The “syncope and dementia” study: a prospective, observational, multicenter study of elderly patients with dementia and episodes of “suspected” transient loss of consciousness

Abstract

Background and aim Syncope and related falls are one of the main causes and the predominant cause of hospitalization in elderly patients with dementia. However, the diagnostic protocol for syncope is difficult to apply to patients with dementia. Thus, we developed a ''simplified'' protocol to be used in a prospective, observational, and multicenter study in elderly patients with dementia and transient loss of consciousness suspected for syncope or unexplained falls. Here, we describe the protocol, its feasibility and the characteristics of the patients enrolled in the study. Methods Patients aged C65 years with a diagnosis of dementia and one or more episodes of transient loss of consciousness during the previous 3 months, subsequently referred to a Geriatric Department in different regions of Italy, from February 2012 to May 2014, were enrolled. A simplified protocol was applied in all patients. Selected patients underwent a second-level evaluation. Results Three hundred and three patients were enrolled; 52.6 % presented with episodes suspected to be syncope, 44.5 % for unexplained fall and 2.9 % both. Vascular dementia had been previously diagnosed in 53.6 % of participants, Alzheimer's disease in 23.5 % and mixed forms in 12.6 %. Patients presented with high comorbidity (CIRS score = 3.6 ± 2), severe functional impairment, (BADL lost = 3 ± 2), and polypharmacy (6 ± 3 drugs). Conclusion Elderly patients with dementia enrolled for suspected syncope and unexplained falls have high comorbidity and disability. The clinical presentation is often atypical and the presence of unexplained falls is particularly frequent.

Clinical differences among the elderly admitted to the emergency department for accidental or unexplained falls and syncope

“…However, if we look at the characteristics of each study group, patients with UF resulted more similar to those with AF than those with syncope. Moreover, dementia per se could act as a risk factor for falls as previously reported 24,29,42. Thus, the above described potential bias may only account for a small percentage of cases and marginally affect the results.…”

Prevalence, predictors and clinical implications of prolonged corrected QT in elderly patients with dementia and suspected syncope

“…This is a secondary analysis of the SYD [10] dataset, that was a prospective observational study involving nine Italian departments of Geriatrics. The overall study population consisted of 522 in-and outpatients aged ≥65 years referring to acute care wards, syncope units or Alzheimer's evaluation units.…”

“…The overall study population consisted of 522 in-and outpatients aged ≥65 years referring to acute care wards, syncope units or Alzheimer's evaluation units. The full study design, including the standardized multidimensional geriatric assessment and the diagnostic protocol applied for the diagnosis and management of syncope, has been described elsewhere [10,11]. Briefly, consecutive patients with a diagnosis of dementia, according to the Diagnostic and Statistical Manual of Mental Disorders IV [12], and at least one episode of suspected syncope or unexplained fall during the previous three months, were enrolled.…”

“…The "Syncope and Dementia" study (SYD) was designed by the Italian Group for the study of Syncope with the endorsement of the Italian Geriatric Society in order to evaluate older patients with dementia and suspected syncope or unexplained falls [10]. Advanced age, the presence of dementia and the use of multiple medications, including antipsychotics and antidepressants, make these patients a potentially interesting target to investigate prevalence and clinical implications of prolonged QTc (corrected QT).…”

Hypotensive Drugs and Syncope Due to Orthostatic Hypotension in Older Adults with Dementia (Syncope and Dementia Study)

“…1 A second-level neuroautonomic, neurological, or cardiological (when needed according to European Society of Cardiology guidelines) evaluation was undertaken in participants in whom a reliable diagnosis could not be established from the initial evaluation. 8 At the end of the diagnostic protocol, participants were divided into 2 groups: syncopal falls and nonsyncopal falls. Nonsyncopal falls included unexplained falls, falls without loss of consciousness (e.g., drop attacks, psychiatric disorders), and falls with nonsyncopal loss of consciousness (e.g., epilepsy, stroke, other metabolic disturbances).…”