Prevalence and Prescribed Treatments of Orthostatic Hypotension in Institutionalized Patients with Parkinson’s Disease

Hommel, Adrianus L.A.J.; Faber, Marjan J.; Weerkamp, Nico J.; Dijk, J. Gert van; Bloem, Bastiaan R.; Koopmans, Raymond T.C.M.

doi:10.3233/jpd-160853

Cited by 10 publications

(6 citation statements)

References 27 publications

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“…CSH involving an excessive fall in arterial pressure is reported to occur in 35%–58% of elderly with AD and DLB . OH develops in nearly 50% of Parkinsonians and may be present in over 90% of PDD patients . OH is an independent risk for incident dementia and often accompanied by disabling symptoms, impaired quality of life, dizziness, nausea, sweating and loss of consciousness .…”

Section: Introductionmentioning

confidence: 99%

Small vessel disease pathological changes in neurodegenerative and vascular dementias concomitant with autonomic dysfunction

et al. 2019

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We performed a clinicopathological study to assess the burden of small vessel disease (SVD) type of pathological changes in elderly demented subjects, who had clinical evidence of autonomic dysfunction, either carotid sinus hypersensitivity or orthostatic hypotension or both or had exhibited unexpected repeated falls. Clinical and neuropathological diagnoses in 112 demented subjects comprised dementia with Lewy bodies (DLB), Parkinson's disease with dementia (PDD), Alzheimer's disease (AD), Mixed dementia (mostly AD‐DLB) and vascular dementia (VaD). Of these, 12 DLB subjects had no recorded unexpected falls in life and therefore no evidence of concomitant autonomic dysfunction. A further 17 subjects were assessed as aging controls without significant pathology or signs of autonomic dysfunction. We quantified brain vascular pathological changes and determined severities of neurodegenerative lesions including α‐synuclein pathology. We found moderate‐severe vascular changes and high‐vascular pathology scores (P < 0.01) in all neurodegenerative dementias and as expected in VaD compared to similar age controls. Arteriolosclerosis, perivascular spacing and microinfarcts were frequent in the basal ganglia and frontal white matter (WM) across all dementias, whereas small infarcts (<5 mm) were restricted to VaD. In a sub‐set of demented subjects, we found that vascular pathology scores were correlated with WM hyperintensity volumes determined by MRI in life (P < 0.02). Sclerotic index values were increased by ~50% in both the WM and neocortex in all dementias compared to similar age controls. We found no evidence for increased α‐synuclein deposition in subjects with autonomic dysfunction. Our findings suggest greater SVD pathological changes occur in the elderly diagnosed with neurodegenerative dementias including DLB and who develop autonomic dysfunction. SVD changes may not necessarily manifest in clinically overt symptoms but they likely confound motor or cognitive dysfunction. We propose dysautonomia promotes chronic cerebral hypoperfusion to impact upon aging‐related neurodegenerative disorders and characterize their end‐stage clinical syndromes.

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Section: Introductionmentioning

confidence: 99%

Small vessel disease pathological changes in neurodegenerative and vascular dementias concomitant with autonomic dysfunction

et al. 2019

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“…In addition, some authors have explored the link between specific autonomic symptoms and the NMSS. Hommel et al, for example, showed that 48.5% of PD patients with orthostatic hypotension declared symptoms (score of one or over on NMSS domain 1), whereas 43.4% of patients with symptoms had no orthostatic hypotension 16 . How the detection rate of the NMSS for these symptoms relates to other scales, however, remains unclear as no other autonomic scales where included in this study.…”

Section: Validationmentioning

confidence: 78%

The Non‐Motor Symptoms Scale in Parkinson’s disease: Validation and use

et al. 2020

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The Non‐Motor Symptoms Scale (NMSS) was developed and validated in 2007 as the first instrument for the comprehensive assessment of a range of non‐motor symptoms in Parkinson's disease (PD). Thirteen years have elapsed since its introduction and extensive international validation with good psychometric attributes has been carried out. Here, we review the validation data of the NMSS and its cross‐validity with other scales, and describe the key evidence derived from use of the NMSS in clinical studies. To date, over 100 clinical studies and trials have made use of it as an outcome measure, showing consistent and strong correlations between NMSS burden and health‐related quality of life measures. Moreover, the scale has shown to be capable of detecting longitudinal changes in non‐motor symptoms, where studies have shown differential changes over time of several of the NMSS domains. The scale has become a key outcome in several randomized clinical trials. Highlighting the prevalence and importance of non‐motor symptoms to quality of life in patients with PD, the development of NMSS has also been useful in signposting clinical and biomarker based research addressing non‐motor symptoms in PD.

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“…13 In another study, prevalence of OH in PD was reported also reported low as we found 45%. 14 Similarly another cross-sectional study reported the prevalence of OH as 51.6%, with almost equal distribution among symptomatic and asymptomatic cases 27 . These findings are almost similar to our statistics.…”

Section: Discussionmentioning

confidence: 95%

Frequency of Orthostatic Hypotension in Parkinson’s Disease

Qayyum¹,

Haq²,

Zafar³

et al. 2021

PJMHS

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Background: Parkinson’s Diseases (PD) cause some non-motor issues that could lead to disability. One of such determinal non-motor symptoms is orthostatic hypotension (OH) which is still understudied in our local setting despite of its high prevalence worldwide among patients of PD. Aim: To determine frequency of orthostatic hypotension in Parkinson’s disease Methods: This Cross-sectional study was conducted at Department of Neurology, Mayo Hospital, Lahore for 6 months after the approval of synopsis [April 9, 2018 till Oct 9, 2018]. A sample of 95 cases was selected using non probability consecutive sampling from 95 patients of Parkinson’s Disease aged 25 years and more. After taking consent from patient and recording sociodemographic information, a lying-to-standing orthostatic test was performed to evaluate the orthostatic hypotension and SBP and DBP was recorded. All data was collected using a self structured proforma and analyzed using SPSS v 21. Results: The mean age of cases was 47.46 ± 8.97 years with male to female ratio of 1.97:1. The mean systolic and diastolic blood pressure was 120.60 ± 11.80 and 86.20 ± 8.68 respectively. The frequency of orthostatic hypotension was seen in 51(53.7%) while other 44(46.3%) cases did not have orthostatic hypotension. Conclusion: Through the findings of this study we conclude that frequency of orthostatic hypotension in Parkinson’s disease is very much high i.e. 53.7% with highest frequency in cases with longer duration of disease. Keywords: Autonomic diseases, Parkinson’s disease, Systolic blood pressure, diastolic blood pressure, Orthostatic hypotension,

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Prevalence and Prescribed Treatments of Orthostatic Hypotension in Institutionalized Patients with Parkinson’s Disease

Abstract: One half of institutionalized PD patients had OH, of whom half were probably symptomatic. OH was rarely noted in the medical records, suggesting underdiagnosis. Finally, OH was rarely treated, suggesting undertreatment.

Cited by 10 publications

References 27 publications

Small vessel disease pathological changes in neurodegenerative and vascular dementias concomitant with autonomic dysfunction

Small vessel disease pathological changes in neurodegenerative and vascular dementias concomitant with autonomic dysfunction

The Non‐Motor Symptoms Scale in Parkinson’s disease: Validation and use

Frequency of Orthostatic Hypotension in Parkinson’s Disease

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