Prevalence and Associated Risk Factors of Symptomatic Orthostatic Hypotension in Patients with Parkinson’s Disease
DOI:
https://doi.org/10.70749/ijbr.v3i7.2065Keywords:
Parkinson’s Disease, Symptomatic Orthostatic Hypotension, Risk Factors.Abstract
Background: A major non-motor consequence of Parkinson's disease (PD) that greatly increases morbidity and lowers quality of life is symptomatic orthostatic hypotension (OH). Finding the prevalence and risk factors for symptomatic OH in PD patients was the goal of this investigation. Objective: In order to enhance early detection and management techniques, it is important to ascertain the prevalence of symptomatic orthostatic hypotension in patients with Parkinson's disease and identify risk factors that are linked to it, such as demographics, disease features, comorbidities, and drug use. Methods: The Neurology Department of a Liaquat National Hospital Karachi hosted a six-month qualitative study. Purposive sampling was used to enroll 130 PD patients in total. Semi-structured interviews and clinical evaluations were used to gather data, with an emphasis on comorbidities, medication use, illness features, and symptoms of OH. To find trends and risk variables, thematic content analysis was employed. Findings: Of the 130 participants, 46 (35.4%) had symptoms of OH. Levodopa use (87.0%), Hoehn & Yahr stage III–IV (76.1%), advanced age ≥65 years (60.9%), male gender (65.2%), disease duration >10 years (43.5%), and combination therapy (54.3%) were the main risk variables. Dizziness (82.6%), weakness (69.6%), blurred vision (52.2%), and syncope (21.7%) were among the most common symptoms. Conclusion: Almost one-third of PD patients experienced symptomatic OH, which was linked to a number of risk factors that could be changed as well as those that couldn't. Improving patient outcomes and safety requires early detection and treatment.
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References
1. Dorsey, E. R., Elbaz, A., Nichols, E., Abbasi, N., Abd-Allah, F., Abdelalim, A., ... & Murray, C. J. (2018). Global, regional, and national burden of Parkinson's disease, 1990–2016: a systematic analysis for the Global Burden of Disease Study 2016. The Lancet Neurology, 17(11), 939-953.
2. Yoo, S., Kim, J., Yoo, J., Yun, E., Yoon, U., Shin, N., & Lee, K. (2021). Delayed orthostatic hypotension in Parkinson’s disease. npj Parkinson's Disease, 7(1).
https://doi.org/10.1038/s41531-021-00181-y
3. Pagano, G., Tan, E. E., Haider, J. M., Bautista, A., & Tagliati, M. (2015). Constipation is reduced by beta-blockers and increased by dopaminergic medications in Parkinson's disease. Parkinsonism & Related Disorders, 21(2), 120-125.
https://doi.org/10.1016/j.parkreldis.2014.11.015
4. Bouhaddi, M., Vuillier, F., Fortrat, J., Cappelle, S., Henriet, M., Rumbach, L., & Regnard, J. (2004). Impaired cardiovascular autonomic control in newly and long-term-treated patients with Parkinson's disease: Involvement of L-dopa therapy. Autonomic Neuroscience, 116(1-2), 30-38.
https://doi.org/10.1016/j.autneu.2004.06.009
5. Isaacson, S., & Skettini, J. (2014). Neurogenic orthostatic hypotension in Parkinson’s disease: Evaluation, management, and emerging role of droxidopa. Vascular Health and Risk Management, 169.
https://doi.org/10.2147/vhrm.s53983
6. Dommershuijsen, L. J., Heshmatollah, A., Mattace Raso, F. U., Koudstaal, P. J., Ikram, M. A., & Ikram, M. K. (2020). Orthostatic hypotension: A prodromal marker of Parkinson's disease? Movement Disorders, 36(1), 164-170.
https://doi.org/10.1002/mds.28303
7. Palma, J. A., & Kaufmann, H. (2019). Orthostatic hypotension in Parkinson disease. Clinics in geriatric medicine, 36(1), 53.
https://doi.org/10.1016/j.cger.2019.09.002
8. Bonuccelli, U., Lucetti, C., Del Dotto, P., Ceravolo, R., Gambaccini, G., Bernardini, S., Rossi, G., & Piaggesi, A. (2003). Orthostatic hypotension in de Novo Parkinson disease. Archives of Neurology, 60(10), 1400.
https://doi.org/10.1001/archneur.60.10.1400
9. Velseboer, D. C., De Haan, R. J., Wieling, W., Goldstein, D. S., & De Bie, R. M. (2011). Prevalence of orthostatic hypotension in Parkinson’s disease: A systematic review and meta-analysis. Parkinsonism & Related Disorders, 17(10), 724-729.
https://doi.org/10.1016/j.parkreldis.2011.04.016
10. Freeman, R., Wieling, W., Axelrod, F. B., Benditt, D. G., Benarroch, E., Biaggioni, I., ... & Van Dijk, J. G. (2011). Consensus statement on the definition of orthostatic hypotension, neurally mediated syncope and the postural tachycardia syndrome. Autonomic Neuroscience, 161(1-2), 46-48.
https://doi.org/10.1016/j.autneu.2011.02.004
11. Ziemssen, T., & Reichmann, H. (2010). Cardiovascular autonomic dysfunction in Parkinson's disease. Journal of the Neurological Sciences, 289(1-2), 74-80.
https://doi.org/10.1016/j.jns.2009.08.031
12. Goldstein, D. S. (2003). Dysautonomia in Parkinson's disease: Neurocardiological abnormalities. The Lancet Neurology, 2(11), 669-676.
https://doi.org/10.1016/s1474-4422(03)00555-6
13. Ha, A. D., Brown, C. H., York, M. K., & Jankovic, J. (2011). The prevalence of symptomatic orthostatic hypotension in patients with Parkinson’s disease and atypical parkinsonism. Parkinsonism & Related Disorders, 17(8), 625-628.
https://doi.org/10.1016/j.parkreldis.2011.05.020
14. Perez-Lloret, S., Rey, M., Fabre, N., Ory, F., Spampinato,, U., Montastruc, J., & Rascol, O. (2012). factors related to orthostatic hypotension in Parkinson's disease. Parkinsonism & Related Disorders, 18, S136.
https://doi.org/10.1016/s1353-8020(11)70605-8
15. Ooi, W. L., Hossain, M., & Lipsitz, L. A. (2000). The association between orthostatic hypotension and recurrent falls in nursing home residents. The American Journal of Medicine, 108(2), 106-111.
https://doi.org/10.1016/s0002-9343(99)00425-8
16. Rudzińska, M., Bukowczan, S., Stożek, J., Zajdel, K., Mirek, E., Chwata, W., Wójcik-Pędziwiatr, M., Banaszkiewicz, K., & Szczudlik, A. (2013). Causes and consequences of falls in Parkinson disease patients in a prospective study. Neurologia i Neurochirurgia Polska, 47(5), 423-430.
https://doi.org/10.5114/ninp.2013.38222
17. Foongsathaporn, C., Panyakaew, P., Jitkritsadakul, O., & Bhidayasiri, R. (2016). What daily activities increase the risk of falling in Parkinson patients? An analysis of the utility of the ABC-16 scale. Journal of the Neurological Sciences, 364, 183-187.
https://doi.org/10.1016/j.jns.2016.03.037
18. Merola, A., Romagnolo, A., Rosso, M., Lopez-Castellanos, J. R., Wissel, B. D., Larkin, S., Bernardini, A., Zibetti, M., Maule, S., Lopiano, L., & Espay, A. J. (2016). Orthostatic hypotension in Parkinson's disease: Does it matter if asymptomatic? Parkinsonism & Related Disorders, 33, 65-71.
https://doi.org/10.1016/j.parkreldis.2016.09.013
19. Franchignoni, F., Martignoni, E., Ferriero, G., & Pasetti, C. (2005). Balance and fear of falling in Parkinson's disease. Parkinsonism & Related Disorders, 11(7), 427-433.
https://doi.org/10.1016/j.parkreldis.2005.05.005
20. Lee, H. K., Altmann, L. J., McFarland, N., & Hass, C. J. (2016). The relationship between balance confidence and control in individuals with Parkinson's disease. Parkinsonism & Related Disorders, 26, 24-28.
https://doi.org/10.1016/j.parkreldis.2016.02.015
21. Cole, M. H., Rippey, J., Naughton, G. A., & Silburn, P. A. (2016). Use of a short-form balance confidence scale to predict future recurrent falls in people with Parkinson disease. Archives of Physical Medicine and Rehabilitation, 97(1), 152-156.
https://doi.org/10.1016/j.apmr.2015.07.027
22. Gupta, V., & Lipsitz, L. A. (2007). Orthostatic hypotension in the elderly: Diagnosis and treatment. The American Journal of Medicine, 120(10), 841-847.
https://doi.org/10.1016/j.amjmed.2007.02.023
23. Vagaonescu, T. D., Saadia, D., Tuhrim, S., Phillips, R. A., & Kaufmann, H. (2000). Hypertensive cardiovascular damage in patients with primary autonomic failure. The Lancet, 355(9205), 725-726.
https://doi.org/10.1016/s0140-6736(99)05320-9
24. Kandiah, N., Mak, E., Ng, A., Huang, S., Au, W. L., Sitoh, Y. Y., & Tan, L. C. (2013). Cerebral white matter hyperintensity in Parkinson's disease: A major risk factor for mild cognitive impairment. Parkinsonism & Related Disorders, 19(7), 680-683.
https://doi.org/10.1016/j.parkreldis.2013.03.008
25. Robertson, D. (2008). The pathophysiology and diagnosis of orthostatic hypotension. Clinical Autonomic Research, 18(S1), 2-7.
https://doi.org/10.1007/s10286-007-1004-0
26. Lanier, J. B., Mote, M. B., & Clay, E. C. (2011). Evaluation and management of orthostatic hypotension. American family physician, 84(5), 527-536.
https://www.aafp.org/pubs/afp/issues/2011/0901/p527.html
27. Isaacson, S., & Skettini, J. (2014). Neurogenic orthostatic hypotension in Parkinson's disease: evaluation, management, and emerging role of droxidopa Vasc. Vascular Health and Risk Management, 169.
https://doi.org/10.2147/vhrm.s53983
28. Low, P. A. (2015). Neurogenic orthostatic hypotension: pathophysiology and diagnosis. Am J Manag Care, 21(13 Suppl), s248-57.
29. Hollister, A. S. (1992). Orthostatic hypotension. Causes, evaluation, and management. Western journal of medicine, 157(6), 652.
https://pmc.ncbi.nlm.nih.gov/articles/PMC1022100/
30. Ma, C. L., Su, L., Xie, J. J., Long, J. X., Wu, P., & Gu, L. (2014). The prevalence and incidence of Parkinson’s disease in China: a systematic review and meta-analysis. Journal of neural transmission, 121(2), 123-134.
https://doi.org/10.1007/s00702-013-1092-z
31. Oka, et al. (2007). Characteristics of orthostatic hypotension in Parkinson's disease Brain.
32. Jain, S., & Goldstein, D. S. (2012). Cardiovascular Dysautonomia in Parkinson Disease: From Pathogenesis to Emerging Therapeutics. Circ Res, ;110(10), 1404–19.
33. Norcliffe-Kaufmann, L., & Kaufmann, H. (2020). Autonomic Failure in Neurodegenerative Disorders. Semin Neurol, 40(4), 500–10.
34. Orimo, S., Uchihara, T., Nakamura, A., Mori, F., Kakita, A., Wakabayashi, K., & Takahashi, H. (2008). Axonal -synuclein aggregates herald centripetal degeneration of cardiac sympathetic nerve in Parkinson's disease. Brain, 131(3), 642-650.
https://doi.org/10.1093/brain/awm302
35. Braune, S., Reinhardt, M., Schnitzer, R., Riedel, A., & Lücking, C. (1999). Cardiac uptake of [123I]MIBG separates Parkinson's disease from multiple system atrophy. Neurology, 53(5), 1020-1020.
https://doi.org/10.1212/wnl.53.5.1020
36. Freeman, R., Wieling, W., Axelrod, F. B., Benditt, D. G., Benarroch, E., Biaggioni, I., Cheshire, W. P., Chelimsky, T., Cortelli, P., Gibbons, C. H., Goldstein, D. S., Hainsworth, R., Hilz, M. J., Jacob, G., Kaufmann, H., Jordan, J., Lipsitz, L. A., Levine, B. D., Low, P. A., … Van Dijk, J. G. (2011). Consensus statement on the definition of orthostatic hypotension, neurally mediated syncope and the postural tachycardia syndrome. Clinical Autonomic Research, 21(2), 69-72.
https://doi.org/10.1007/s10286-011-0119-5
37. Camacho-Soto A, Sriram A, Noyce AJ, Willis AW. The Risk of Orthostatic Hypotension in Parkinson’s Disease Patients with Obesity. Mov Disord Clin Pract. 2020;7(1):77–83.
38. Senard, J. M., Rai, S., Lapeyre-Mestre, M., Brefel, C., Rascol, O., Rascol, A., & Montastruc, J. L. (1997). Prevalence of orthostatic hypotension in Parkinson's disease. Journal of Neurology, Neurosurgery & Psychiatry, 63(5), 584-589.
https://doi.org/10.1136/jnnp.63.5.584
39. Oka, H., Mochio, S., Morita, M., Onouchi, K., Yoshioka, M., & Inoue, K. (2006). P35.25 visual hallucination and cardiovascular autonomic dysfunction in Parkinson’s disease. Clinical Neurophysiology, 117, 176-177.
https://doi.org/10.1016/j.clinph.2006.06.610
40. Velseboer, D. C., De Haan, R. J., Wieling, W., Goldstein, D. S., & de Bie, R. M. (2011). Prevalence of orthostatic hypotension in Parkinson’s disease: A systematic review and meta-analysis. Parkinsonism & Related Disorders, 17(10), 724-729.
https://doi.org/10.1016/j.parkreldis.2011.04.016
41. Chaudhuri, K. R., Healy, D. G., & Schapira, A. H. (2006). Non-motor symptoms of Parkinson's disease: Diagnosis and management. The Lancet Neurology, 5(3), 235-245.
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