Delayed orthostatic hypotension in Parkinson's disease

Abstract

Orthostatic hypotension (OH) is relatively common in the early stage of Parkinson's disease (PD). It is divided into delayed OH and classical OH. Classical OH in PD has been investigated widely, however, the clinical implications of delayed OH in PD have seldom been studied. The purpose of this study is to characterize delayed OH in PD. A total of 285 patients with early drug-naïve PD were enrolled and divided into three groups according to orthostatic change: no-OH, delayed OH, and classical OH. The disease severity in terms of motor, non-motor, and cognitive functions was assessed. The cortical thickness of 82 patients was analyzed with brain magnetic resonance imaging. The differences among groups and linear tendency in the order of no-OH, delayed OH, and classical OH were investigated. Seventy-seven patients were re-evaluated. Initial and follow-up evaluations were explored to discern any temporal effects of orthostasis on disease severity. Sixty-four (22.5%) patients were defined as having delayed OH and 117 (41.1%) had classical OH. Between-group comparisons revealed that classical OH had the worst outcomes in motor, non-motor, cognitive, and cortical thickness, compared to the other groups. No-OH and delayed OH did not differ significantly. Linear trends across the pre-ordered OH subtypes found that clinical parameters worsened along with the orthostatic challenge. Clinical scales deteriorated and the linear gradient was maintained during the follow-up period. This study suggests that delayed OH is a mild form of classical OH in PD. PD with delayed OH has milder disease severity and progression.

Fig. 1. Enrolled patients study flow.

NMSS Non-Motor Symptoms Scale, PDQ-39 Parkinson’s Disease Quality of Life-39, OHQ Orthostatic Hypotension Questionnaire, MADRS Montgomery-Asberg Depression Rating Scale, RBDSQ REM Sleep Behavior Disorder Screening Questionnaire, UPDRS Unified Parkinson’s Disease Rating Scale, MMSE Mini-Mental Status Examination.

Fig. 2. Temporal progression of cognitive and motor severities across the groups.

Error bars: standard error of the mean. UPDRS Unified Parkinson’s Disease Rating Scale, MMSE Mini-Mental Status Examination, OH orthostatic hypotension.