Highlights
- •Unexplained falls in dementia patients may mask a syncopal event (syncopal fall).
- •Precipitating factors (e.g. postural change during the event) predict syncopal fall.
- •Benzodiazepines and insulin predict non-syncopal origin of unexplained falls.
- •A clinical score might aid in discriminating syncopal from non-syncopal falls.
Abstract
Background
Dementia patients have an increased risk of fall, and some of them might suffer from
undiagnosed syncope. The present analysis aimed at identifying predictors of differential
diagnosis between syncopal and non-syncopal fall in patients with dementia included
in the “Syncope & Dementia” registry.
Methods
We enrolled patients aged 65+ with a diagnosis of dementia and a history of syncope and/or unexplained fall. All
subjects underwent a comprehensive geriatric assessment, including the syncope protocol
of the European Society of Cardiology. Subjects whose syncope diagnosis was confirmed
were labeled as “Confirmed Syncope” (CS). Patients with unexplained fall were labeled
as “Syncopal Fall” (SF), if a final diagnosis of syncope was performed, or as “Non-Syncopal
Fall” (NSF), if syncope was excluded.
Results
We included 372 subjects (mean age 84, 61% females). Mini Mental State Examination
score was higher among SF (18.5 ± 4.9) compared to NSF patients (15.6 ± 5.8, p = 0.02). In a multinomial logistic regression model with NSF as the reference group,
CS patients less often suffered injuries and more often reported history of syncope,
while patients with SF had a better cognitive status and were more often exposed to
precipitating factors, including postural changes and neck movements. The absence
of prodromes and the intake of benzodiazepines and insulin was highest in NSF patients.
A simple score including main clinical predictors showed an 82% sensitivity with a
56% specificity in discriminating SF from NSF patients.
Conclusion
Simple clinical markers can aid in the differential diagnosis of unexplained falls
in dementia, separating syncopal from non-syncopal falls.
Graphical abstract
Graphical Abstract
Keywords
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Article info
Publication history
Published online: February 02, 2018
Accepted:
November 10,
2017
Received in revised form:
September 29,
2017
Received:
June 1,
2017
Identification
Copyright
© 2017 Published by Elsevier B.V. on behalf of European Federation of Internal Medicine.
