Treating Orthostatic Hypotension in Patients with Parkinson's Disease and Atypical Parkinsonism Improves Function

Hohler, Anna DePold; Amariei, D.; Katz, Douglas I.; DePiero, Theslee Joy; Allen, Valerie; Boyle, Suzanne; Phenix, Heidi; DeAngelis, Tara Ashley; Geibel, Carrie Denise; Smith, Karla M.; Saint‐Hilaire, Marie; Ellis, Terry

doi:10.3233/jpd-2012-012101

Cited by 13 publications

(6 citation statements)

References 32 publications

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“…After initiating midodrine, a PD-dementia patient with severe OH had sustained improvement in cognition and hypotensive episodes ( 37 ). A cohort of 40 OH+ parkinsonian patients showed better Cognitive Functional Independence Measures following treatment with midodrine and/or fludrocortisone ( 38 ). Although these results are suggestive, prospective studies with greater sample sizes are needed to establish whether treating OH can delay or prevent cognitive decline in PD.…”

Section: Discussionmentioning

confidence: 99%

Orthostatic Hypotension Is Associated With Cognitive Decline in Parkinson Disease

2020

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Introduction: Cognitive impairment and orthostatic hypotension (OH) are common, disabling Parkinson disease (PD) symptoms that are strongly correlated. Whether the relationship is causative or associative remains unknown. OH may occur without classic orthostatic symptoms of cerebral hypoperfusion (i.e., lightheadedness or dizziness). Whether longitudinal differences in cognition occur between symptomatic and asymptomatic OH patients has not been explored. Objectives: We characterized the prevalence of OH, orthostatic symptoms, and cognitive impairment among PD patients and compared cognition between patients with and without OH, and between patients with symptomatic and asymptomatic OH. Methods: Our cross-sectional, retrospective, observational study included 226 clinically diagnosed PD patients who underwent repeated standardized evaluations. Among these, 62 had longitudinal follow-up of > 3.5 years. We compared longitudinal Montreal Cognitive Assessment (MoCA) scores between patients remaining OH-free ( n = 14) and those without baseline OH that developed OH ( n = 28), matched for age, sex, education, and PD duration. We also compared MoCA scores between groups with asymptomatic OH ( n = 13) and symptomatic OH ( n = 13) matched for the same factors. Results: In the cross-sectional analysis, OH patients had worse cognition. In the longitudinal analysis (mean follow-up = 5.3 years), OH patients had worse cognitive decline ( p = 0.027). Cognitive impairment was similar between asymptomatic and symptomatic OH patients in the cross-sectional and longitudinal analyses. Conclusions: OH is associated with cognitive impairment in PD. Further studies are needed in larger cohorts to expand our findings and to determine whether treating OH can prevent or delay cognitive dysfunction.

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Section: Discussionmentioning

confidence: 99%

Orthostatic Hypotension Is Associated With Cognitive Decline in Parkinson Disease

2020

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“…Symptomatic burden can lead to immobility and physical deconditioning, which, in turn, further worsen the severity of OH . Randomized, placebo‐controlled, clinical trials show that effective treatment of OH can decrease symptoms, increase physical activity levels, and improve functionality . This suggests that treatment of OH may help prevent this incapacitating downward spiral.…”

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confidence: 99%

Orthostatic Hypotension in Parkinson Disease: How Much You Fall or How Low You Go?

et al. 2015

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Background Orthostatic hypotension (OH) is frequent in patients with Parkinson disease (PD) and can occur with or without symptoms. Pharmacological treatments are effective but often exacerbate supine hypertension. Guidelines exist for the diagnosis but not for the treatment of OH. We examined the relationship between blood pressure and symptoms in a cohort of PD patients with the goal of identifying a hemodynamic target to guide treatment. Methods We measured blood pressure supine and upright (tilt or active standing) and identified the presence or absence of symptomatic OH by using a validated patient-reported outcome questionnaire in 210 patients with PD. We evaluated the usefulness of the 20/10 and 30/15 mmHg diagnostic criteria (systolic/diastolic) to identify symptomatic OH. Results Fifty percent of the PD patient cohort met criteria for the 20/10 fall and 30% for the 30/15 blood pressure fall. Among the patients who met either OH criteria, the percentage of those with symptoms was small (33% of those with 20/10 and 44% of those with 30/15 mmHg; 16% and 13%, respectively overall). Symptomatic OH was associated with an upright mean blood pressure below 75 mmHg. A mean standing blood pressure <75 mmHg had a sensitivity of 97% and a specificity of 98% for detecting symptomatic OH. Conclusions Although the prevalence of OH in PD is high, not all patients have symptoms of organ hypoperfusion. A mean standing blood pressure below 75 mmHg appears to be a useful benchmark when deciding whether the benefits of initiating pharmacological treatment of OH outweigh the risks of exacerbating supine hypertension.

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“…Although consensus guidelines for the pharmacologic treatment of OH are lacking, randomized placebo-controlled clinical trials show that effective treatment of OH can help reduce symptomatic burden [35], increase physical activity levels [36], and improve motor functionality [37]. This gives strength to the concept that a prompt recognition of OH and an adequate treatment may help prevent these negative consequences.…”

Section: Discussionmentioning

confidence: 99%

Comprehensive telemedicine solution for remote monitoring of Parkinson’s disease patients with orthostatic hypotension during COVID-19 pandemic

et al. 2022

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Objective Orthostatic hypotension (OH) represents a frequent but under-recognized phenomenon in Parkinson’s disease (PD). During COVID-19 pandemic, Information and Communication Technologies (ICT) have become pivotal in the management of chronic diseases like PD, not only to assess motor impairment, but also for vital signs monitoring. This pilot study aimed to propose a real-time remote home-monitoring system and protocol for PD patients with OH. Methods Vital parameters were acquired by wireless devices and transmitted to an ICT platform, providing data and smart notifications to the healthcare provider through an interactive web portal. Eight patients with idiopathic PD and OH underwent 5-day monitoring. Data about OH episodes, therapeutic interventions, impact on daily activities, and patient satisfaction were collected and analyzed. Results The proposed solution allowed the identification of 65 OH episodes and subsequent medical interventions. Thirty-five episodes were asymptomatic, especially in the postprandial and in the afternoon recordings. Systolic-blood-pressure (SBP) and diastolic-blood-pressure (DBP) were significantly lower in symptomatic episodes, while the pressure drops resulted significantly higher in presence of symptoms. High usability and patient satisfaction scores were observed. Conclusion The proposed home-monitoring system and protocol have proved to provide useful information and to allow prompt interventions in the management of PD patients with OH during COVID-19 pandemic.

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Treating Orthostatic Hypotension in Patients with Parkinson's Disease and Atypical Parkinsonism Improves Function

Cited by 13 publications

References 32 publications

Orthostatic Hypotension Is Associated With Cognitive Decline in Parkinson Disease

Orthostatic Hypotension Is Associated With Cognitive Decline in Parkinson Disease

Orthostatic Hypotension in Parkinson Disease: How Much You Fall or How Low You Go?

Comprehensive telemedicine solution for remote monitoring of Parkinson’s disease patients with orthostatic hypotension during COVID-19 pandemic

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