One-Dimensional Statistical Parametric Mapping Identifies Impaired Orthostatic Cerebrovascular and Cardiovascular Response in Frailty Index.

Orthostasis is a potent physiological stressor which adapts with age. The age-related accumulation of health deficits in multiple physiological systems may impair the physiological response to orthostasis and lead to negative health outcomes such as falls, depression, and cognitive decline. Research to date has focused on changes with orthostasis at prespecified intervals of time, without consideration for whole signal approaches. One-dimensional statistical parametric mapping identified regions in time of significant association between variables of interest using a general linear model. Frailty index operationalized accumulated health and social deficits using 32-items from a computer-assisted interview. This study examined the association of frailty index on blood pressure, heart rate, and cerebral oxygenation during an orthostatic test in a sample of 2742 adults aged 50 or older from The Irish Longitudinal Study on Ageing. Frailty index was seen to be negatively associated with cerebral oxygenation changes from baseline over a period of 7 seconds (p = .036). Heart rate and systolic blood pressure were positively and negatively associated with frailty index over periods of 17 seconds (p = .001) and 10 seconds (p = .015), respectively. Statistical parametric mapping demonstrated these significant regions of cerebral oxygenation during orthostasis provide indirect evidence of impaired autoregulation associated with frailty. Statistical parametric mapping also replicated prior relationships in heart rate and systolic blood pressure associated with a higher frailty index. These findings highlight the utility of 1-dimensional statistical parametric modeling in identifying significant regions of interest in physiological recordings.

Maguire F ，Romero-Ortuno R ，O'Connor JD ，Reilly RB ，Knight SP ，Kenny RA ... -  《-》

Impairments in Hemodynamic Responses to Orthostasis Associated with Frailty: Results from The Irish Longitudinal Study on Ageing (TILDA).

To characterize the relationships between orthostatic blood pressure (BP) and heart rate recovery and frailty in an older population. Cross-sectional study. Two health centers in the Republic of Ireland. The Irish Longitudinal Study on Ageing participants aged 50 and older (N=4,334). Continuous noninvasive BP responses during active standing were captured using digital photoplethysmography. Frailty was assessed using the Cardiovascular Health Study criteria. Linear mixed models (random intercept) with piecewise splines were used to model differences in rate of BP and heart rate recovery. Ninety-three (2.2%) participants were frail, and 1,366 (31.5%) were prefrail. Adjusting for age and sex, frailty was associated with a slower rate of systolic BP recovery 10 to 20 seconds after standing (frailty by time = -4.12, 95% confidence interval=-5.53 to -2.72) and with subsequent deficits in BP 20 to 50 seconds after standing. Similar results were seen for diastolic BP and heart rate. Further adjustment for health behaviors, morbidities, and medications reduced, but did not attenuate, these associations. Of the 5 frailty criteria, only slow gait speed was consistently related to impaired BP and heart rate responses in the full model. Frailty, particularly slow gait speed, was associated with slower rate of BP and heart rate recovery after active standing. Impaired BP recovery may be a marker of physiological frailty.

O'Connell MD ，Savva GM ，Finucane C ，Romero-Ortuno R ，Fan CW ，Kenny RA ... -  《-》

Supine Hypertension Is Associated With an Impaired Cerebral Oxygenation Response to Orthostasis: Finding From The Irish Longitudinal Study on Ageing.

Newman L ，O'Connor JD ，Romero-Ortuno R ，Reilly RB ，Kenny RA ... -  《-》

Cardiovascular responses to orthostasis and their association with falls in older adults.

Shaw BH ，Loughin TM ，Robinovitch SN ，Claydon VE ... -  《-》

Relationships between orthostatic hypotension, frailty, falling and mortality in elderly care home residents.

Shaw BH ，Borrel D ，Sabbaghan K ，Kum C ，Yang Y ，Robinovitch SN ，Claydon VE ... -  《BMC Geriatrics》