Objective: To assess prevalence of neurogenic and peripheral orthostatic hypotension (nOH/pOH) in the PPMI (https://www.ppmi-info.org) idiopathic Parkinson disease (PD) cohort and to examine whether nOH, compared to pOH, increases likelihood and progression of depression and cognitive impairment.

Background: There is debate whether associations between OH and worse cognitive and depression outcomes in PD results from mutual structure hypoperfusion or neurodegeneration. OH can be categorized as pOH/nOH based on the orthostatic ratio of heart-rate (HR) to systolic blood pressure (SBP) change. We reasoned that, should a shared neurodegenerative mechanism relate these three non-motor symptoms, then patients with nOH should be more likely to have worse cognition and depression over time than those with pOH or with no OH at all.

Method: Measures of orthostatic vitals, Montreal Cognitive Assessment (MoCA), and Geriatric Depression Scale II (GDS) were assessed in PPMI cohort idiopathic PD patients at baseline and years 1-5. Patients were classified as OH+/- based on standard criteria prior to sub-classification as nOH (ΔHR/ΔSBP<0.5) or pOH (ratio>0.5). Prevalence of each group and sub-group were determined at each visit. Variation Associations between presence of p/nOH and clinicodemographic variables including age, sex, disease duration, MoCA, and GDS were assessed with independent ANOVAs.

Results: Of N=428 idiopathic PD patients for whom orthostatic vitals were available at baseline, 54 (12.6%) and 18 (4.2%) exhibited pOH and nOH, respectively. Prevalence of pOH and nOH did not vary in a statistically-significant manner year-over-year (P=0.07). Average prevalence estimates [±95% CI] over years 1-5 were 10.7% [8.9-12.5%] for pOH and 4.5% [4.0-4.9%] for nOH. No significant variation in tested variables with presence of nOH/pOH was observed.

Conclusion: In the PPMI cohort of idiopathic PD both neurogenic and peripheral orthostatic hypotension were likely to be present, with relatively stable prevalence over at least the first five years of disease duration. We found no significant association of variation in some basic clinicodemographic variables, nor cognitive or depressive symptoms. Whether pOH/nOH is associated with modified presentation of other PD features in the PPMI cohort, including after five years of disease duration, will be part of future investigation.

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MDS Abstracts - https://www.mdsabstracts.org/abstract/prevalence-of-neurogenic-orthostatic-hypotension-in-the-idiopathic-parkinson-progression-marker-initiative-cohort/