Skip to main content
Advertisement
  • Neurology.org
  • Journals
    • Neurology
    • Clinical Practice
    • Genetics
    • Neuroimmunology & Neuroinflammation
  • Specialty Sites
    • COVID-19
    • Practice Current
    • Practice Buzz
    • Without Borders
    • Equity, Diversity and Inclusion
    • Innovations in Care Delivery
  • Collections
    • Topics A-Z
    • Residents & Fellows
    • Infographics
    • Patient Pages
    • Null Hypothesis
    • Translations
  • Podcast
  • CME
  • About
    • About the Journals
    • Contact Us
    • Editorial Board
  • Authors
    • Submit a Manuscript
    • Author Center

Advanced Search

Main menu

  • Neurology.org
  • Journals
    • Neurology
    • Clinical Practice
    • Genetics
    • Neuroimmunology & Neuroinflammation
  • Specialty Sites
    • COVID-19
    • Practice Current
    • Practice Buzz
    • Without Borders
    • Equity, Diversity and Inclusion
    • Innovations in Care Delivery
  • Collections
    • Topics A-Z
    • Residents & Fellows
    • Infographics
    • Patient Pages
    • Null Hypothesis
    • Translations
  • Podcast
  • CME
  • About
    • About the Journals
    • Contact Us
    • Editorial Board
  • Authors
    • Submit a Manuscript
    • Author Center
  • Home
  • Latest Articles
  • Current Issue
  • Past Issues
  • Residents & Fellows

User menu

  • Subscribe
  • My Alerts
  • Log in

Search

  • Advanced search
Neurology
Home
The most widely read and highly cited peer-reviewed neurology journal
  • Subscribe
  • My Alerts
  • Log in
Site Logo
  • Home
  • Latest Articles
  • Current Issue
  • Past Issues
  • Residents & Fellows

Share

October 06, 2020; 95 (14) Article

Orthostatic hypotension, dizziness, neurology outcomes, and death in older adults

View ORCID ProfileStephen P. Juraschek, W.T. Longstreth, Oscar L. Lopez, John S. Gottdiener, Lewis A. Lipsitz, Lewis H. Kuller, Kenneth J. Mukamal
First published July 30, 2020, DOI: https://doi.org/10.1212/WNL.0000000000010456
Stephen P. Juraschek
From the Department of Medicine (S.P.J., L.A.L., K.J.M.), Beth Israel Deaconess Medical Center, Boston, MA; Departments of Neurology and Epidemiology (W.T.L.), University of Washington, Seattle; Department of Neurology (O.L.L.) and Department of Epidemiology, Graduate School of Public Health (L.H.K.), University of Pittsburgh, PA; Department of Medicine (J.S.G.), University of Maryland, Baltimore; and Hinda and Arthur Marcus Institute for Aging Research (L.A.L.), Hebrew SeniorLife, Roslindale, MA.
  • Find this author on Google Scholar
  • Find this author on PubMed
  • Search for this author on this site
  • ORCID record for Stephen P. Juraschek
W.T. Longstreth Jr
From the Department of Medicine (S.P.J., L.A.L., K.J.M.), Beth Israel Deaconess Medical Center, Boston, MA; Departments of Neurology and Epidemiology (W.T.L.), University of Washington, Seattle; Department of Neurology (O.L.L.) and Department of Epidemiology, Graduate School of Public Health (L.H.K.), University of Pittsburgh, PA; Department of Medicine (J.S.G.), University of Maryland, Baltimore; and Hinda and Arthur Marcus Institute for Aging Research (L.A.L.), Hebrew SeniorLife, Roslindale, MA.
  • Find this author on Google Scholar
  • Find this author on PubMed
  • Search for this author on this site
Oscar L. Lopez
From the Department of Medicine (S.P.J., L.A.L., K.J.M.), Beth Israel Deaconess Medical Center, Boston, MA; Departments of Neurology and Epidemiology (W.T.L.), University of Washington, Seattle; Department of Neurology (O.L.L.) and Department of Epidemiology, Graduate School of Public Health (L.H.K.), University of Pittsburgh, PA; Department of Medicine (J.S.G.), University of Maryland, Baltimore; and Hinda and Arthur Marcus Institute for Aging Research (L.A.L.), Hebrew SeniorLife, Roslindale, MA.
  • Find this author on Google Scholar
  • Find this author on PubMed
  • Search for this author on this site
John S. Gottdiener
From the Department of Medicine (S.P.J., L.A.L., K.J.M.), Beth Israel Deaconess Medical Center, Boston, MA; Departments of Neurology and Epidemiology (W.T.L.), University of Washington, Seattle; Department of Neurology (O.L.L.) and Department of Epidemiology, Graduate School of Public Health (L.H.K.), University of Pittsburgh, PA; Department of Medicine (J.S.G.), University of Maryland, Baltimore; and Hinda and Arthur Marcus Institute for Aging Research (L.A.L.), Hebrew SeniorLife, Roslindale, MA.
  • Find this author on Google Scholar
  • Find this author on PubMed
  • Search for this author on this site
Lewis A. Lipsitz
From the Department of Medicine (S.P.J., L.A.L., K.J.M.), Beth Israel Deaconess Medical Center, Boston, MA; Departments of Neurology and Epidemiology (W.T.L.), University of Washington, Seattle; Department of Neurology (O.L.L.) and Department of Epidemiology, Graduate School of Public Health (L.H.K.), University of Pittsburgh, PA; Department of Medicine (J.S.G.), University of Maryland, Baltimore; and Hinda and Arthur Marcus Institute for Aging Research (L.A.L.), Hebrew SeniorLife, Roslindale, MA.
  • Find this author on Google Scholar
  • Find this author on PubMed
  • Search for this author on this site
Lewis H. Kuller
From the Department of Medicine (S.P.J., L.A.L., K.J.M.), Beth Israel Deaconess Medical Center, Boston, MA; Departments of Neurology and Epidemiology (W.T.L.), University of Washington, Seattle; Department of Neurology (O.L.L.) and Department of Epidemiology, Graduate School of Public Health (L.H.K.), University of Pittsburgh, PA; Department of Medicine (J.S.G.), University of Maryland, Baltimore; and Hinda and Arthur Marcus Institute for Aging Research (L.A.L.), Hebrew SeniorLife, Roslindale, MA.
  • Find this author on Google Scholar
  • Find this author on PubMed
  • Search for this author on this site
Kenneth J. Mukamal
From the Department of Medicine (S.P.J., L.A.L., K.J.M.), Beth Israel Deaconess Medical Center, Boston, MA; Departments of Neurology and Epidemiology (W.T.L.), University of Washington, Seattle; Department of Neurology (O.L.L.) and Department of Epidemiology, Graduate School of Public Health (L.H.K.), University of Pittsburgh, PA; Department of Medicine (J.S.G.), University of Maryland, Baltimore; and Hinda and Arthur Marcus Institute for Aging Research (L.A.L.), Hebrew SeniorLife, Roslindale, MA.
  • Find this author on Google Scholar
  • Find this author on PubMed
  • Search for this author on this site
Full PDF
Short Form
Citation
Orthostatic hypotension, dizziness, neurology outcomes, and death in older adults
Stephen P. Juraschek, W.T. Longstreth, Oscar L. Lopez, John S. Gottdiener, Lewis A. Lipsitz, Lewis H. Kuller, Kenneth J. Mukamal
Neurology Oct 2020, 95 (14) e1941-e1950; DOI: 10.1212/WNL.0000000000010456

Citation Manager Formats

  • BibTeX
  • Bookends
  • EasyBib
  • EndNote (tagged)
  • EndNote 8 (xml)
  • Medlars
  • Mendeley
  • Papers
  • RefWorks Tagged
  • Ref Manager
  • RIS
  • Zotero
Permissions

Make Comment

See Comments

Downloads
89

Share

  • Article
  • Figures & Data
  • Info & Disclosures
  • CME Course
Loading

This article requires a subscription to view the full text. If you have a subscription you may use the login form below to view the article. Access to this article can also be purchased.

Abstract

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 (β = −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 (β = 0.16; 0.03–0.30), brain infarcts (OR 1.31; 1.06–1.63), lower baseline cognition (β = −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.

Glossary

3MSE=
modified Mini-Mental State Examination;
ARIC=
Atherosclerosis Risk in Communities;
BMI=
body mass index;
BP=
blood pressure;
CHS=
Cardiovascular Health Study;
CVD=
cardiovascular disease;
CI=
confidence interval;
DBP=
diastolic blood pressure;
HDL=
high-density lipoprotein;
HR=
hazard ratio;
OH=
orthostatic hypotension;
OR=
odds ratio;
SBP=
systolic blood pressure

Footnotes

  • Go to Neurology.org/N for full disclosures. Funding information and disclosures deemed relevant by the authors, if any, are provided at the end of the article.

  • CME Course: NPub.org/cmelist

  • Received October 23, 2019.
  • Accepted in final form April 16, 2020.
  • © 2020 American Academy of Neurology
View Full Text

AAN Members

We have changed the login procedure to improve access between AAN.com and the Neurology journals. If you are experiencing issues, please log out of AAN.com and clear history and cookies. (For instructions by browser, please click the instruction pages below). After clearing, choose preferred Journal and select login for AAN Members. You will be redirected to a login page where you can log in with your AAN ID number and password. When you are returned to the Journal, your name should appear at the top right of the page.

Google Safari Microsoft Edge Firefox

Click here to login

AAN Non-Member Subscribers

Click here to login

Purchase access

For assistance, please contact:
AAN Members (800) 879-1960 or (612) 928-6000 (International)
Non-AAN Member subscribers (800) 638-3030 or (301) 223-2300 option 3, select 1 (international)

Sign Up
Information on how to subscribe to Neurology and Neurology: Clinical Practice can be found here 

Purchase
Individual access to articles is available through the Add to Cart option on the article page.  Access for 1 day (from the computer you are currently using) is US$ 39.00.  Pay-per-view content is for the use of the payee only, and content may not be further distributed by print or electronic means.  The payee may view, download, and/or print the article for his/her personal, scholarly, research, and educational use.  Distributing copies (electronic or otherwise) of the article is not allowed.

Disputes & Debates: Rapid online correspondence

  • Author response: Orthostatic Hypotension, Dizziness, Neurology Outcomes, and Death in Older Adults
    • Stephen P. Juraschek, Physician investigator, Beth Israel Deaconess Medical Center
    Submitted August 20, 2020
  • Reader response: Orthostatic Hypotension, Dizziness, Neurology Outcomes, and Death in Older Adults
    • Pinar Soysal, Geriatrician, Department of Geriatric Medicine, Bezmialem Vakif University (Istanbul, Turkey)
    Submitted August 13, 2020
Comment

NOTE: All authors' disclosures must be entered and current in our database before comments can be posted. Enter and update disclosures at http://submit.neurology.org. Exception: replies to comments concerning an article you originally authored do not require updated disclosures.

  • Stay timely. Submit only on articles published within the last 8 weeks.
  • Do not be redundant. Read any comments already posted on the article prior to submission.
  • 200 words maximum.
  • 5 references maximum. Reference 1 must be the article on which you are commenting.
  • 5 authors maximum. Exception: replies can include all original authors of the article.
  • Submitted comments are subject to editing and editor review prior to posting.

More guidelines and information on Disputes & Debates

Compose Comment

More information about text formats

Plain text

  • No HTML tags allowed.
  • Web page addresses and e-mail addresses turn into links automatically.
  • Lines and paragraphs break automatically.
Author Information
NOTE: The first author must also be the corresponding author of the comment.
First or given name, e.g. 'Peter'.
Your last, or family, name, e.g. 'MacMoody'.
Your email address, e.g. higgs-boson@gmail.com
Your role and/or occupation, e.g. 'Orthopedic Surgeon'.
Your organization or institution (if applicable), e.g. 'Royal Free Hospital'.
Publishing Agreement
NOTE: All authors, besides the first/corresponding author, must complete a separate Disputes & Debates Submission Form and provide via email to the editorial office before comments can be posted.
CAPTCHA
This question is for testing whether or not you are a human visitor and to prevent automated spam submissions.

Vertical Tabs

You May Also be Interested in

Back to top
  • Article
    • Abstract
    • Glossary
    • Methods
    • Results
    • Discussion
    • Study funding
    • Disclosure
    • Acknowledgment
    • Appendix Authors
    • Footnotes
    • References
  • Figures & Data
  • Info & Disclosures
  • CME Course

More Online

CME Course

Alert Me

  • Alert me when eletters are published
Neurology: 96 (2)

Articles

  • Ahead of Print
  • Current Issue
  • Past Issues
  • Popular Articles
  • Translations

About

  • About the Journals
  • Ethics Policies
  • Editors & Editorial Board
  • Contact Us
  • Advertise

Submit

  • Author Center
  • Submit a Manuscript
  • Information for Reviewers
  • AAN Guidelines
  • Permissions

Subscribers

  • Subscribe
  • Activate a Subscription
  • Sign up for eAlerts
  • RSS Feed
Site Logo
  • Visit neurology Template on Facebook
  • Follow neurology Template on Twitter
  • Visit Neurology on YouTube
  • Neurology
  • Neurology: Clinical Practice
  • Neurology: Genetics
  • Neurology: Neuroimmunology & Neuroinflammation
  • AAN.com
  • AANnews
  • Continuum
  • Brain & Life
  • Neurology Today

Wolters Kluwer Logo

Neurology | Print ISSN:0028-3878
Online ISSN:1526-632X

© 2021 American Academy of Neurology

  • Privacy Policy
  • Feedback
  • Advertise