{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,5,11]],"date-time":"2026-05-11T22:46:11Z","timestamp":1778539571697,"version":"3.51.4"},"reference-count":90,"publisher":"Wiley","issue":"1","license":[{"start":{"date-parts":[[2006,1,24]],"date-time":"2006-01-24T00:00:00Z","timestamp":1138060800000},"content-version":"vor","delay-in-days":1180,"URL":"http:\/\/onlinelibrary.wiley.com\/termsAndConditions#vor"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["Annals of the New York Academy of Sciences"],"published-print":{"date-parts":[[2002,11]]},"abstract":"<jats:p><jats:bold>A<jats:sc>bstract<\/jats:sc>: <\/jats:bold> Neurocardiovascular instability (NCVI, neurally mediated disorders causing hypotension with or without bradycardia) represents abnormal neural control of the cardiovascular system and presents as dizziness, syncope, or falls. The mechanisms underpinning NCVI are incompletely understood. The three most common disorders are carotid sinus syndrome (CSS), orthostatic hypotension (OH), and vasovagal syndrome (VVS): CSS, cardioinhibition &gt; 3 s and\/or vasodepressor response \u2265 50 mmHg drop in systolic pressure during carotid sinus stimulation; OH: fall in systolic blood pressure &gt; 20 mmHg during standing; VVS: cardioinhibition &gt; 3 s and\/or vasodepressor response &gt; 50 mmHg during prolonged head\u2010up tilting. In fallers with cognitive impairment or dementia, the prevalence of NCVI is 70%. Multifactorial interventions, including treatment of NCVI, significantly reduce falls and syncope. The predominant components of NCVI in fallers with cognitive impairment and dementia are CSS and OH. In Lewy body and Alzheimer's dementia, the prevalence of NCVI is up to 60%, again predominantly CSS and OH. The prevalence of cardioinhibitory carotid sinus hypersensitivity is particularly high in Lewy body dementia\u201441% compared with 12% in Alzheimer's disease and 3% in case controls. In addition, patients with Lewy body dementia have greater heart rate slowing (&gt;2 s) and falls in systolic blood pressure (&gt;20 mmHg) than those with Alzheimer's disease or controls during carotid sinus stimulation. The extent of deep white matter hyperintensities on MRI correlates with systolic fall during carotid sinus stimulation (<jats:styled-content><jats:italic>R<\/jats:italic>= 0.58<\/jats:styled-content>; <jats:styled-content><jats:italic>p<\/jats:italic> &lt; 0.005<\/jats:styled-content>), suggesting a possible causal association between bradyarrhythmia\u2010induced hypotension and microvascular pathology. NCVI is common in patients with dementia and may be a reversible cause of falls and syncope. Repeated hypotensive episodes may exaggerate cognitive decline in these patients.<\/jats:p>","DOI":"10.1111\/j.1749-6632.2002.tb04816.x","type":"journal-article","created":{"date-parts":[[2009,7,9]],"date-time":"2009-07-09T19:51:19Z","timestamp":1247169079000},"page":"183-195","source":"Crossref","is-referenced-by-count":83,"title":["Neurocardiovascular Instability in Cognitive Impairment and Dementia"],"prefix":"10.1111","volume":"977","author":[{"given":"ROSE ANNE M.","family":"KENNY","sequence":"first","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"RAJ","family":"KALARIA","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"CLIVE","family":"BALLARD","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"311","published-online":{"date-parts":[[2006,1,24]]},"reference":[{"key":"e_1_2_12_2_2","doi-asserted-by":"publisher","DOI":"10.1001\/archneurpsyc.1943.02290230022002"},{"key":"e_1_2_12_3_2","first-page":"947","article-title":"Effect of ageing on renin activity and aldosterone secretion","volume":"87","author":"Crane M.G.","year":"1976","journal-title":"J. Lab. Clin. Med."},{"key":"e_1_2_12_4_2","first-page":"411","article-title":"Age as a determinant of renal sodium conservation in normal man","volume":"87","author":"Epstein M.","year":"1976","journal-title":"J. Lab. Clin. Med."},{"key":"e_1_2_12_5_2","doi-asserted-by":"publisher","DOI":"10.1161\/01.CIR.53.4.720"},{"key":"e_1_2_12_6_2","doi-asserted-by":"publisher","DOI":"10.1016\/0021-9681(86)90187-6"},{"key":"e_1_2_12_7_2","doi-asserted-by":"publisher","DOI":"10.1093\/geronj\/44.6.M179"},{"issue":"2","key":"e_1_2_12_8_2","doi-asserted-by":"crossref","first-page":"E8","DOI":"10.1161\/circ.105.2.e8","article-title":"Randomized assessment of syncope trial","volume":"105","author":"Carey B.J.","year":"2002","journal-title":"Circulation"},{"key":"e_1_2_12_9_2","doi-asserted-by":"publisher","DOI":"10.1093\/ageing\/30.4.289"},{"key":"e_1_2_12_10_2","doi-asserted-by":"publisher","DOI":"10.1111\/j.1540-8159.1982.tb06559.x"},{"key":"e_1_2_12_11_2","doi-asserted-by":"publisher","DOI":"10.1093\/ageing\/20.6.449"},{"key":"e_1_2_12_12_2","doi-asserted-by":"publisher","DOI":"10.1016\/S0735-1097(01)01537-6"},{"key":"e_1_2_12_13_2","doi-asserted-by":"publisher","DOI":"10.1093\/ageing\/22.1.53"},{"key":"e_1_2_12_14_2","doi-asserted-by":"publisher","DOI":"10.1093\/gerona\/55.8.M458"},{"key":"e_1_2_12_15_2","doi-asserted-by":"publisher","DOI":"10.1093\/cvr\/18.12.746"},{"key":"e_1_2_12_16_2","doi-asserted-by":"publisher","DOI":"10.1161\/01.CIR.71.5.927"},{"issue":"2","key":"e_1_2_12_17_2","first-page":"261","article-title":"Central alpha\u20102 adrenoceptors have no role in the pathogenesis of the vasodepressor component of carotid sinus hypersensitivity","volume":"35","author":"Parry S.W.","year":"2000","journal-title":"JACC"},{"key":"e_1_2_12_18_2","doi-asserted-by":"publisher","DOI":"10.1016\/0002-9343(93)90261-M"},{"key":"e_1_2_12_19_2","doi-asserted-by":"publisher","DOI":"10.1093\/cvr\/21.7.545"},{"key":"e_1_2_12_20_2","unstructured":"Kenny R.A. & A.B. Dey. 2002. Syncope.InBrocklehursts Textbook of Geriatric Medicine. Sixth edition. Chapter 38. Churchill Livingstone. Edinburgh\/New York. In press."},{"issue":"5271","key":"e_1_2_12_21_2","first-page":"42","article-title":"Live long and prosper","volume":"273","author":"Roush W.","year":"1996","journal-title":"Science"},{"key":"e_1_2_12_22_2","doi-asserted-by":"publisher","DOI":"10.1111\/j.1540-8159.1997.tb03912.x"},{"key":"e_1_2_12_23_2","doi-asserted-by":"publisher","DOI":"10.1161\/01.CIR.62.4.697"},{"key":"e_1_2_12_24_2","doi-asserted-by":"crossref","unstructured":"Shaw F.E. J. Bond D.A. Richardsonet al.2002. Randomized controlled trial of multi\u2010factorial post\u2010fall intervention in older people with cognitive impairment and dementia presenting to the accident and emergency department. BMJ. In press.","DOI":"10.1136\/bmj.326.7380.73"},{"key":"e_1_2_12_25_2","doi-asserted-by":"publisher","DOI":"10.1093\/ageing\/23.1.57"},{"key":"e_1_2_12_26_2","doi-asserted-by":"publisher","DOI":"10.1093\/ageing\/31.4.272"},{"key":"e_1_2_12_27_2","doi-asserted-by":"publisher","DOI":"10.1053\/euhj.2001.2739"},{"key":"e_1_2_12_28_2","doi-asserted-by":"publisher","DOI":"10.1016\/0002-8703(92)90507-R"},{"key":"e_1_2_12_29_2","doi-asserted-by":"publisher","DOI":"10.1111\/j.1445-5994.1986.tb01110.x"},{"key":"e_1_2_12_30_2","doi-asserted-by":"publisher","DOI":"10.1093\/ageing\/28.2.127"},{"key":"e_1_2_12_31_2","doi-asserted-by":"publisher","DOI":"10.1111\/j.1540-8159.1988.tb06286.x"},{"key":"e_1_2_12_32_2","first-page":"453","article-title":"The influence of age on the response of blood pressure and heart rate to carotid sinus massage in healthy volunteers","volume":"1","author":"Wentink J.R.M.","year":"1993","journal-title":"Cardiol. Eld."},{"key":"e_1_2_12_33_2","doi-asserted-by":"publisher","DOI":"10.1093\/ageing\/25.5.362"},{"key":"e_1_2_12_34_2","doi-asserted-by":"crossref","unstructured":"Kenny R.A. 2002. Neurally mediated syncope.InClinics in Geriatric Medicine: Falls and Syncope in Elderly Patients pp. 192\u2010210. Saunders. Philadelphia.","DOI":"10.1016\/S0749-0690(02)00005-8"},{"key":"e_1_2_12_35_2","doi-asserted-by":"publisher","DOI":"10.1046\/j.1532-5415.2001.49115.x"},{"key":"e_1_2_12_36_2","doi-asserted-by":"publisher","DOI":"10.1111\/j.1532-5415.1994.tb06505.x"},{"key":"e_1_2_12_37_2","doi-asserted-by":"publisher","DOI":"10.1016\/S0002-9149(98)00130-1"},{"key":"e_1_2_12_38_2","doi-asserted-by":"publisher","DOI":"10.1093\/ageing\/29.5.413"},{"key":"e_1_2_12_39_2","doi-asserted-by":"publisher","DOI":"10.1136\/heart.83.1.22"},{"key":"e_1_2_12_40_2","doi-asserted-by":"publisher","DOI":"10.1046\/j.1532-5415.2001.49050.x"},{"key":"e_1_2_12_41_2","doi-asserted-by":"publisher","DOI":"10.1016\/0002-9149(84)90632-5"},{"key":"e_1_2_12_42_2","doi-asserted-by":"crossref","unstructured":"Morley C.A. E.J. Perrins S.L. Chanet al.1983. Long\u2010term comparison of DVI and VVI pacing in carotid sinus syndrome.InProceedings of the VIIth World Symposium on Cardiac Pacing pp. 929\u2010935. Steinkopff. Darmstadt.","DOI":"10.1007\/978-3-642-72367-4_129"},{"key":"e_1_2_12_43_2","doi-asserted-by":"publisher","DOI":"10.1136\/hrt.47.5.411"},{"key":"e_1_2_12_44_2","doi-asserted-by":"publisher","DOI":"10.1016\/0002-9149(92)90860-2"},{"key":"e_1_2_12_45_2","doi-asserted-by":"publisher","DOI":"10.1136\/hrt.69.4.308"},{"key":"e_1_2_12_46_2","unstructured":"Mathias C.J. & R. Bannister. 1992. Investigation of autonomic disorders.InAutonomic Failure: A Textbook of Clinical Disorders of the Autonomic Nervous System pp. 255\u2010290. Oxford Medical Pub. Oxford."},{"key":"e_1_2_12_47_2","unstructured":"Wieling W. 1996. Laboratory assessment of disturbances in cardiovascular control.InSyncope in the Older Patient: Causes Investigations and Consequences of Syncope and Falls pp. 47\u201071. Chapman & Hall. London."},{"key":"e_1_2_12_48_2","doi-asserted-by":"publisher","DOI":"10.1042\/cs0790073"},{"key":"e_1_2_12_49_2","doi-asserted-by":"publisher","DOI":"10.1042\/cs0830149"},{"key":"e_1_2_12_50_2","doi-asserted-by":"publisher","DOI":"10.1212\/WNL.46.5.1470"},{"key":"e_1_2_12_51_2","doi-asserted-by":"publisher","DOI":"10.1042\/cs0690337"},{"key":"e_1_2_12_52_2","first-page":"321","article-title":"Orthostatic hypotension (OH) as a predictor of two year mortality in elderly men: the Honolulu Heart Program","volume":"5","author":"Schatz I.J.","year":"1995","journal-title":"Clin. Auton. Res."},{"key":"e_1_2_12_53_2","unstructured":"Bannister R. & C.J. Mathias. 1992. Clinical features and manifestations and investigation of primary autonomic failure syndromes.InAutonomic Failure: A Textbook of Clinical Disorders of the Autonomic Nervous System pp. 531\u2010547. Oxford Medical Pub. Oxford."},{"key":"e_1_2_12_54_2","doi-asserted-by":"publisher","DOI":"10.1007\/BF01819025"},{"key":"e_1_2_12_55_2","first-page":"82","article-title":"Suboccipital (coat hanger) and other muscular pains\u2014frequency in autonomic failure and other neurological problems, and association with postural hypotension","volume":"4","author":"Bleasdale\u2010Barr K.","year":"1994","journal-title":"Clin. Auton. Res."},{"key":"e_1_2_12_56_2","doi-asserted-by":"publisher","DOI":"10.1111\/j.1540-8159.1997.tb03911.x"},{"key":"e_1_2_12_57_2","doi-asserted-by":"publisher","DOI":"10.1093\/qjmed\/90.1.1"},{"key":"e_1_2_12_58_2","doi-asserted-by":"publisher","DOI":"10.1016\/S0002-9343(97)89517-4"},{"key":"e_1_2_12_59_2","doi-asserted-by":"publisher","DOI":"10.1053\/eupc.1999.0064"},{"key":"e_1_2_12_60_2","doi-asserted-by":"publisher","DOI":"10.1053\/euhj.1999.2046"},{"key":"e_1_2_12_61_2","doi-asserted-by":"publisher","DOI":"10.1093\/qjmed\/92.12.697"},{"key":"e_1_2_12_62_2","doi-asserted-by":"publisher","DOI":"10.1093\/qjmed\/92.11.623"},{"key":"e_1_2_12_63_2","doi-asserted-by":"publisher","DOI":"10.1136\/heart.83.5.564"},{"key":"e_1_2_12_64_2","first-page":"180","article-title":"Proposed classification for tilt induced vasovagal syncope","volume":"3","author":"Sutton R.","year":"1992","journal-title":"Eur. J. Cardiac Pacing Electrophysiol."},{"key":"e_1_2_12_65_2","doi-asserted-by":"publisher","DOI":"10.1016\/S0140-6736(86)91665-X"},{"key":"e_1_2_12_66_2","doi-asserted-by":"publisher","DOI":"10.1016\/S0140-6736(89)92155-7"},{"key":"e_1_2_12_67_2","doi-asserted-by":"publisher","DOI":"10.1016\/0002-8703(89)90671-6"},{"key":"e_1_2_12_68_2","doi-asserted-by":"publisher","DOI":"10.1053\/euhj.2001.2739"},{"key":"e_1_2_12_69_2","doi-asserted-by":"publisher","DOI":"10.1111\/j.1532-5415.1994.tb06582.x"},{"key":"e_1_2_12_70_2","doi-asserted-by":"publisher","DOI":"10.1111\/j.1532-5415.1986.tb04222.x"},{"key":"e_1_2_12_71_2","doi-asserted-by":"publisher","DOI":"10.1056\/NEJM198307143090205"},{"key":"e_1_2_12_72_2","doi-asserted-by":"publisher","DOI":"10.1111\/j.1365-2362.1990.tb02268.x"},{"key":"e_1_2_12_73_2","doi-asserted-by":"publisher","DOI":"10.7326\/0003-4819-115-11-865"},{"key":"e_1_2_12_74_2","doi-asserted-by":"publisher","DOI":"10.1111\/j.1076-7460.2001.00841.x"},{"key":"e_1_2_12_75_2","doi-asserted-by":"publisher","DOI":"10.1016\/0002-9343(94)90051-5"},{"key":"e_1_2_12_76_2","doi-asserted-by":"publisher","DOI":"10.1016\/S0735-1097(01)01241-4"},{"key":"e_1_2_12_77_2","doi-asserted-by":"publisher","DOI":"10.1111\/j.1532-5415.1988.tb06155.x"},{"key":"e_1_2_12_78_2","doi-asserted-by":"crossref","first-page":"637","DOI":"10.1016\/S0749-0690(18)30929-7","article-title":"Abnormalities in blood pressure homeostasis that contribute to falls in the elderly","volume":"91","author":"Lipsitz L.A.","year":"1985","journal-title":"Clin. Geriatr. Med."},{"key":"e_1_2_12_79_2","unstructured":"Kenny R.A. 2002. Falls and Syncope in Elderly Patients.InClinics in Geriatric Medicine. Saunders. Philadelphia."},{"key":"e_1_2_12_80_2","doi-asserted-by":"publisher","DOI":"10.1159\/000022063"},{"key":"e_1_2_12_81_2","doi-asserted-by":"publisher","DOI":"10.1056\/NEJM198812293192604"},{"key":"e_1_2_12_82_2","doi-asserted-by":"publisher","DOI":"10.1093\/geront\/33.2.200"},{"key":"e_1_2_12_83_2","doi-asserted-by":"publisher","DOI":"10.1093\/geronj\/42.4.412"},{"key":"e_1_2_12_84_2","unstructured":"Kenny R.A. F.E. Shaw J.T. O'Brienet al.2002. Carotid sinus syndrome is common in dementia with Lewy body and correlates with deep white matter lesions. Arch. Neurol. In press."},{"key":"e_1_2_12_85_2","doi-asserted-by":"publisher","DOI":"10.1161\/01.HYP.23.5.565"},{"key":"e_1_2_12_86_2","unstructured":"Kenny R.A. K. Wesnes & N.R. Stout. 2002. Cognitive impairment is common in patients with symptomatic orthostatic hypotension and associated with the degree of fall in orthostatic blood pressure. Neurology. Submitted."},{"key":"e_1_2_12_87_2","doi-asserted-by":"publisher","DOI":"10.1007\/BF01828840"},{"key":"e_1_2_12_88_2","unstructured":"National Institute for Clinical Excellence. 2001. Guidance on the use of donepezil rivastigmine and galantamine for the treatment of Alzheimer's disease. Technology Appraisal Guidance No. 19. Department of Health London."},{"key":"e_1_2_12_89_2","unstructured":"McLaren A. J. Allen A. Murrayet al.2002. Cardiovascular effects of donepezil in patients with dementia. Dement. Ger. Cognit. Dis. In press."},{"key":"e_1_2_12_90_2","unstructured":"Newby J. I. McKeith & R.A. Kenny. 2002. Carotid sinus syndrome unmasked by anticholinesterase treatment. BMJ. Submitted."},{"key":"e_1_2_12_91_2","doi-asserted-by":"publisher","DOI":"10.1016\/S0140-6736(00)03399-7"}],"container-title":["Annals of the New York Academy of Sciences"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/api.wiley.com\/onlinelibrary\/tdm\/v1\/articles\/10.1111%2Fj.1749-6632.2002.tb04816.x","content-type":"unspecified","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/nyaspubs.onlinelibrary.wiley.com\/doi\/pdf\/10.1111\/j.1749-6632.2002.tb04816.x","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2023,9,25]],"date-time":"2023-09-25T08:27:07Z","timestamp":1695630427000},"score":1,"resource":{"primary":{"URL":"https:\/\/nyaspubs.onlinelibrary.wiley.com\/doi\/10.1111\/j.1749-6632.2002.tb04816.x"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2002,11]]},"references-count":90,"journal-issue":{"issue":"1","published-print":{"date-parts":[[2002,11]]}},"alternative-id":["10.1111\/j.1749-6632.2002.tb04816.x"],"URL":"https:\/\/doi.org\/10.1111\/j.1749-6632.2002.tb04816.x","archive":["Portico"],"relation":{},"ISSN":["0077-8923","1749-6632"],"issn-type":[{"value":"0077-8923","type":"print"},{"value":"1749-6632","type":"electronic"}],"subject":[],"published":{"date-parts":[[2002,11]]}}}