Aristide Merola1, Alberto Romagnolo2, Michela Rosso3, José Ricardo Lopez-Castellanos3, Benjamin D Wissel3, Sydney Larkin3, Andrea Bernardini2, Maurizio Zibetti2, Simona Maule4, Leonardo Lopiano2, Alberto J Espay3. 1. Gardner Family Center for Parkinson's Disease and Movement Disorders, Department of Neurology, University of Cincinnati, Cincinnati, OH, USA. Electronic address: merolaae@ucmail.uc.edu. 2. Department of Neuroscience "Rita Levi Montalcini", University of Turin, Via Cherasco 15, 10124, Torino, Italy. 3. Gardner Family Center for Parkinson's Disease and Movement Disorders, Department of Neurology, University of Cincinnati, Cincinnati, OH, USA. 4. Department of Medical Sciences, Autonomic Unit and Hypertension Unit, University of Turin, Corso Bramante 88, 10126, Torino, Italy.
Abstract
INTRODUCTION: Orthostatic hypotension (OH) may frequently be asymptomatic in patients with Parkinson's disease (PD). However, the relationship between symptomatic/asymptomatic status and functional disability remains unclear. METHODS: Using orthostatic blood pressure (BP) measurements and the Orthostatic Hypotension Symptom Assessment (OHSA) questionnaire, 121 consecutive PD patients without history of chronic hypertension and not taking alpha-adrenergic antagonists for bladder disorders were classified according to (1) OH symptomatic status, based on presence/absence of orthostatic symptoms (symptomatic OH: OHSA item 1 ≥ 1), and (2) OH severity, based on the magnitude of BP fall on the lying-to-standing test: OH- (<20/10 mmHg); moderate OH+ (≥20/10 mmHg but < 30/15 mmHg); and severe OH+ (≥30/15 mmHg). The primary endpoints were the activities of daily living/instrumental activities of daily living (ADL/iADL) and the Ambulatory Capacity Measure (ACM). Secondary endpoints included PD quality of life (PDQ-8) and prevalence of falls. RESULTS: The overall prevalence of OH+ was 30.6% (37/121 patients), with 62.2% symptomatic (23/37) and 37.8% asymptomatic (14/37). Symptomatic and asymptomatic OH + patients had similar impairments in ADL/iADL and ACM, significantly worse than OH- (p ≤ 0.035). There was a trend for worse ADL/iADL and ACM scores in severe OH + compared to moderate OH+, but both were worse than OH- (p ≤ 0.048). Symptomatic and asymptomatic OH + showed similar impairment in PDQ-8 and higher prevalence of falls compared to OH-. CONCLUSIONS: Asymptomatic OH+ was associated with similar impairments in ADL/iADL and ACM than symptomatic OH+. These findings support screening for OH in PD patients regardless of postural lightheadedness.
INTRODUCTION:Orthostatic hypotension (OH) may frequently be asymptomatic in patients with Parkinson's disease (PD). However, the relationship between symptomatic/asymptomatic status and functional disability remains unclear. METHODS: Using orthostatic blood pressure (BP) measurements and the Orthostatic Hypotension Symptom Assessment (OHSA) questionnaire, 121 consecutive PDpatients without history of chronic hypertension and not taking alpha-adrenergic antagonists for bladder disorders were classified according to (1) OH symptomatic status, based on presence/absence of orthostatic symptoms (symptomatic OH: OHSA item 1 ≥ 1), and (2) OH severity, based on the magnitude of BP fall on the lying-to-standing test: OH- (<20/10 mmHg); moderate OH+ (≥20/10 mmHg but < 30/15 mmHg); and severe OH+ (≥30/15 mmHg). The primary endpoints were the activities of daily living/instrumental activities of daily living (ADL/iADL) and the Ambulatory Capacity Measure (ACM). Secondary endpoints included PD quality of life (PDQ-8) and prevalence of falls. RESULTS: The overall prevalence of OH+ was 30.6% (37/121 patients), with 62.2% symptomatic (23/37) and 37.8% asymptomatic (14/37). Symptomatic and asymptomatic OH + patients had similar impairments in ADL/iADL and ACM, significantly worse than OH- (p ≤ 0.035). There was a trend for worse ADL/iADL and ACM scores in severe OH + compared to moderate OH+, but both were worse than OH- (p ≤ 0.048). Symptomatic and asymptomatic OH + showed similar impairment in PDQ-8 and higher prevalence of falls compared to OH-. CONCLUSIONS: Asymptomatic OH+ was associated with similar impairments in ADL/iADL and ACM than symptomatic OH+. These findings support screening for OH in PDpatients regardless of postural lightheadedness.
Authors: Alessandra Fanciulli; Nicole Campese; Georg Goebel; Jean Pierre Ndayisaba; Sabine Eschlboeck; Christine Kaindlstorfer; Cecilia Raccagni; Roberta Granata; Ubaldo Bonuccelli; Roberto Ceravolo; Klaus Seppi; Werner Poewe; Gregor K Wenning Journal: Neurology Date: 2020-09-16 Impact factor: 9.910
Authors: Andrea Pilotto; Alberto Romagnolo; Andrea Scalvini; Mario Masellis; Yasushi Shimo; Laura Bonanni; Richard Camicioli; Lily L Wang; Alok K Dwivedi; Katherine Longardner; Federico Rodriguez-Porcel; Mark DiFrancesco; Joaquin A Vizcarra; Elisa Montanaro; Simona Maule; Alessandro Lupini; Carmen Ojeda-López; Sandra E Black; Stefano Delli Pizzi; Myrlene Gee; Ryota Tanaka; Kazuo Yamashiro; Taku Hatano; Barbara Borroni; Roberto Gasparotti; Maria C Rizzetti; Nobutaka Hattori; Leonardo Lopiano; Irene Litvan; Alberto J Espay; Alessandro Padovani; Aristide Merola Journal: Neurology Date: 2021-06-07 Impact factor: 11.800