Time course of symptomatic orthostatic hypotension and urinary incontinence in patients with postmortem confirmed parkinsonian syndromes: a clinicopathological study

Abstract

Objective-Although both orthostatic hypotension and urinary incontinence have been reported in a number of parkinsonian syndromes, such as Parkinson's disease (PD), multiple system atrophy (MSA), dementia with Lewy bodies (DLB), corticobasal degeneration (CBD), and progressive supranuclear palsy (PSP), diVerences in the evolution of these features have not been studied systematically in pathologically confirmed cases. Methods-77 cases with pathologically confirmed parkinsonian syndromes (PD, n=11; MSA, n=15; DLB, n=14; CBD, n=13; PSP, n=24), collected up to 1994, formed the basis for a multicentre clinicopathological study organised by the NINDS to improve the diVerential diagnosis of parkinsonian disorders. The present study determined the time course-that is, latency to onset and duration from onset to death, of symptomatic orthostatic hypotension, and urinary incontinence in the NINDS series. Furthermore, the diagnostic validity of a predefined latency to onset within 1 year of disease onset of symptomatic orthostatic hypotension or urinary incontinence was analysed. Results-Significant group diVerences for latency, but not duration, of symptomatic orthostatic hypotension and urinary incontinence were found. Latencies to onset of either feature were short in patients with MSA, intermediate in patients with DLB, CBD, and PSP, and long in those with PD. Symptomatic orthostatic hypotension occurring within the first year after disease onset predicted MSA in 75% of cases; early urinary incontinence was less predictive for MSA (56%). Conclusion-Latency to onset, but not duration, of symptomatic orthostatic hypotension or urinary incontinence diVerentiates PD from other parkinsonian syndromes, particularly MSA. (J Neurol Neurosurg Psychiatry 1999;67:620-623)

Orthostatic Hypotension in De Novo Parkinson Disease

“…8,17 Data from retrospective studies show differences in the frequency and severity of autonomic dysfunction between MSA and PD 13,14 ; symptomatic OH occurring within 1 year of disease onset predicted the diagnosis of MSA in 75% of patients.…”

Epidemiology of Multiple System Atrophy: A Prevalence and Pilot Risk Factor Study in Aquitaine, France

“…The clinical relevance of this result is uncertain: is it a very early sign of the disease process (autonomic failure?) [66] or a true risk factor for developing the disease? Other investigations taking blood pressure history into account more precisely should give further clues regarding this issue.…”

Review: Treatment of dysautonomia in extrapyramidal disorders

“…Although autonomic dysfunction is accepted to be an important clinical symptom in MSA and PD patients, the role of autonomic dysfunction in progressive supranuclear palsy (PSP) patients is still quite unclear because of contradictory data on this issue [Kimber et al 2000;Wenning et al 1999]. As we have recently shown, 71% of PSP patients presented with pathologically small pupils in darkness at least in one eye in comparison to 32% MSA, 16% PD patients and 7% healthy controls [Schmidt et al 2007].…”