ABSTRACT
OBJECTIVE: To evaluate orthostatic hypotension (OH) prevalence, risk factors, signs and symptoms, and treatment response in patients with dementia. BACKGROUND: No previous studies had systematically delineated the clinical features of OH in patients with dementia and determined the effects of treatment. Diagnosing this treatable disorder may prevent the severe consequences of falls, syncope, confusion, ischemic brain injury, and death; mortality risk rises with worsening OH. Lesser consequences include skin injuries, sprains, fractures, and subdural hematomas. METHODS: We reviewed the charts of 188 patients with dementia who had been treated by author D.F., a solo neurologist/neurobehaviorist. About half of the patients had been diagnosed with OH. D.F. had treated the OH until the patients had much improved blood pressure and symptoms, were asymptomatic, or no longer met OH diagnostic criteria. We collected data on diagnoses, blood pressures, and clinical features before and after treatment. RESULTS: Our patients' most frequent OH signs and symptoms were mental fluctuations (65.6% of patients), excessive sleeping in chairs (29.2%), slow falls without losing consciousness (20.8%), lethargy or fatigue (15.6%), and dizziness (13.5%). All 5 of these signs and symptoms improved significantly with treatment. CONCLUSIONS: Patients with dementia were less likely to have traditional OH symptoms like dizziness than to have mental fluctuations and confusion, drowsiness, and slow falls. Blaming these problems on worsening dementia and neglecting OH as a potential cause may delay diagnosis and specific treatments that can improve patients' safety, daily function, and quality of life.
Subject(s)
Dementia/diagnosis , Dementia/epidemiology , Hypotension, Orthostatic/diagnosis , Hypotension, Orthostatic/epidemiology , Age Distribution , Aged , Aged, 80 and over , Alzheimer Disease/diagnosis , Alzheimer Disease/epidemiology , Blood Pressure Monitoring, Ambulatory , Chronic Disease , Comorbidity , Dementia/psychology , Diagnosis, Differential , Female , Humans , Hypertension/drug therapy , Hypertension/epidemiology , Hypotension, Orthostatic/drug therapy , Logistic Models , Long-Term Care , Male , Middle Aged , Prevalence , Quality of Life , Retrospective Studies , Risk Factors , Sex Distribution , Sphygmomanometers , Treatment OutcomeABSTRACT
OBJECTIVES: This study describes the early experience of robotic prostatectomy exclusively at a teaching community hospital. METHODS: This is a retrospective report of 153 consecutive patients on whom 4 physicians were the operating surgeon. RESULTS: The average hospital stay was 1.5 days, the mean operative time was 175 minutes, and the estimated operative blood loss was <300mL. The perioperative complication rate was 7.8% (12/153). The prostate-specific antigen failure rate was 2% (2/114). Urinary continence was maintained in 98% of patients 9 months after surgery. Postoperative Gleason scores differed significantly from preoperative biopsy results (P<0.001). Pathological records reported positive margins in 35% (54/153) of specimens. T3 tumors had positive margins more than twice as often as T2 tumors (P<0.002). Surgeon experience correlated with shorter operative times (P=0.001), but not with positive margins. Increasing body mass index was associated with increased operating time (P<0.001). CONCLUSIONS: Robotic prostatectomy appears to be a safe and successful option for prostate cancer treatment in a teaching community hospital.
