Objective: To explore the prevalence and factors related to orthostatic hypotension (OH) and orthostatic intolerance (OI) in recently diagnosed drug-naïve PD patients from the Parkinson’s Progression Markers Initiative (PPMI) database.

Background: Orthostatic disorders are frequent and disabling features of Parkinson’s disease (PD).

Method: The PPMI is an observational cohort study aimed at identifying clinical, imaging and biologic markers of PD progression. For this sub-study, 421 recently diagnosed drug-naïve PD patients and 195 healthy controls were included. Patients were assessed with MDS-UPDRS, MoCA, SCOPA, ESS, RBD Screening Questionnaire, GDS-15, STAI, and UPSIT; DAT imaging was used to assess dopaminergic loss. Level of β-amyloid fragment 1-42, α-synuclein and total or phosphorylated tau proteins were measured in cerebrospinal fluid. Orthostatic symptoms were assessed using the Scale for Outcomes in PD – Autonomic (SCOPA-AUT). Blood Pressure (BP) was measured after lying down for 5 minutes and again 3 minutes after standing up. Orthostatic hypotension was defined as systolic and/or diastolic BP fall ≥ 20/10 mmHg. Orthostatic intolerance was defined as the presence of symptoms in the absence of other orthostatic syndromes.

Results: At baseline, healthy controls and PD patients had similar OH prevalence (9.7% vs 14.0%, p=0.138), though BP fall after orthostatism was greater in the latter (mmHg: systolic BP 2.19 vs. 4.65, p=0.023; diastolic BP= 1.83 vs. 3.48, p=0.022). PD patients showed a higher prevalence of OI (28.7% vs 13.9% in controls, p<0.001). Over the 2-year follow-up, SCOPA-AUT cardiovascular scores largely increased (p<0.01) and OH prevalence was higher in PD patients compared with controls (16.5% vs. 8.7%, p<0.016). Multivariate analysis showed that OH at Year 2 was associated with exposure to α1-adrenergic blockers and MDS-UPDRS II+III score, while OI was related to baseline SCOPA-AUT gastrointestinal and thermoregulation scores, and anxiety scores.

Conclusion: Orthostatic disorders affected a large number of recently diagnosed, drug-naïve PD patients. The prevalence of OH increased in PD patients over the 2-year follow-up. Orthostatic hypotension was associated with PD severity and exposure to a drug with hypotensive effects, while OI was related to autonomic and neuropsychiatric symptoms.

« Back to 2019 International Congress

MDS Abstracts - https://www.mdsabstracts.org/abstract/prevalence-and-factors-related-to-orthostatic-hypotension-and-orthostatic-intolerance-in-recently-diagnosed-drug-naive-parkinsons-disease-patients/