scholarly journals Management of Orthostatic Hypotension in Parkinson’s Disease

2020 ◽  
Vol 10 (s1) ◽  
pp. S57-S64
Author(s):  
Alessandra Fanciulli ◽  
Fabian Leys ◽  
Cristian Falup-Pecurariu ◽  
Roland Thijs ◽  
Gregor K. Wenning
Keyword(s):  
Parkinson’S Disease ◽  
Parkinson's Disease ◽  
Orthostatic Hypotension ◽  
Organ Damage ◽  
Lifestyle Changes ◽  
Behavioral Measures ◽  
Blurred Vision ◽  
Supine Hypertension ◽  
Nocturnal Hypertension ◽  
Short And Long Term

Orthostatic hypotension (OH) is a common non-motor feature of Parkinson’s disease that may cause unexplained falls, syncope, lightheadedness, cognitive impairment, dyspnea, fatigue, blurred vision, shoulder, neck, or low-back pain upon standing. Blood pressure (BP) measurements supine and after 3 minutes upon standing screen for OH at bedside. The medical history and cardiovascular autonomic function tests ultimately distinguish neurogenic OH, which is due to impaired sympathetic nerve activity, from non-neurogenic causes of OH, such as hypovolemia and BP lowering drugs. The correction of non-neurogenic causes and exacerbating factors, lifestyle changes and non-pharmacological measures are the cornerstone of OH treatment. If these measures fail, pharmacological interventions (sympathomimetic agents and/or fludrocortisone) should be introduced stepwise depending on the severity of symptoms. About 50% of patients with neurogenic OH also suffer from supine and nocturnal hypertension, which should be monitored for with in-office, home and 24 h-ambulatory BP measurements. Behavioral measures help prevent supine hypertension, which is eventually treated with non-pharmacological measures and bedtime administration of short-acting anti-hypertensive drugs in severe cases. If left untreated, OH impacts on activity of daily living and increases the risk of syncope and falls. Supine hypertension is asymptomatic, but often limits an effective treatment of OH, increases the risk of hypertensive emergencies and, combined with OH, facilitates end-organ damage. A timely management of both OH and supine hypertension ameliorates quality of life and prevents short and long-term complications in patients with Parkinson’s disease.

Case 40: Parkinson’s Disease with Compensated Orthostatic Hypotension

2019 ◽  
pp. 233-236
Author(s):  
Peter Novak
Keyword(s):  
Parkinson’S Disease ◽  
Parkinson's Disease ◽  
Blood Flow ◽  
Cerebral Blood Flow ◽  
Orthostatic Hypotension ◽  
Autonomic Failure ◽  
Neurogenic Orthostatic Hypotension ◽  
Supine Hypertension ◽  
Reduced Flow

Autonomic failure manifesting as neurogenic orthostatic hypotension and supine hypertension are common manifestations of cardiovascular dysautonomia in Parkinson’s disease. Depending on the cerebral blood flow, neurogenic orthostatic hypotension can be either compensated (with stable orthostatic cerebral blood flow) and noncompensated (with reduced flow).

Lower vascular tone and larger plasma volume in Parkinson's disease with orthostatic hypotension

2011 ◽  
Vol 111 (2) ◽  
pp. 443-448 ◽  
Author(s):  
J. T. Groothuis ◽  
R. A. J. Esselink ◽  
J. P. H. Seeger ◽  
M. J. H. van Aalst ◽  
M. T. E. Hopman ◽  
...  
Keyword(s):  
Parkinson’S Disease ◽  
Parkinson's Disease ◽  
Blood Flow ◽  
Orthostatic Hypotension ◽  
Vascular Resistance ◽  
Plasma Volume ◽  
Venous Pressure ◽  
Dilution Method ◽  
Significant Difference ◽  
Head Up Tilt

The pathophysiology of orthostatic hypotension in Parkinson's disease (PD) is incompletely understood. The primary focus has thus far been on failure of the baroreflex, a central mediated vasoconstrictor mechanism. Here, we test the role of two other possible factors: 1) a reduced peripheral vasoconstriction (which may contribute because PD includes a generalized sympathetic denervation); and 2) an inadequate plasma volume (which may explain why plasma volume expansion can manage orthostatic hypotension in PD). We included 11 PD patients with orthostatic hypotension (PD + OH), 14 PD patients without orthostatic hypotension (PD − OH), and 15 age-matched healthy controls. Leg blood flow was examined using duplex ultrasound during 60° head-up tilt. Leg vascular resistance was calculated as the arterial-venous pressure gradient divided by blood flow. In a subset of 9 PD + OH, 9 PD − OH, and 8 controls, plasma volume was determined by indicator dilution method with radiolabeled albumin (125I-HSA). The basal leg vascular resistance was significantly lower in PD + OH (0.7 ± 0.3 mmHg·ml−1·min) compared with PD − OH (1.3 ± 0.6 mmHg·ml−1·min, P < 0.01) and controls (1.3 ± 0.5 mmHg·ml−1·min, P < 0.01). Leg vascular resistance increased significantly during 60° head-up tilt with no significant difference between the groups. Plasma volume was significantly larger in PD + OH (3,869 ± 265 ml) compared with PD − OH (3,123 ± 377 ml, P < 0.01) and controls (3,204 ± 537 ml, P < 0.01). These results indicate that PD + OH have a lower basal leg vascular resistance in combination with a larger plasma volume compared with PD − OH and controls. Despite the increase in leg vascular resistance during 60° head-up tilt, PD + OH are unable to maintain their blood pressure.

2.282 FACTORS RELATED TO ORTHOSTATIC HYPOTENSION IN PARKINSON'S DISEASE

2012 ◽  
Vol 18 ◽  
pp. S136
Author(s):  
S. Perez-Lloret ◽  
M.V. Rey ◽  
N. Fabre ◽  
F. Ory ◽  
U. Spampinato, ◽  
...  
Keyword(s):  
Parkinson’S Disease ◽  
Parkinson's Disease ◽  
Orthostatic Hypotension

scholarly journals Initial circulatory response to active standing in Parkinson's disease without typical orthostatic hypotension

2014 ◽  
Vol 72 (3) ◽  
pp. 208-213
Author(s):  
Guillermo Delgado ◽  
Bruno Estañol ◽  
Mayela Rodríguez-Violante ◽  
Jesús Antonio González-Hermosillo ◽  
Óscar Infante-Vázquez
Keyword(s):  
Parkinson’S Disease ◽  
Parkinson's Disease ◽  
Orthostatic Hypotension ◽  
Initial Response ◽  
Upright Position ◽  
Resistance Response ◽  
Circulatory Response ◽  
Volume Clamp Method ◽  
Sample Points ◽  
Prolonged Latency

While the circulatory response to orthostatic stress has been already evaluated in Parkinson's disease patients without typical orthostatic hypotension (PD-TOH), there is an initial response to the upright position which is uniquely associated with active standing (AS). We sought to assess this response and to compare it to that seen in young healthy controls (YHC). Method In 10 PD-TOH patients (8 males, 60±7 years, Hoehn and Yahr ≤3) the changes in systolic blood pressure (SBP) and heart rate that occur in the first 30 seconds (sec) of standing were examined. Both parameters were non-invasively and continuously monitored using the volume-clamp method by Peñáz and the Physiocal criteria by Wesseling. The choice of sample points was prompted by the results of previous studies. These sample points were compared to those of 10 YHC (8 males, 32±8 years). Results The main finding of the present investigation was an increased time between the AS onset and SBP overshoot in PD-TOH group (24±4 vs. 19±3 sec; p<0.05). Conclusion This delay might reflect a prolonged latency in the baroreflex-mediated vascular resistance response, but more studies are needed to confirm this preliminary hypothesis.

scholarly journals Orthostatic Hypotension in Drug-Naïve Patients with Parkinson’s Disease

2011 ◽  
Vol 4 (1) ◽  
pp. 33-37 ◽  
Author(s):  
Hyo-Jin Bae ◽  
Sang-Myung Cheon ◽  
Jae Woo Kim
Keyword(s):  
Parkinson’S Disease ◽  
Parkinson's Disease ◽  
Orthostatic Hypotension ◽  
Drug Naïve

scholarly journals Increased neuromuscular consistency in gait and balance after partnered, dance-based rehabilitation in Parkinson’s disease

2017 ◽  
Vol 118 (1) ◽  
pp. 363-373 ◽  
Author(s):  
Jessica L. Allen ◽  
J. Lucas McKay ◽  
Andrew Sawers ◽  
Madeleine E. Hackney ◽  
Lena H. Ting
Keyword(s):  
Parkinson’S Disease ◽  
Parkinson's Disease ◽  
Motor Skill ◽  
Motor Performance ◽  
Neuromuscular Control ◽  
Muscle Coordination ◽  
Short Term ◽  
Behavioral Measures ◽  
Motor Module ◽  
Reactive Balance

Here we examined changes in muscle coordination associated with improved motor performance after partnered, dance-based rehabilitation in individuals with mild to moderate idiopathic Parkinson’s disease. Using motor module (a.k.a. muscle synergy) analysis, we identified changes in the modular control of overground walking and standing reactive balance that accompanied clinically meaningful improvements in behavioral measures of balance, gait, and disease symptoms after 3 wk of daily Adapted Tango classes. In contrast to previous studies that revealed a positive association between motor module number and motor performance, none of the six participants in this pilot study increased motor module number despite improvements in behavioral measures of balance and gait performance. Instead, motor modules were more consistently recruited and distinctly organized immediately after rehabilitation, suggesting more reliable motor output. Furthermore, the pool of motor modules shared between walking and reactive balance increased after rehabilitation, suggesting greater generalizability of motor module function across tasks. Our work is the first to show that motor module distinctness, consistency, and generalizability are more sensitive to improvements in gait and balance function after short-term rehabilitation than motor module number. Moreover, as similar differences in motor module distinctness, consistency, and generalizability have been demonstrated previously in healthy young adults with and without long-term motor training, our work suggests commonalities in the structure of muscle coordination associated with differences in motor performance across the spectrum from motor impairment to expertise. NEW & NOTEWORTHY We demonstrate changes in neuromuscular control of gait and balance in individuals with Parkinson’s disease after short-term, dance-based rehabilitation. Our work is the first to show that motor module distinctness, consistency, and generalizability across gait and balance are more sensitive than motor module number to improvements in motor performance following short-term rehabilitation. Our results indicate commonalities in muscle coordination improvements associated with motor skill reacquisition due to rehabilitation and motor skill acquisition in healthy individuals.

Short- and long-term motor outcome of STN-DBS in Parkinson's disease: Focus on gender differences

2021 ◽  
Vol 429 ◽  
pp. 119560
Author(s):  
Nico Golfrè Andreasi ◽  
Roberta Telese ◽  
Luigi Romito ◽  
Roberto Cilia ◽  
Antonio Elia ◽  
...  
Keyword(s):  
Parkinson’S Disease ◽  
Gender Differences ◽  
Parkinson's Disease ◽  
Motor Outcome ◽  
Short And Long Term ◽  
Disease Focus ◽  
Stn Dbs
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