A comparison of the prevalence of orthostatic hypotension between older patients with Alzheimer's Disease, Lewy body dementia, and without dementia

Orthostatic hypotension (OH) is reported to be more prevalent particularly in patients with Dementia with Lewy bodies (DLB) because of the autonomic dysfunction, but prevalence of OH is not known in patients with Alzheimer Disease (AD). The aim of the present study was to determine whether OH can be used to distinguish DLB from AD. 38 patients with DLB, 88 patients with AD and 521 patients without dementia, underwent Comprehensive Geriatric Assessment. OH were evaluated for the 1st (OH1) and 3rd (OH3) minutes, taking the data in supine position as the basis, by Head-Up-Tilt Test. Prevalence of OH1 was 43.2% in AD, 44.7% in DLB and 17.9% in patients without dementia, and OH3 was 44.3% in AD, 47.4% in DLB and 17.9% in non-dementia group. The frequency of OH1 and OH3 was higher in the AD and DLB groups than in the patients without dementia (p0.05). The percentage of asymptomatic patients with OH was 87.2% and 89.6% during 1st and 3rd minutes, respectively, and this percentage was similar in three groups (p>0.05, for each). There was no significant difference between the two dementia groups in terms of comorbidities, drugs and laboratory values (p>0.05). OH is more prevalent in patients with AD than controls and similar levels are observed in those with DLB. The prevalence of OH equally is greater with DLB or AD disease progression. Clinicians should be aware of OH and its related consequences in the management of the AD in older adults

Relationship between sarcopenia and orthostatic hypotension

Background: The relationship between sarcopenia and orthostatic hypotension (OH) is unclear. Objectives: The aim of the present study was to investigate associations between sarcopenia/sarcopenia severity and OH. Design: 511 patients attending a geriatric outpatient clinic were included. OH was defined as a decrease in systolic and/or diastolic blood pressure of ≥20 mmHg and/or ≥10 mmHg, respectively, when one transitions from the supine to an upright position. OH was measured by the Head-up Tilt Table test at 1, 3, and 5 minutes (OH1, OH3, and OH5, respectively). Sarcopenia and severity were defined according to the revised European consensus on definition and diagnosis. Results:The mean age of the sample was 75.40±7.35 years and 69.9% were female.The prevalence of probable sarcopenia, sarcopenia and severe sarcopenia was 42.2%, 6.06% and 11.1%, respectively. After adjustment for all covariates, systolic OH1, OH1 and systolic OH5 were statistically significant between severe sarcopenia and the robust group (Odd Ratio (OR):3.26 Confidence Interval [CI] 0.98-10.84; p=0.05 for systolic OH1, OR:4.31 CI 1.31-14.15; p=0.016 for OH1, OR:4.09 CI 1.01-16.55; p=0.048 for systolic OH5). Only systolic OH1 was statistically different between sarcopenia and severe sarcopenia groups (OR:2.64 CI; 1.87-8.73; p=0.012). OH1 and OH5 were statistically significant between severe sarcopenia and probable sarcopenia groups (p0.05). Conclusions: There is a close relationship between sarcopenia and severe sarcopenia and OH in older adults. Therefore, when a healthcare practitioner is evaluating an older patient with sarcopenia, OH should also be evaluated and vice versa

Cognitive and Metabolic Outcomes of Vildagliptin Addition to the Therapy in Patients with Type 2 Diabetes Mellitus: 26 Week Follow-up Study

Aims: Type 2 Diabetes Mellitus(DM) is a well-known risk factor for cognitive impairment. Recent evidences suggest that Dipeptidyl peptidase-4(DPP-4) inhibitors might have neuroprotective effects. Therefore, this study aimed to investigate vildagliptin, a DPP-4 inhibitor, effects on cognitive function in older patients with DM. Materials and Methods: A retrospective longitudinal clinical trial was carried out on total 130 subjects with type 2 DM. Patients underwent comprehensive geriatric assessment twice within six months interval. The patients were divided into three groups according to antidiabetic treatment: untreated control group (patients achieve individual goal HbA1c without antidiabetic medication), vildagliptin(+) group(patients using vildagliptin alone or combination) and the vildagliptin(–) group. Results: The mean age was 75.72 ± 7.46 years. The control group was older, of a lighter weight and also had a higher female gender ratio(p ≤ 0.01). When sex, age, educational level and metabolic profile were adjusted, there was only change in copying subdomain of Mini Mental State Examination between vildagliptin(+) and other groups at the end of 6 months. Vildagliptin also resulted in reduction of HbA1c and weight(p<0.05). Conclusion: The addition of vildagliptin to treatment improved the copying subdomain of cognitive function and metabolic control of the older patients with type 2 DM within 6 months