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Review
. 2020 May 9;11(3):679-691.
doi: 10.14336/AD.2019.0805. eCollection 2020 May.

Parkinson Disease and Orthostatic Hypotension in the Elderly: Recognition and Management of Risk Factors for Falls

Peter A LeWitt  1 , Steve Kymes  2 , Robert A Hauser  3
Affiliations
Review

Parkinson Disease and Orthostatic Hypotension in the Elderly: Recognition and Management of Risk Factors for Falls

Peter A LeWitt et al. Aging Dis. .

Abstract

Parkinson disease (PD) is often associated with postural instability and gait dysfunction that can increase the risk for falls and associated consequences, including injuries, increased burden on healthcare resources, and reduced quality of life. Patients with PD have nearly twice the risk for falls and associated bone fractures compared with their general population counterparts of similar age. Although the cause of falls in patients with PD may be multifactorial, an often under-recognized factor is neurogenic orthostatic hypotension (nOH). nOH is a sustained decrease in blood pressure upon standing whose symptomology can include dizziness/lightheadedness, weakness, fatigue, and syncope. nOH is due to dysfunction of the autonomic nervous system compensatory response to standing and is a consequence of the neurodegenerative processes of PD. The symptoms associated with orthostatic hypotension (OH)/nOH can increase the risk of falls, and healthcare professionals may not be aware of the real-world clinical effect of nOH, the need for routine screening, or the value of early diagnosis of nOH when treating elderly patients with PD. nOH is easily missed and, importantly, healthcare providers may not realize that there are effective treatments for nOH symptoms that could help lessen the fall risk resulting from the condition. This review discusses the burden of, and key risk factors for, falls among patients with PD, with a focus on practical approaches for the recognition, assessment, and successful management of OH/nOH. In addition, insights are provided as to how fall patterns can suggest fall etiology, thereby influencing the choice of intervention.

Keywords: Parkinson disease; elderly; falls; neurodegeneration; neurogenic orthostatic hypotension; treatment.

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Conflict of interest statement

Conflict of Interests Robert A. Hauser has consulted for Acadia Pharmaceuticals, Acorda Therapeutics, Adamas Pharmaceuticals, AlphaSights, Amneal Pharmaceuticals, Inc., ApoPharma Inc., Aptis Partners LLC, Clinical SCORE LLC., CNS Ratings LLC, Compass Group, Decision Resource Group, Dedham Group, Defined Health, Enterin Inc., Ernest and Young S.L., Extera Partners LLC., Gerson Lehman Group Inc., Global Kinetics Corporation, Guidepoint Global, Health Advances, Impax Lab, Impel Neuropharma, IntraMed Educational Group, IQVIA, International Stem Cell Corporation, Jazz Pharmaceuticals, Kashiv Pharma, L.E.K Consulting, Lundbeck A/S, Lundbeck LLC, Med IQ, Medscape, Mitsubishi Tanabe Pharma America, Michael J. Fox Foundation, Morgan, Lewi, and Bockius LLP, Neuro Challenge Foundation for Parkinson's, Neurocrea LLC, Neurocrine Biosciences Inc, Neurocrine Continental, Inc., Northwestern University, Orbees Inc., Orion, Parkinson's Foundation, Partners Healthcare, Penn Technology Partnership, Perception OpCo, Prescott Medical Communications Group, Prilenia Therapeutics LLC, Parkinson’s Study Group, Regenera Pharma, Scion Neurostim LLC, Seelos Therapeutics, Slingshot Insights, Sunovion Pharmaceuticals Inc., Teva Pharmaceuticals, US World Meds, and WebMD. He has received research support from AbbVie Inc., Acorda Therapeutics, AstraZeneca, Axovant Sciences, Biogen Inc., Cavion, Enterin Inc., Impax Laboratories LLC, Intec Pharma Ltd, Jazz Pharmaceuticals, NeuroDerm Ltd., Lundbeck, Michael J. Fox Foundation for Parkinson’s Research, F. Hoffman-La Roche, Dart NeuroScience LLC, Prexton Therapeutics, Revance Therapeutics Inc., and Sunovion Pharmaceuticals, and grant support from the Parkinson’s Foundation. Steve Kymes is employed by Lundbeck and owns stock in Lundbeck. Peter A. LeWitt has served as a consultant and has been an investigator in clinical trials sponsored by Impax Laboratories Inc. He has also served as a consultant or advisor for Acorda, Britannia, Concit, Dexcel, Depomed, Insightec, Intec, Ipsen, Merck, Merz, NeuroDerm, Noven, Parkinson Study Group, Pfizer, ProStrakan, Teva, and US WorldMeds and has received speaker honoraria from the International Parkinson's Disease and Movement Disorders Society, Lundbeck, US WorldMeds, and the World Parkinson Congress. He is compensated for services as editor in chief of Clinical Neuropharmacology and serves without compensation on the editorial boards of Journal of Neural Transmission, Translational Neurodegeneration, and Journal of Parkinson's Disease. The Parkinson's Disease and Movement Disorders Program, which he directs, has received clinical research grant support (for conducting clinical trial and other research) from Acorda, Adamas, Biotie, Great Lakes Neurotechnologies, Kyowa, Michael J. Fox Foundation for Parkinson's Research, Pharma 2B, and US WorldMeds.

Figures

Figure 1.
Figure 1.
Impact of falls and fall risk in patients with PD and nOH. nOH=neurogenic orthostatic hypotension; PD=Parkinson disease [36,55-57].
See this image and copyright information in PMC

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