Parkinson’s disease with orthostatic hypotension: analyses of clinical characteristics and influencing factors

Li, Lixia; Guo, Ping; Ding, Duyu; Lian, Teng-hong; Zuo, Lijun; Du, Fenghe; Zhang, Wei

doi:10.1080/01616412.2019.1610224

Cited by 13 publications

(16 citation statements)

References 33 publications

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“…The factors associated with autonomic dysfunction in our cohort of patients with early PD are in line with those of previous studies, suggesting age, disease severity, and other nonmotor symptoms may affect autonomic dysfunction [ 12 , 20 – 26 ] [ 13 , 23 , 27 ]. Our study is the first to report an association between impulsivity and compulsivity and apathy with autonomic dysfunction in patients with early PD.…”

Section: Discussionsupporting

confidence: 91%

Lower Urinary Tract and Gastrointestinal Dysfunction Are Common in Early Parkinson’s Disease

Martínez-Ramírez

Velázquez-Ávila

Almaraz-Espinoza

et al. 2020

Parkinson's Disease

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Purpose. Autonomic dysfunction is a common nonmotor feature and early manifestation of Parkinsons disease (PD). Autonomic dysfunction in PD is associated with a worse prognosis. We sought to characterize autonomic dysfunction and identify associated factors in patients with early PD. Methods. An observational, cross-sectional, descriptive, and analytical study was conducted to evaluate patients with early PD from the Parkinsons Progression Markers Initiative. We utilized the Scales for Outcomes in Parkinsons Disease-Autonomic dysfunction questionnaire to determine the prevalence and frequencies of autonomic symptomatology. The cohort was grouped into high and low dysautonomic scores. A regression model identified variables that independently explained dysautonomic scores in our early PD cohort. Results. 414 PD patients had a mean age of 61.1 (SD 9.7) years at diagnosis and mean disease duration of 6.7 (SD 6.6) months. Among all patients, 43.7% (181/414) had high dysautonomic scores. Urinary and gastrointestinal symptoms were the most prevalent and frequently reported dysautonomic symptoms. Patients with fatigue (beta = 4.28, p < 0.001 ), probable rapid eye movement sleep behavior disorder (beta = 2.71, p < 0.001 ), excessive daytime sleepiness (beta = 1.88, p = 0.039 ), impulsivity and compulsivity (beta = 2.42, p < 0.001 ), and increasing age (beta = 1.05, p < 0.001 ) were more likely to have high dysautonomic scores. Conclusion. Lower urinary tract and gastrointestinal symptoms are prevalent and frequent in early PD patients. Fatigue, sleep disorders, impulsivity and compulsivity, and age are predictors of autonomic dysfunction. Autonomic symptoms predominated in this group of early PD patients in the disease course and were associated with more severe disease.

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Section: Discussionsupporting

confidence: 91%

Lower Urinary Tract and Gastrointestinal Dysfunction Are Common in Early Parkinson’s Disease

Martínez-Ramírez

Velázquez-Ávila

Almaraz-Espinoza

et al. 2020

Parkinson's Disease

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“…In some studies, statistically significant associations were found between OH and clinical manifestations severity as well as abnormal imaging findings. OH was associated with more severe PD disease [16,19,20], higher rates of depression [16,34], anxiety [20] and fatigue [20,24], as well as more severe cognitive impairment [16,19,20,24,42], autonomic dysfunction [16,20] and motor symptoms [16,20], although not all these results were reproduced by other studies. A couple of them found no significant differences in disease severity [21,26,28,33,41] or motor symptoms [19,21,41] between OH and non-OH group.…”

Section: Resultsmentioning

confidence: 78%

“…It is curious that no subanalysis of PD patients with HBP was performed, therefore there is no available data regarding the interaction between HBP and OH in PD patients. In two studies, PD patients with OH had a slightly lower prevalence of HBP compared to non-OH patients (33.3% in OH vs. 49.2% in non-OH, p = 0.19; 21.7% in OH vs. 26.5% in non-OH, p = 0.53) [19,25], in other two studies there were opposite results (42.86% in OH vs. 38.61% in non-OH, p = 0.61; 38% in OH vs. 20% in non-OH, p = 0.04) [20,21], whereas another one reported equal prevalence of HBP among the two groups (p = 1) [28], which makes it difficult to draw conclusions regarding the association between HBP and OH. In one study, a group of 26 patients with untreated HBP without PD served as control group for PD patients without HBP, revealing higher left ventricular mass (indexed to body surface) in both HBP and reverse dipper PD compared to non-reverse dipper PD patients [17].…”

Section: Resultsmentioning

confidence: 87%

“…Another finding of the studies included in this review is the high prevalence of OH, correlated with unfavorable outcomes such as more severe non-motor symptoms [16,19,20,24,34,42], atrophy of the striatum [19] and carotid artery thickening (the latter in the novo untreated PD patients) [37]. This prompts early detection and proper management of OH in PD patients.…”

Section: Summary Of Evidencementioning

confidence: 92%

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Blood Pressure Patterns in Patients with Parkinson’s Disease: A Systematic Review

Tulbă

Cozma

Bălănescu

et al. 2021

JPM

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(1) Background: Cardiovascular autonomic dysfunction is a non-motor feature in Parkinson’s disease with negative impact on functionality and life expectancy, prompting early detection and proper management. We aimed to describe the blood pressure patterns reported in patients with Parkinson’s disease, as measured by 24-h ambulatory blood pressure monitoring. (2) Methods: We conducted a systematic search on the PubMed database. Studies enrolling patients with Parkinson’s disease undergoing 24-h ambulatory blood pressure monitoring were included. Data regarding study population, Parkinson’s disease course, vasoactive drugs, blood pressure profiles, and measurements were recorded. (3) Results: The search identified 172 studies. Forty studies eventually fulfilled the inclusion criteria, with 3090 patients enrolled. Abnormal blood pressure profiles were commonly encountered: high blood pressure in 38.13% of patients (938/2460), orthostatic hypotension in 38.68% (941/2433), supine hypertension in 27.76% (445/1603) and nocturnal hypertension in 38.91% (737/1894). Dipping status was also altered often, 40.46% of patients (477/1179) being reverse dippers and 35.67% (310/869) reduced dippers. All these patterns were correlated with negative clinical and imaging outcomes. (4) Conclusion: Patients with Parkinson’s disease have significantly altered blood pressure patterns that carry a negative prognosis. Ambulatory blood pressure monitoring should be validated as a biomarker of PD-associated cardiovascular dysautonomia and a tool for assisting therapeutic interventions.

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“…Previous studies have shown that DM, 8,9,11 metabolic syndrome, 13 and cardiovascular diseases 12 are associated with motor symptom progression and impairment of balance in PD. There are few studies on HbA1c, including one showing that higher levels are associated with orthostatic hypotension, 18 and a study reporting that almost two‐thirds of the non‐diabetic individuals in a PD cohort were insulin‐resistant, often with normal fasting glucose and HbA1c 19 . Few studies have investigated the association of HbA1c with long‐term PD outcome.…”

Section: Discussionmentioning

confidence: 99%

Euglycemia Indicates Favorable Motor Outcome in Parkinson's Disease

et al. 2021

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Background: The interplay between glycemic control and Parkinson's disease (PD) has long been recognized but not fully understood. Objectives: To investigate the association of glycated hemoglobin (HbA1c) levels with motor and cognitive symptom progression in a prospective PD cohort. Methods: Of 244 PD patients, 17 had low HbA1c (≤30 mmol/mol), 184 were euglycemic (HbA1c 31-41 mmol/mol), 18 had high HbA1c (HbA1 ≥42 mmol/mol), and 25 had diabetes mellitus (DM). Survival analysis was applied on time until Hoehn and Yahr stage ≥3 (motor outcome) and until mild cognitive impairment. Results: Low HbA1c (HR 2.7; 95% CI 1.3-6; P = 0.01) as well as high HbA1c (HR 3.6; 95% CI 1.5-8.9; P = 0.005) but not DM were independent predictors of unfavorable motor outcome. Conclusions: Both high and low HbA1c levels may be associated with motor symptom progression in PD; however, further studies are needed to confirm these findings and increase understanding regarding causality.

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Parkinson’s disease with orthostatic hypotension: analyses of clinical characteristics and influencing factors

Cited by 13 publications

References 33 publications

Lower Urinary Tract and Gastrointestinal Dysfunction Are Common in Early Parkinson’s Disease

Lower Urinary Tract and Gastrointestinal Dysfunction Are Common in Early Parkinson’s Disease

Blood Pressure Patterns in Patients with Parkinson’s Disease: A Systematic Review

Euglycemia Indicates Favorable Motor Outcome in Parkinson's Disease

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