Etiology of syncope and unexplained falls in elderly adults with Dementia: Syncope and Dementia (SYD) study
Open accessAbstract
OBJECTIVES: To investigate the etiology of transient loss of consciousness (T-LOC) suspected to be syncope and unexplained falls in elderly adults with dementia. DESIGN: Prospective, observational, multicenter study. SETTING: Acute care wards, syncope units or centers for the diagnosis of dementia. PARTICIPANTS: Individuals aged 65 and older with a diagnosis of dementia and one or more episodes of T-LOC of a suspected syncopal nature or unexplained falls during the previous 3 months were enrolled. MEASUREMENTS: The causes of T-LOC suspected to be syncope and unexplained falls were evaluated using a simplified protocol based on European Society of Cardiology guidelines. RESULTS: Of 357 individuals enrolled, 181 (50.7%) had been referred for T-LOC suspected to be syncope, 166 (46.5%) for unexplained falls, and 10 (2.8%) for both. An initially suspected diagnosis of syncope was confirmed in 158 (87.3%), and syncope was identified as the cause of the event in 75 (45.2%) of those referred for unexplained falls. Orthostatic hypotension was the cause of the event in 117 of 242 (48.3%) participants with a final diagnosis of syncope. CONCLUSION: The simplified syncope diagnostic protocol can be used in elderly people with dementia referred for suspected syncope or unexplained falls. Unexplained falls may mask a diagnosis of syncope or pseudosyncope in almost 50% of cases. Given the high prevalence of orthostatic syncope in participants (~50%), a systematic reappraisal of drugs potentially responsible for orthostatic hypotension is warranted.
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The prescription of polypharmacy, cardiovascular medications, and psychotropic and dopaminergic drugs increases the risk of syncope and falls.
“The prescription of polypharmacy, cardiovascular medications, and psychotropic (neuroleptics and antidepressants) and dopaminergic drugs also increases the risk of syncope and falls. 381-385”
From 2018 ESC Guidelines for the diagnosis and management of syncope (2018) · cites this paper as [385]
The Discussion (page unavailable in our copy) says antihypertensive drugs may help explain the high prevalence of orthostatic syncope in these elderly adults with dementia, and identifies hypotensive compounds as drugs that increase fall risk. Table 2 lists multiple medications, antidepressants, antipsychotics, and antiparkinsonian drugs used by participants, but does not establish that polypharmacy or those psychotropic and dopaminergic drugs increased syncope or fall risk. The claim also states the medication effect more definitively than the Discussion does. (LLM, conf=0.87)
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Diretriz Brasileira de Cardiogeriatria – 2026
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- Authors
- Ungar, A., Mussi, C., Ceccofiglio, A., Bellelli, G., Nicosia, F., Bo, M., Riccio, D., Martone, A. M., Guadagno, L., Noro, G., Ghidoni, G., Rafanelli, M., Marchionni, N., & Abete, P.
- Affiliations
- Azienda Ospedaliero-Universitaria Careggi (IT)
- University of Modena and Reggio Emilia (IT)
- Azienda Ospedaliera San Gerardo (IT)
- Azienda Socio Sanitaria Territoriale degli Spedali Civili di Brescia (IT)
- Azienda Ospedaliera Citta' della Salute e della Scienza di Torino (IT)
- Santissima Trinità (IT)
- Università Cattolica del Sacro Cuore (IT)
- University of Naples Federico II (IT)
- Ospedale Santa Chiara (IT)
- Corresponding author
- Ungar, Andrea
- ORCID
- Venue
- Journal of the American Geriatrics Society
- Publisher
- Wiley
- Published
- 2016-06-28
- Volume
- 64
- Issue
- 8
- Pages
- 1567-1573
- ISSN
- 0002-8614 (ISSN-L)
- 1532-5415
- OpenAlex
- W2472395506
- Cited by
- 80
- References
- 37
- Citations by year
- 2026: 4 · 2025: 7 · 2024: 8 · 2023: 9 · 2022: 6 · 2021: 11 · 2020: 11 · 2019: 6 · 2018: 11 · 2017: 6
- FWCI
- 8.49
- Type
- journal article
- Language
- en
- Open access
- bronze
- doi.org
- Locations
- Journal of the American Geriatrics Society (publishedVersion)
- PubMed (publishedVersion)
- Florence Research (University of Florence) (submittedVersion, other-oa)
- BOA (University of Milano-Bicocca) (submittedVersion)
- IRIS UNIMORE (University of Modena and Reggio Emilia) (submittedVersion, cc-by)
- Institutional Research Information System University of Turin (University of Turin) (submittedVersion)
- Funders
- Università degli Studi di Firenze
- Università Cattolica del Sacro Cuore
- Topics
- Health Sciences › Medicine › Surgery › Cardiovascular Syncope and Autonomic Disorders
- Health Sciences › Health Professions › Physical Therapy, Sports Therapy and Rehabilitation › Balance, Gait, and Falls Prevention
- Health Sciences › Medicine › Psychiatry and Mental health › Dementia and Cognitive Impairment Research
- Keywords
- syncope, unexplained falls, dementia, older adults, transient loss of consciousness, orthostatic hypotension, orthostatic syncope, etiology
- MeSH terms
- Accidental Falls, Aged, Aged, 80 and over, Alzheimer Disease, Cross-Sectional Studies, Diagnosis, Differential, Female, Humans, Hypotension, Orthostatic, Italy, Male, Prospective Studies, Risk Factors, Syncope, Frail Elderly, Guideline Adherence, Orthostatic Intolerance
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