***TASK*** the task is to summarize an input biomedical literature in six sentences 
    ***INPUT*** the input is a biomedical literature 
    ***OUTPUT*** the output is the summary of an input biomedical literature in six sentences 
    ***DOCUMENTATION*** 
    ***EXAMPLES*** 
    Input: OBJECTIVES To determine the prognostic role of orthostatic hypotension for cardiovascular disease ( CVD ) and all-cause mortality in elderly people . DESIGN Prospect i ve study . SETTING Community based . PARTICIPANTS Five thous and sixty-four subjects from the Rotterdam study aged 55 and older . MEASUREMENTS  Orthostatic hypotension  was measured using a Dinamap automatic blood pressure recorder . Orthostatic hypotension  is defined as a decline in systolic blood pressure of 20 mmHg or more or a decline in diastolic blood pressure of 10 mmHg or more from supine to st and ing position at any of three measurements taken 1 , 2 , and 3 minutes after st and ing . RESULTS At baseline , 901 subjects had  orthostatic hypotension  . During follow-up , 668 subjects had  coronary heart disease  ( CHD ) ( mean follow-up 6.0 + /- 3.5 years ) , and 1,835 subjects died ( mean follow-up period 7.8 + /- 3.8 years ) . Orthostatic hypotension increased the risk of CHD ( hazard ratio (HR)=1.31 , 95 % confidence interval (CI)=1.08 - 1.57 ) and all-cause mortality ( HR=1.22 , 95 % CI=1.09 - 1.36 ) , in models adjusted for age and sex . The risk was slightly lower after additional adjustment for cardiovascular risk factors . In analyses stratified for age , the HRs for all-cause mortality were 1.80 ( 95 % CI 1.25 - 2.60 ) , 1.13 ( 0.89 - 1.42 ) , and 1.27 ( 95 % CI=1.11 - 1.44 ) , in the first , second , and third tertile of age , respectively . CONCLUSION Orthostatic hypotension increases the risk of CHD and all-cause mortality in elderly people . The risk of CVD and mortality is strongest in younger and very old subjects Background Falls are a major cause of morbidity and mortality in dementia , but there have been no prospect i ve studies of risk factors for falling specific to this patient population , and no successful falls intervention/prevention trials . This prospect i ve study aim ed to identify modifiable risk factors for falling in older people with mild to moderate dementia . Methods and Findings 179 participants aged over 65 years were recruited from outpatient clinics in the UK ( 38 Alzheimer 's disease ( AD ) , 32 Vascular dementia ( VAD ) , 30 Dementia with Lewy bodies ( DLB ) , 40 Parkinson 's disease with dementia ( PDD ) , 39 healthy controls ) . A multifactorial assessment of baseline risk factors was performed and fall diaries were completed prospect ively for 12 months . Dementia participants experienced nearly 8 times more incident falls ( 9118/1000 person-years ) than controls ( 1023/1000 person-years ; incidence density ratio : 7.58 , 3.11–18.5 ) . In dementia , significant univariate predictors of sustaining at least one fall included diagnosis of Lewy body disorder ( proportional hazard ratio ( HR ) adjusted for age and sex : 3.33 , 2.11–5.26 ) , and history of falls in the preceding 12 months ( HR : 2.52 , 1.52–4.17 ) . In multivariate analyses , significant potentially modifiable predictors were symptomatic orthostatic hypotension ( HR : 2.13 , 1.19–3.80 ) , autonomic symptom score ( HR per point 0–36 : 1.055 , 1.012–1.099 ) , and Cornell depression score ( HR per point 0–40 : 1.053 , 1.01–1.099 ) . Higher levels of physical activity were protective ( HR per point 0–9 : 0.827 , 0.716–0.956 ) . Conclusions The management of symptomatic orthostatic hypotension , autonomic symptoms and depression , and the encouragement of physical activity may provide the core elements for the most fruitful strategy to reduce falls in people with dementia . R and omised controlled trials to assess such a strategy are a priority BACKGROUND Previous studies have reported a higher prevalence of dementia in persons with low blood pressure . OBJECTIVE To examine whether low blood pressure is prospect ively associated with the occurrence of Alzheimer disease and dementia in elderly people . SUBJECTS AND METHODS A community-based , dementia-free cohort ( n = 1270 ) aged 75 to 101 years was longitudinally examined twice within 6 years to detect incident dementia using the Diagnostic and Statistical Manual of Mental Disorders , Revised Third Edition criteria . Cox proportional hazards models were used to analyze blood pressure in association with dementia after adjustment for several potential confounders . RESULTS During the 6-year period , 339 subjects were diagnosed with dementia , including 256 persons with Alzheimer disease . Subjects with very high systolic pressure ( > 180 vs 141 - 180 mm Hg ) had an adjusted relative risk of 1.5 ( 95 % confidence interval [ CI ] , 1.0 - 2.3 ; P = .07 ) for Alzheimer disease , and 1.6 ( 95 % CI , 1.1 - 2.2 ) for dementia . Low systolic pressure ( < /=140 mm Hg ) was not related to incident dementia . In contrast , high diastolic pressure ( > 90 mm Hg ) was not associated with dementia incidence , whereas extremely low diastolic pressure ( < /=65 vs 66 - 90 mm Hg ) produced an adjusted relative risk of 1.7 ( 95 % CI , 1.1 - 2.4 ) for Alzheimer disease and 1.5 ( 95 % CI , 1.0 - 2.1 ; P = .03 ) for dementia . The latter association was pronounced particularly in persons who used antihypertensive drugs . CONCLUSIONS Both low diastolic and high systolic pressure are associated with an increased risk of Alzheimer disease and dementia in this elderly population . The atherosclerotic process may explain the observed associations . In addition , low diastolic pressure may increase dementia risk by affecting cerebral perfusion Background and Purpose — A long-term follow-up study was conducted in patients with lacunar infa rct to assess how 24-hour blood pressure monitoring values and MRI findings , in particular lacunar infa rcts and diffuse white matter lesions , can predict subsequent development of dementia and vascular events , which include cerebrovascular and cardiovascular events . Methods — One hundred seventy-seven patients were tracked for a mean of 8.9 years of follow-up . Documented events comprise the development of dementia and the occurrence of vascular events . The predictors for developing dementia and vascular events were separately evaluated by Cox proportional hazards analysis . Results — Twenty-six patients developed dementia  ( 0.17/100 patient-years ) . Male sex ( relative risk [ RR ] , 4.2 ; 95 % CI , 1.2 to 14.7 ) , cognitive impairment ( RR , 3.0 ; 95 % CI , 1.0 to 8.5 ) , confluent DWML ( moderate : RR , 7.1 ; 95 % CI , 1.6 to 31.5 ; severe : RR , 35.8 ; 95 % CI , 7.2 to 177.3 ) , and nondipping status ( RR , 7.1 ; 95 % CI , 2.2 to 22.0 ) were independent predictors for dementia . Forty-six patients suffered from vascular events ( 3.11/100 patient-years ) . Diabetes mellitus ( RR , 5.7 ; 95 % CI , 2.7 to 11.9 ) , multiple lacunae ( moderate : RR , 6.4 ; 95 % CI , 2.5 to 15.8 ; severe : RR , 8.5 ; 95 % CI , 3.1 to 23.3 ) , and high 24-hour systolic blood pressure ( > 145 mm Hg versus < 130 mm Hg ) ( RR , 10.3 ; 95 % CI , 1.3 to 81.3 ) were independent predictors for vascular events . Conclusions — Predictors for developing dementia and vascular events appear to differ . Male sex , confluent diffuse white matter lesions , and nondipping status were independent predictors for subsequent development of dementia , while diabetes mellitus , multiple lacunae , and high 24-hour systolic blood pressure were independent predictors for vascular events Objectives Home blood pressure measurement ( HBPM ) is recommended by guidelines for hypertension management . However , this method might be difficult to use in elderly individuals with cognitive disorders . Our aim was to assess the agreement and the feasibility of HBPM by a relative as compared with 24-h ambulatory blood pressure monitoring ( ABPM ) in elderly patients with dementia . Methods Sixty out patients with dementia aged 75 years and older with office hypertension ( ≥140/90 mmHg ) were subjected successively to HBPM by a trained relative and 24-h ABPM . The order of the two methods was r and omized . Current guidelines ’ thresholds for the diagnosis of hypertension were used . Results The mean ( SD ) age of the patients was 80.8 ( 6.1 ) years ( 55 % women ) and the mean ( SD ) mini-mental state examination score was 20.1 ( 6.9 ) .  The feasibility of relative-HBPM  was very high , with a 97 % success rate ( defined by ≥12/18 measurements reported ) . The blood pressure measurements were highly correlated between the two methods ( r=0.75 and 0.64 for systolic blood pressure and diastolic blood pressure , respectively ; P<0.001 for both ) . The agreement between the methods for the diagnosis of sustained hypertension and white-coat hypertension was excellent ( overall agreement , 92 % ; & kgr ; coefficient , 0.81 ; 95 % CI , 0.61–0.93 ) . Similar results were found for daytime-ABPM  . Conclusion In cognitively impaired elderly patients , HBPM by a relative using an automated device was a good alternative to 24-h ABPM Background : The role of blood pressure ( BP ) as a risk factor for dementia is complex and may be age dependent . In very old individuals , low BP might increase risk for dementia , perhaps by reducing cerebral perfusion pressure . Methods : The association between BP and dementia was examined in the Bronx Aging Study , a prospect i ve study of 488 community-dwelling elderly individuals over age 75 , dementia-free at baseline ( 1980 to 1983 ) and followed at 12- to 18-month intervals . Subjects with baseline BP and with at least one follow-up visit were included ( n = 406 ) .  Incident dementia was diagnosed using the criteria of the Diagnostic and Statistical Manual of Mental Disorders ( 3rd rev . ed . ) . Results : Over 21 years ( median 6.7 years ) , 122 subjects developed dementia ( 65 Alzheimer ’s disease [ AD ] , 28 vascular dementia , 29 other dementias ) . Relative risk of dementia increased for each 10-mm Hg decrement in diastolic ( hazard ratio [ HR ] 1.20 , 95 % CI 1.03 to 1.40 ) and mean arterial ( HR 1.16 , 95 % CI 1.02 to 1.32 ) pressure , adjusted for age , sex , and education . Low diastolic BP significantly influenced risk of developing AD but not vascular dementia . Upon examination of groups defined by BP , mildly to moderately raised systolic BP ( 140 to 179 mm Hg ) was associated with reduced risk for AD ( HR vs normal systolic BP group 0.55 , 95 % CI 0.32 to 0.96 ) , whereas low diastolic BP ( ≤70 mm Hg ) was associated with increased risk of AD ( HR vs normal diastolic BP group 1.91 , 95 % CI 1.05 to 3.48 ) . Subjects with persistent low BP over 2 years had higher risk of developing dementia ( HR 2.19 , 95 % CI 1.27 to 3.77 ) . Conclusions : Low diastolic pressure is associated with higher risk of dementia  in elderly individuals over age 75 .  Dementia risk was higher in subjects with persistently low BP Antihypertensive therapy based on the angiotensin-converting enzyme ( ACE ) inhibitor perindopril reduced the incidence of recurrent stroke in the Perindopril Protection against Recurrent Stroke Study ( PROGRESS ) . The present study assessed the effect of perindopril on the 24-h blood pressure ( BP ) in hypertensive patients with lacunar infa rct ion using ambulatory BP monitoring ( ABPM ) . There was a 4-week observation period , a 4-week treatment period 1 ( perindopril at 2 mg/day ) , and a 4-week treatment period  
    Output:
    
The little available evidence suggested increased levels of dementia being associated with reduced tolerability .
CONCLUSIONS ABPM is well tolerated in people with mild-moderate dementia and provides some additional information over and above office BP alone .
However , few studies have addressed ABPM in people with more severe dementia