Postprandial Hypotension Is More Common Than Orthostatic Hypotension In Older Adults With Dementia With Lewy Bodies: A Cross-Sectional Study

Purpose Dysautonomia is one of the supportive clinical features in dementia with Lewy bodies (DLB). This study aimed to investigate the prevalence of postural and postprandial blood pressure changes as a sign of dysautonomia in DLB patients. Methods The study group comprised 125 patients with DLB (76 females; mean age 78.4 ± 7.1 years) and 126 controls (89 females; mean age 74.5 ± 6.8 years). Postprandial blood pressure changes were assessed by ambulatory 24-hour blood pressure monitorization. Postural blood pressure changes were assessed via the head-up tilt table test. Results The frequency of postprandial hypotension (PPH), orthostatic hypotension (OH), and delayed OH was higher in patients with DLB compared to controls (89.4% vs 50.8%; p < 0.001, 45.5% vs 28.6%; p = 0.006, and 13.3% vs 5.6%; p = 0.045, respectively); whereas the frequency of supine hypertension (HT), and orthostatic hypertension (OHT) was similar. However, supine HT in non-hypertensive participants was higher in DLB patients than in controls (n = 45, 48.9% vs n = 37, 27%; p = 0.043). PPH and OH were independently associated with DLB (odds ratio [OR]:10.52 confidence interval [CI]%95 3.11–35.61; p < 0.00, and OR:1.96 CI%95 1.05–3.69; p = 0.035, respectively) after adjustment for age, the number of drugs, anti-psychotics, antiparkinsonian drugs, angiotensin receptor blockers, and beta blockers. Conclusion The study demonstrated that PPH was the most common type of dysautonomia, followed by OH and supine HT in older patients with DLB Given the potential complications of postural blood pressure changes and PPH in such patients, autonomic dysfunction should be evaluated in the follow-up of DLB.