Syncope in the elderly: diagnosis, evaluation, and treatment.

Syncope is more common in older persons than in any other age group. Age-related physiologic impairments of heart rate, blood pressure, baroreflex sensitivity, and cerebral blood flow, in combination with a higher prevalence of comorbid disorders and concomitant medications, account for the increased susceptibility of older persons to syncope. A number of age-related factors confound the assessment of syncope in older persons. Examples include (1). more than one possible attributable diagnosis; (2). polypharmacy; (3). cardiovascular and cerebrovascular comorbidity; (4). amnesia for loss of consciousness; (5). lack of witness accounts; (6). syncopal events presenting as falls; and (7). coexistent cognitive impairment and dementia. Cardiovascular risk factors are increasingly recognized as key triggers for dementia, with enormous potential for early detection and intervention. One such possible risk factor is bradyarrhythmia. Successful interventions for cardiovascular disorders that cause syncope in the elderly have wider implications than control of syncopal events and include reductions in falls and possibly prevention or modification of cognitive impairment and dementia.