalar de Emergência/estatística & dados numéricos , Idoso , Idoso de 80 Anos ou mais , Feminino , Transtornos Neurológicos da Marcha/diagnóstico , Avaliação Geriátrica/métodos , Avaliação Geriátrica/estatística & dados numéricos , Humanos , Hipotensão Ortostática/complicações , Hipotensão Ortostática/diagnóstico , Masculino , Avaliação de Resultados em Cuidados de Saúde , Doenças do Sistema Nervoso Periférico/complicações , Doenças do Sistema Nervoso Periférico/diagnóstico , Polimedicação , Estudos Prospectivos , Medição de Risco , Fatores de Risco , Baixa Visão/complicações , Acuidade Visual/fisiologia
3.
PLoS One ; 15(10): e0240491, 2020.
Artigo em Inglês | MEDLINE | ID: mdl-33057432

RESUMO

Orthostatic hypotension (OH) frequently accompanies autonomic dysfunction and is an important risk factor for cognitive impairment in Parkinson's disease (PD). While OH is usually diagnosed based on an orthostatic blood pressure drop, the association between the heart rate response and cognitive impairment remains unclear. We retrospectively analyzed 143 cases of clinically diagnosed PD to determine the association between the absence of a heart rate response and cognitive impairment in PD with OH. Among the patients with OH, neurogenic OH was diagnosed in cases without a heart rate increase, while all other patients were diagnosed with non-neurogenic OH. Dementia was found in 23 of 143 PD cases (16.1%) in this cohort. The presence of OH was an independent risk factor for dementia in PD in addition to the disease severity, years of education and beta-blockers use. Neurogenic OH was significantly associated with dementia compared to the no OH group (hazard ratio [HR] 7.3, 95% confidence interval [CI] 2.2-24.6, P<0.01), an association that was preserved after adjusting for age, gender and other covariant factors. However, no such association was observed for non-neurogenic OH (HR 2.9, 95%CI 0.8-10.9, P = 0.12). While the cognitive impairment was significantly worse in the neurogenic OH group than the no-OH group, the groups were otherwise similar. The blood pressure decrease was significantly lower in both OH groups than in the no-OH group, despite no significant differences between the OH groups. Our finding showed that OH without a heart rate response was an important predictor of cognitive impairment in PD.


Assuntos
Disfunção Cognitiva/etiologia , Frequência Cardíaca , Hipotensão Ortostática/fisiopatologia , Doença de Parkinson/complicações , Idoso , Pressão Sanguínea , Disfunção Cognitiva/patologia , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Prognóstico , Estudos Retrospectivos , Fatores de Risco
4.
Neurology ; 95(21): e2854-e2865, 2020 11 24.
Artigo em Inglês | MEDLINE | ID: mdl-32938788

RESUMO

OBJECTIVES: To assess the frequency of transient orthostatic hypotension (tOH) and its clinical impact in Parkinson disease (PD), we retrospectively studied 173 patients with PD and 173 age- and sex-matched controls with orthostatic intolerance, who underwent cardiovascular autonomic function testing under continuous noninvasive blood pressure (BP) monitoring. METHODS: We screened for tOH (systolic BP fall ≥20 mm Hg or diastolic ≥10 mm Hg resolving within the first minute upon standing) and classic OH (cOH, sustained systolic BP fall ≥20 mm Hg or diastolic ≥10 mm Hg within 3 minutes upon standing). In patients with PD, we reviewed the medical records of the 6 months preceding and following autonomic testing for history of falls, syncope, and orthostatic intolerance. RESULTS: tOH occurred in 24% of patients with PD and 21% of controls, cOH in 19% of patients with PD and in none of the controls, independently of any clinical-demographic or PD-specific characteristic. Forty percent of patients with PD had a history of falls, in 29% of cases due to syncope. Patients with PD with history of orthostatic intolerance and syncope had a more severe systolic BP fall and lower diastolic BP rise upon standing, most pronounced in the first 30-60 seconds. CONCLUSIONS: tOH is an age-dependent phenomenon, which is at least as common as cOH in PD. Transient BP falls when changing to the upright position may be overlooked with bedside BP measurements, but contribute to orthostatic intolerance and syncope in PD. Continuous noninvasive BP monitoring upon standing may help identify a modifiable risk factor for syncope-related falls in parkinsonian patients.


Assuntos
Acidentes por Quedas/prevenção & controle , Hipotensão Ortostática/complicações , Doença de Parkinson/complicações , Síncope/complicações , Idoso , Sistema Nervoso Autônomo/fisiopatologia , Determinação da Pressão Arterial/métodos , Feminino , Humanos , Hipotensão/complicações , Hipotensão Ortostática/fisiopatologia , Masculino , Pessoa de Meia-Idade , Intolerância Ortostática/complicações , Fatores de Risco
5.
J Cardiovasc Transl Res ; 13(4): 549-569, 2020 08.
Artigo em Inglês | MEDLINE | ID: mdl-32748206

RESUMO

Heart failure (HF)is a condition at high risk for orthostatic hypotension (OH)given the large proportion of patients at an advanced age and high burden of comorbidities contributing to OH, as well as a high prevalence of medications with neurovascular and volume modulating properties. Early identification of OH in HF seems to be crucial as OH can have an impact on patient symptoms, activity level and independence, be a marker of specific pathophysiological changes or be an indicator of need for personalized treatment. OH might contribute significantly to bad enough prognosis in HF, as, besides a risk of falls and cognitive decline, it was found to be associated with cardiovascular morbidity and mortality. In this review, we aimed to incentivize the routine use of orthostatic testing in HF, as well as stimulate future research in this field, which could lead to significant advances in the treatment and outcomes.


Assuntos
Pressão Sanguínea , Insuficiência Cardíaca/fisiopatologia , Hipotensão Ortostática/fisiopatologia , Postura , Adulto , Idoso , Idoso de 80 Anos ou mais , Comorbidade , Feminino , Insuficiência Cardíaca/diagnóstico , Insuficiência Cardíaca/epidemiologia , Insuficiência Cardíaca/terapia , Humanos , Hipotensão Ortostática/diagnóstico , Hipotensão Ortostática/epidemiologia , Hipotensão Ortostática/terapia , Masculino , Pessoa de Meia-Idade , Prevalência , Prognóstico , Adulto Jovem
6.
Neurology ; 95(14): e1941-e1950, 2020 10 06.
Artigo em Inglês | MEDLINE | ID: mdl-32732296

RESUMO

OBJECTIVE: To test the hypothesis that orthostatic hypotension (OH) might cause cerebral hypoperfusion and injury, we examined the longitudinal relationship between OH or orthostatic symptoms and incident neurologic outcomes in a community population of older adults. METHODS: Cardiovascular Health Study participants (≥65 years) without dementia or stroke had blood pressure (BP) measured after lying down for 20 minutes and after standing 3 for minutes. Participants reported dizziness immediately upon standing and any dizziness in the past 2 weeks. OH was defined as a drop in standing systolic/diastolic BP ≥20/≥10 mm Hg. We determined the association between OH or dizziness with (1) MRI brain findings (ventricular size, white matter hyperintensities, brain infarcts) using linear or logistic regression, (2) cognitive function (baseline and over time) using generalized estimating equations, and (3) prospective adjudicated events (dementia, stroke, death) using Cox models. Models were adjusted for demographic characteristics and OH risk factors. We used multiple imputation to account for missing OH or dizziness (n = 534). RESULTS: Prior to imputation, there were 5,007 participants (mean age 72.7 ± 5.5 years, 57.6% women, 10.9% Black, 16% with OH). OH was modestly associated with death (hazard ratio [HR] 1.11; 95% confidence interval 1.02-1.20), but not MRI findings, cognition, dementia, or stroke. In contrast, dizziness upon standing was associated with lower baseline cognition (ß = -1.20; -1.94 to -0.47), incident dementia (HR 1.32; 1.04-1.62), incident stroke (HR 1.22; 1.06-1.41), and death (HR 1.13; 1.06-1.21). Similarly, dizziness over the past 2 weeks was associated with higher white matter grade (ß = 0.16; 0.03-0.30), brain infarcts (OR 1.31; 1.06-1.63), lower baseline cognition (ß = -1.18; -2.01 to -0.34), and death (HR 1.13; 1.04-1.22). CONCLUSIONS: Dizziness was more consistently associated with neurologic outcomes than OH 3 minutes after standing. Delayed OH assessments may miss pathologic information related to cerebral injury.


Assuntos
Encéfalo/patologia , Cognição/fisiologia , Tontura , Hipotensão Ortostática , Idoso , Demência/epidemiologia , Tontura/fisiopatologia , Feminino , Humanos , Hipotensão Ortostática/fisiopatologia , Masculino , Fatores de Risco , Acidente Vascular Cerebral/epidemiologia
8.
Blood Press Monit ; 25(5): 267-270, 2020 Oct.
Artigo em Inglês | MEDLINE | ID: mdl-32675475

RESUMO

OBJECTIVES: Orthostatic hypotension is a well-known disorder, but orthostatic hypertension (OHT) still remains unclear in older adults. The aim of this study was to determine the comparison orthostatic hypotension with OHT according to fall risk and geriatric assessment parameters. METHODS: A total of 741 patients who were admitted to the geriatric clinic and underwent comprehensive geriatric assessment were reviewed. Orthostatic blood pressure changes were measured by head-up-tilt Table test within the first three minutes. Orthostatic hypotension was defined as 20 or 10-mmHg drop in systolic and/or diastolic blood pressure from supine to standing position. OHT was defined as an increase in systolic blood pressure of 10 mmHg or more while the patient was standing up from the supine position. RESULTS: The mean age was 75 ± 8 and 65. About 65% of all participants were female. The rate of orthostatic hypotension and OHT was 17.3 and 7.2%, respectively. The falls and dementia were more frequent, and the Instrumental Activities of Daily Living (IADL) score was lower in orthostatic hypotension group than in OHT and control groups (P < 0.05). These variables were similar between OHT and control groups (P > 0.05). The rates of falls [odds ratio (OR) = 2.02; 95% confidence interval (CI), (0.94-4.33); P = 0.044] and dementia [OR = 2.65; 95% CI, (1.08-6.48); P = 0.032] in orthostatic hypotension group were still higher than in OHT group, even after adjusting for age, sex, estimated glomerular filtration rate and drugs. CONCLUSION: Orthostatic hypotension may be more significant in terms of falls, dementia and impaired IADLs scores in older adults than in OHT and control groups. It seems that OHT may be of no clinical importance in geriatric practice.


Assuntos
Hipertensão , Hipotensão Ortostática , Atividades Cotidianas , Idoso , Pressão Sanguínea , Determinação da Pressão Arterial , Feminino , Humanos , Hipotensão Ortostática/diagnóstico , Masculino
10.
Neurology ; 95(14): e1932-e1940, 2020 10 06.
Artigo em Inglês | MEDLINE | ID: mdl-32690802

RESUMO

OBJECTIVE: To determine whether orthostatic hypotension (OHYPO) and visit-to-visit blood pressure (BP) postural changes variability are associated with incident dementia. METHODS: We studied 2,131 older adults from the Health, Aging, and Body Composition cohort study. Orthostatic BP was repeatedly assessed over a 5-year baseline period. OHYPO was defined as a fall ≥15 mm Hg in systolic or ≥7 mm Hg in diastolic BP after standing from a sitting position for one-third or more of the visits. Systolic OHYPO and diastolic OHYPO were also examined separately. BP postural changes variability over time was evaluated with several indicators, including SD and coefficient of variation (CV). Incident dementia was determined over 12 years after the baseline period by dementia medication use, ≥1.5 SD decline in Modified Mini-Mental State Examination score, or hospitalization records. RESULTS: Of 2,131 participants (mean age 73 years, 53% female, 39% Black), 309 (14.5%) had OHYPO, 192 (9.0%) had systolic OHYPO, 132 (6.2%) had diastolic OHYPO, and 462 (21.7%) developed dementia. After adjustment for demographics, seated systolic BP (SBP), antihypertensive drugs, cerebrovascular disease, diabetes mellitus, depressive symptoms, smoking, alcohol, body mass index, and presence of 1 or 2 APOE ε4 alleles, systolic OHYPO was associated with greater dementia risk (adjusted hazard ratio [HR] 1.37, 95% confidence interval [CI] 1.01-1.88), unlike diastolic OHYPO and OHYPO. SBP postural changes variability was also associated with higher dementia risk (highest tertile of variability [CV]: adjusted HR 1.35, 95% CI 1.06-1.71). CONCLUSION: Systolic OHYPO and visit-to-visit SBP postural changes variability were associated with greater dementia risk. Our findings raise the question of potential preventive interventions to control orthostatic SBP and its fluctuations.


Assuntos
Pressão Sanguínea/fisiologia , Demência/epidemiologia , Hipotensão Ortostática/fisiopatologia , Idoso , Feminino , Humanos , Incidência , Masculino , Postura/fisiologia , Fatores de Risco
12.
J Neuropathol Exp Neurol ; 79(7): 813-816, 2020 07 01.
Artigo em Inglês | MEDLINE | ID: mdl-32529258

RESUMO

The aim of our study was to assess the distribution of phosphorylated α-synuclein (p-syn) deposits in a patient affected by early stage Parkinson disease and orthostatic hypotension through a longitudinal skin biopsy study. We found widespread p-syn spatial diffusion from deep autonomic dermis nerve bundles to autonomic terminals, suggesting a centrifugal spread of p-syn from ganglia to the innervation target structures. Furthermore, the case suggests the possibility of discriminating synucleinopathies at an early stage of disease by means of skin biopsy. If confirmed, these data support skin biopsy as a useful and promising tool for the diagnosis, longitudinal evaluation, and pathological understanding of Parkinson disease.


Assuntos
Hipotensão Ortostática/metabolismo , Doença de Parkinson/metabolismo , Pele/metabolismo , alfa-Sinucleína/metabolismo , Idoso , Biópsia , Feminino , Humanos , Hipotensão Ortostática/diagnóstico por imagem , Hipotensão Ortostática/patologia , Estudos Longitudinais , Doença de Parkinson/diagnóstico por imagem , Doença de Parkinson/patologia , Fosforilação/fisiologia , Pele/patologia
14.
Harefuah ; 159(5): 334-338, 2020 May.
Artigo em Hebraico | MEDLINE | ID: mdl-32431122

RESUMO

INTRODUCTION: We describe the incidence of orthostatic hypotension (OH) and postprandial hypotension (PPH) in a population of elderly people. METHODS: Blood pressure was measured with the subjects lying in bed and after postural change to sitting. Blood pressure was also measured before and after breakfast. We examined the association between postprandial hypotension, caloric intake and the alertness of the subjects. A total of 101 residents of the Geriatric Ward in the Laniado Hospital were included in the study. RESULTS: We found a significant change in blood pressure before and after food consumption (p≤0.001, T(65)=3.31(. Post prandial hypotension PPH was found in half of the patients. Overall, no significant postural change in blood pressure was found between lying and sitting (p>0.05) although orthostatic hypotension was found in 27% of the patients. No association was found between caloric intake, postprandial hypotension and the level of alertness. DISCUSSION: The high prevalence of OH and PPH in the elderly requires strict blood pressure surveillance with appropriate and timely adjustment of drug therapy.


Assuntos
Geriatria , Hipotensão , Idoso , Pressão Sanguínea , Humanos , Hipotensão Ortostática , Período Pós-Prandial , Prevalência
15.
Cardiovasc Ther ; 2020: 2478781, 2020.
Artigo em Inglês | MEDLINE | ID: mdl-32426035

RESUMO

It was indeed a Don Quixote-like pursuit of the mechanism of essential hypertension when we serendipitously discovered α 2-adrenoceptors (α 2-ARs) in skin-lightening experiments in the frog. Now α 2-ARs lurk on the horizon involving hypertension causality, renal denervation for hypertension, injury from falling in the elderly and prazosin's mechanism of action in anxiety states such as posttraumatic stress disorder (PTSD). Our goal here is to focus on this horizon and bring into clear view the role of α 2-AR-mediated mechanisms in these seemingly unrelated conditions. Our narrative begins with an explanation of how experiments in isolated perfused kidneys led to the discovery of a sodium-retaining process, a fundamental mechanism of hypertension, mediated by α 2-ARs. In this model system and in the setting of furosemide-induced sodium excretion, α 2-AR activation inhibited adenylate cyclase, suppressed cAMP formation, and caused sodium retention. Further investigations led to the realization that renal α 2-AR expression in hypertensive animals is elevated, thus supporting a key role for kidney α 2-ARs in the pathophysiology of essential hypertension. Subsequent studies clarified the molecular pathways by which α 2-ARs activate prohypertensive biochemical systems. While investigating the role of α 1-adrenoceptors (α 1-ARs) versus α 2-ARs in renal sympathetic neurotransmission, we noted an astonishing result: in the kidney α 1-ARs suppress the postjunctional expression of α 2-ARs. Here, we describe how this finding relates to a broader understanding of the role of α 2-ARs in diverse disease states. Because of the capacity for qualitative and quantitative monitoring of α 2-AR-induced regulatory mechanisms in the kidney, we looked to the kidney and found enlightenment.


Assuntos
Pressão Sanguínea , Hipertensão Essencial/metabolismo , Rim/metabolismo , Receptores Adrenérgicos alfa 2/metabolismo , Acidentes por Quedas , Antagonistas de Receptores Adrenérgicos alfa 2/uso terapêutico , Animais , Anti-Hipertensivos/uso terapêutico , Ansiedade/metabolismo , Ansiedade/fisiopatologia , Ansiedade/psicologia , Denervação Autônoma , Pressão Sanguínea/efeitos dos fármacos , Diuréticos/uso terapêutico , Hipertensão Essencial/fisiopatologia , Hipertensão Essencial/terapia , Humanos , Hipotensão Ortostática/metabolismo , Hipotensão Ortostática/fisiopatologia , Rim/efeitos dos fármacos , Rim/fisiopatologia , Receptores Adrenérgicos alfa 1/metabolismo , Receptores Adrenérgicos alfa 2/efeitos dos fármacos , Eliminação Renal , Reabsorção Renal , Transdução de Sinais , Sódio/metabolismo , Transtornos de Estresse Pós-Traumáticos/metabolismo , Transtornos de Estresse Pós-Traumáticos/fisiopatologia , Transtornos de Estresse Pós-Traumáticos/psicologia
16.
Arq Bras Cardiol ; 114(6): 1040-1048, 2020 06.
Artigo em Inglês, Português | MEDLINE | ID: mdl-32401848

RESUMO

Background Orthostatic hypotension (OH) has been neglected in clinical practice, and there are no studies on its prevalence in the Brazilian population. Objective To determine the prevalence of OH and blood pressure (BP) changes after the postural change maneuver in participants of the Longitudinal Study of Adult Health. Methods In this descriptive study of baseline data (N = 14,833 adults, ages 35 - 74 years), participants remained lying down for 20 minutes and subsequently stood up actively. BP measurements were taken while the participants were supine and at 2, 3, and 5 minutes after standing. OH was defined as a reduction of ≥ 20 mmHg in systolic BP and/or a reduction of ≥ 10 mmHg in diastolic BP at 3 minutes, and its prevalence was determined with a 95% confidence interval (CI). The distribution of BP variation after the postural change maneuver was determined in a subsample (N = 8,011) obtained by removing patients with cardiovascular morbidity and/or diabetes. Results The prevalence of OH was 2.0% (95% CI: 1.8 - 2.3), increasing with age. If the criterion applied were a BP reduction during any measurement, the prevalence would increase to 4.3% (95% CI: 4.0 - 4.7). Symptoms (dizziness, scotoma, nausea, etc.) were reported by 19.7% of participants (95% CI: 15.6 - 24.6) with OH and 1.4% (95% CI: 1.2 - 1.6) of participants without OH. The -2 Z-scores of BP variation before and after the postural change maneuver in the subsample were -14.1 mmHg for systolic BP and -5.4 mmHg for diastolic BP. Conclusion Prevalence of OH varies depending on when BP is measured. Current cutoff points may underestimate the actual occurrence of OH in the population. (Arq Bras Cardiol. 2020; 114(6):1040-1048).


Assuntos
Pressão Sanguínea/fisiologia , Hipotensão Ortostática/epidemiologia , Adulto , Idoso , Determinação da Pressão Arterial , Brasil/epidemiologia , Humanos , Estudos Longitudinais , Pessoa de Meia-Idade , Prevalência
17.
Neurol Clin ; 38(2): 269-292, 2020 05.
Artigo em Inglês | MEDLINE | ID: mdl-32279710

RESUMO

Parkinson disease (PD) is well recognized by its motor features of bradykinesia, tremor, rigidity, and gait and balance difficulties. However, PD is also characterized by a myriad of nonmotor symptoms, which may occur even before motor symptoms, early in the course of disease, and throughout the advancing disease. These nonmotor symptoms span multiple different systems, invoke multiple different neurotransmitters, and require multiple strategies for treatment including pharmacologic and nonpharmacologic interventions and, often, multiple different disciplines. This article discusses symptoms, assessments, and therapeutics for the nonmotor symptoms of PD including those affecting mood, cognition, behavior, sleep, autonomic function, and sensory systems.


Assuntos
Doença de Parkinson/complicações , Doença de Parkinson/terapia , Transtornos Cognitivos/etiologia , Transtornos Cognitivos/terapia , Constipação Intestinal/etiologia , Constipação Intestinal/terapia , Humanos , Hipotensão Ortostática/etiologia , Hipotensão Ortostática/terapia , Transtornos Mentais/etiologia , Transtornos Mentais/terapia , Transtornos do Sono-Vigília/etiologia , Transtornos do Sono-Vigília/terapia , Bexiga Urinaria Neurogênica/etiologia , Bexiga Urinaria Neurogênica/terapia
18.
BMC Neurol ; 20(1): 157, 2020 Apr 27.
Artigo em Inglês | MEDLINE | ID: mdl-32340608

RESUMO

BACKGROUND: The "hot cross bun" (HCB) sign, a cruciform hyperintensity in the pons on magnetic resonance imaging (MRI), has gradually been identified as a typical finding in multiple system atrophy, cerebellar-type (MSA-C). Few reports have evaluated the sensitivity of an HCB, including a cruciform hyperintensity and vertical line in the pons, which precedes a cruciform hyperintensity, in the early stages of MSA-C. Moreover, the difference in frequency and timing of appearance of an HCB between MSA-C and spinocerebellar ataxia type 3 (SCA3) has not been fully investigated. METHODS: This study investigated the time at which an HCB and orthostatic hypotension (OH) appeared in 41 patients with MSA-C, based on brain MRI and head-up tilt test. The MRI findings were compared with those of 26 patients with SCA3. The pontine signal findings on T2-weighted MRI were graded as 0 (no change), 1 (a vertical T2 high-intensity line), or 2 (a cruciform T2 high-intensity line), with grades 1 or 2 considered as an HCB. OH 30/15 was defined as a decrease in systolic blood pressure of > 30 mmHg or diastolic blood pressure of > 15 mmHg. RESULTS: Among the 24 patients with MSA-C within 2 years from the onset of motor symptoms, an HCB was detected in 91.7%, whereas OH 30/15 was present in 60.0%. Among the 36 patients with MSA-C within 3 years from the onset of motor symptoms, a grade 2 HCB was detected in 66.7% of those with MSA-C but in none of those with SCA-3. CONCLUSIONS: HCB is a highly sensitive finding for MSA-C, even in the early stages of the disease. A grade 2 HCB in the early stage is an extremely specific finding for differentiating MSA-C from SCA-3.


Assuntos
Hipotensão Ortostática/etiologia , Doença de Machado-Joseph/diagnóstico , Atrofia de Múltiplos Sistemas/diagnóstico , Adulto , Idoso , Idoso de 80 Anos ou mais , Cerebelo/patologia , Feminino , Humanos , Imagem por Ressonância Magnética/métodos , Masculino , Pessoa de Meia-Idade , Ponte/patologia , Estudos Retrospectivos , Adulto Jovem
19.
J Clin Neurosci ; 75: 40-44, 2020 May.
Artigo em Inglês | MEDLINE | ID: mdl-32234335

RESUMO

The degree and frequency of orthostatic hypotension (OH) are high in patients with multiple system atrophy (MSA); however, the association of orthostatic blood pressure (BP) with the symptoms of OH and cognitive impairment in these patients remains unclear. The aim of this study was to clarify whether absolute BP and/or changes in BP during standing are related to OH symptoms and cognitive impairment in patients with MSA. Thirty-two patients with MSA were examined using the head-up tilt and cognitive function tests. OH symptoms were evaluated using a patient-reported scale. The results were compared with those for 15 age- and sex-matched healthy controls. Seventeen of the 32 (53.1%) patients had OH, with eight of them exhibiting OH symptoms, which were related to the absolute BP value at 60° tilt. However, OH symptoms were not related to the degree of decrease in BP during the tilt test, and they were frequently observed in patients with a mean BP of <80 mmHg at 60° tilt (sensitivity, 67%; specificity, 91%). Cognitive dysfunction assessed by the Mini-Mental State Examination (MMSE; ≤ 26) was also associated with a low mean BP at 60° tilt (odds ratio, 1.32; 95% confidence interval, 1.04-1.67; p = 0.02). The upright BP value is associated with OH symptoms and the MMSE score in patients with MSA. Thus, careful observation of OH symptoms can enable early management of BP and the detection of cognitive impairment in these patients.


Assuntos
Disfunção Cognitiva/etiologia , Hipotensão Ortostática/complicações , Atrofia de Múltiplos Sistemas/complicações , Idoso , Pressão Sanguínea/fisiologia , Encéfalo/patologia , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Atrofia de Múltiplos Sistemas/patologia , Teste da Mesa Inclinada , Substância Branca/patologia
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