Objective: This study aimed to evaluate the prevalence of orthostatic hypotension (OH) and postprandial hypotension (PPH) in patients with Parkinson’s disease (PD), multiple system atrophy (MSA), and dementia with Lewy bodies (DLB).

Background: α-synucleinopathies are neurodegenerative diseases characterized by the abnormal accumulation of α-synuclein aggregates in neurons, nerve fibers or glial cells. There are three main types of α-synucleinopathy, Parkinson’s disease (PD), multiple system atrophy (MSA), and dementia with Lewy bodies (DLB). Autonomic dysfunction is a prominent feature in α-synucleinopathies. Abnormal cardiovascular responses such as orthostatic hypotension (OH) and postprandial hypotension (PPH) are common nonmotor symptoms in patients with α-synucleinopathy. There is inconsistent evidence about the prevalence of OH and PPH in PD, MSA, and DLB. To estimate the prevalence of OH and PPH in these diseases more precisely we conducted a systematic review and meta-analysis.

Method: From PubMed and Embase databases, we identified studies published up till January 2019. The Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines for meta-analysis was followed. The primary outcome measure was frequencies of OH and PPH as reported in prevalence (%). The pooled prevalence of symptoms and 95 % confidence intervals were obtained by using a random effects model. Analyses were performed with Comprehensive Meta-Analysis (CMA) software.

Results: The primary search strategy yielded 651 articles of which 45 met the inclusion criteria. The summary prevalence of clinically OH was 32.8 % (95 % CI, 21.1-42.3 %) and PPH was 51.6 % (95 % CI, 30.2-68.8 %) in PD patients. The prevalence of OH and PPH were 72.3 % (95 % CI, 65.8– 82.6%) and 53.2 % (95 % CI, 28.6–73.7 %) in patients with MSA; the prevalence of OH was 35 % (95 % CI, 23.1-48.6 %) in DLB patients.

Conclusion: Orthostatic hypotension and postprandial hypotension are common symptoms in patients with PD, MSA, and DLB. Clinicians should be mindful of these symptoms and provide adjunct treatment. Further studies are needed to understand the natural history and etiology of these symptoms in neurogenic diseases.

« Back to 2019 International Congress

MDS Abstracts - https://www.mdsabstracts.org/abstract/prevalence-of-orthostatic-hypotension-and-postprandial-hypotension-in-neurodegenerative-diseases-with-synucleinopathy-a-systematic-review-and-meta-analysis/