Cerebral hypoperfusion and future falls risk among community dwelling older adults with orthostatic hypotension

作者：Paul Claffey, L Pérez-Denia, Louise Newman, Ciarán Finucane, Rose Anne Kenny, Robert Briggs · 发表于：Age and Ageing · 年份：2025 · DOI：10.1093/ageing/afaf379 · 被引用次数：2 · 研究领域：Cardiovascular Syncope and Autonomic Disorders、Heart Rate Variability and Autonomic Control、Optical Imaging and Spectroscopy Techniques

BACKGROUND: Falls are a major health concern for older adults, affecting one-third of those over 65 years annually, with 10%-20% leading to injury or hospitalisation. Whilst falls are often multifactorial, unexplained falls may overlap with syncope. Orthostatic hypotension (OH), characterised by a significant drop in blood pressure (BP) upon standing, is a potent falls risk factor, likely due to cerebral hypoperfusion. While the association between OH and falls is well established, few studies have examined the combined role of OH and real-time cerebral perfusion measures in predicting future unexplained falls. METHODS: Frontal lobe cerebral oxygenation (Tissue Saturation Index, TSI) was measured using near-infrared spectroscopy alongside continuous beat-to-beat BP monitoring (Finometer) during active standing in 2478 participants (≥55 years) from Wave 3 of The Irish Longitudinal Study on Ageing. OH was defined as a sustained SBP drop ≥20 mmHg and/or DBP drop ≥10 mmHg at 30, 60 or 90 seconds post-standing. A TSI drop ≥75th centile at 30 seconds was classified as 'greater TSI drop.' Associations between TSI change and OH were analysed using multilevel mixed-effects regression, and longitudinal relationships with unexplained falls were assessed over four years. RESULTS: One-fifth of participants had OH, associated with older age and cardiovascular disease. OH was associated with significantly greater TSI change from baseline at 30, 60 and 90 seconds (p < .001) in adjusted model...