Truly unexplained falls after evaluation for syncope: A new diagnostic entity with severe prognosis

Published:February 13, 2022DOI:


      • Syncope and unexplained falls had a different prognosis according to their etiology.
      • Mortality rate was higher in TUF than benign syncope.
      • TUF was an independent predictor of one-year mortality in subjects with dementia.
      • Accurate assessment of syncope or fall in dementia is important for prognostication.



      To compare one-year mortality risk associated with syncope and unexplained fall in older adults with dementia.


      522 patients (aged >65 years) with dementia and history of transient loss of consciousness and/or unexplained falls were evaluated. The diagnosis of syncope was based on European Society of Cardiology guidelines. A “Syncopal Fall” was defined in patients with an initial clinical presentation of unexplained fall, but a final diagnosis of syncope after complete assessment. A “Truly Unexplained Fall” was defined in patients with an initial clinical presentation of unexplained fall, in whom a diagnosis of syncope had been excluded after the diagnostic work-up. One-year follow-up was assessed by phone interview.


      Follow-up data were available for 501 participants (mean age 83 ± 6 years, 65% female). After a mean follow-up of 324 ± 93 days, death from any cause was reported in 188 participants (24%). Advanced age, male sex, cognitive and functional impairment were associated with a higher mortality rate. Patients with “Truly Unexplained Falls” had a higher mortality risk compared with syncope and “Syncopal Fall”. A diagnosis of “Truly Unexplained Falls” remained an independent predictor of one-year all-cause mortality in multivariate model.


      We propose the novel diagnostic category of “Truly Unexplained Fall”, resulting from the application of syncope guidelines to subjects with unexplained falls. This condition in older adults with dementia is a predictor of one-year all-cause mortality. For this new high risk profile, we advice a comprehensive geriatric assessment focused on risk factors for fall, aimed at a possible improvement of prognosis.



      ADL (Activities of Daily Living), CIRS (Cumulative Illness Rating Scale), CS (Confirmed Syncope), ESC (European Society of Cardiology), MMSE (Mini Mental State Examination), OH (Orthostatic Hypotension), SF (Syncopal Fall), SYD (Syncope and Dementia), TLOC (Transient Loss Of Consciousness), TUF (Truly Unexplained Fall)
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