Abstract
BackgroundNeurogenic orthostatic hypotension (nOH) results from impaired vasoconstriction due to dysfunction of the autonomic nervous system and is commonly associated with Parkinson disease (PD), multiple system atrophy (MSA), and pure autonomic failure. nOH can increase the risk of falls due to symptoms that include postural lightheadedness or dizziness, presyncope, and syncope. The purpose of this study was to obtain information from patients and caregivers regarding the symptoms and burden of nOH to expand on limited knowledge regarding the impact of nOH on quality of life.MethodsThis author-designed survey included questions regarding nOH (e.g., frequency and impact of symptoms, management) and was conducted online by Harris Poll via distribution to individuals who agreed to participate in Harris Poll online surveys or who were members of relevant disease advocacy organizations. Eligible patients were aged ≥ 18 years with PD, MSA, or pure autonomic failure and ≥ 1 of the following: orthostatic hypotension (OH), nOH, low blood pressure upon standing, or OH/nOH symptoms. Eligible caregivers cared for such patients but were not necessarily linked to any patient participant.ResultsSurvey responses were received from 363 patients and 128 caregivers. PD was the most frequent underlying disorder (90% of patients; 88% of individuals managed by the caregivers). Despite meeting survey diagnosis criteria, a formal diagnosis of OH or nOH was reported by only 36% of patients and 16% of caregivers. The most frequent symptoms of nOH were dizziness or lightheadedness, fatigue when standing, and difficulty walking. A negative impact on patient quality of life caused by nOH symptoms was reported by 59% of patients and 75% of caregivers. Most respondents (≥87%) reported that nOH symptoms adversely affected patients’ ability to perform everyday activities (most frequently physical activity/exercise, housework, and traveling). Falls (≥1) in the previous year due to nOH symptoms were reported by 57% of patients and 80% of caregivers.ConclusionsThese survey results support the premise that nOH symptoms have a substantial negative impact on patient function and quality of life. The relatively low rates of formal nOH/OH diagnosis suggest the need for heightened awareness regarding the condition and its symptom burden.
Highlights
Neurogenic orthostatic hypotension results from impaired vasoconstriction due to dysfunction of the autonomic nervous system and is commonly associated with Parkinson disease (PD), multiple system atrophy (MSA), and pure autonomic failure. nOH can increase the risk of falls due to symptoms that include postural lightheadedness or dizziness, presyncope, and syncope
The neurogenic form of Orthostatic hypotension (OH) is commonly associated with neurodegenerative disorders that affect the central or peripheral autonomic nervous system, such as Parkinson disease (PD), multiple system atrophy (MSA), and pure autonomic failure, or it may be secondary to conditions such as diabetic peripheral neuropathy [1,2,3,4,5,6]
Most patients experienced long-term nOH symptoms, with 48% and 21% of patient respondents reporting living with symptoms for ≥5 and ≥ 10 years, respectively
Summary
Neurogenic orthostatic hypotension (nOH) results from impaired vasoconstriction due to dysfunction of the autonomic nervous system and is commonly associated with Parkinson disease (PD), multiple system atrophy (MSA), and pure autonomic failure. nOH can increase the risk of falls due to symptoms that include postural lightheadedness or dizziness, presyncope, and syncope. Neurogenic orthostatic hypotension (nOH) results from impaired vasoconstriction due to dysfunction of the autonomic nervous system and is commonly associated with Parkinson disease (PD), multiple system atrophy (MSA), and pure autonomic failure. OH generally results from 3 common etiologies: (1) medications such as antidepressants or antihypertensive agents, (2) non-neurologic conditions such as hypovolemia or cardiovascular disorders causing cardiac failure, or (3) impaired vasoconstriction due to dysfunction of the autonomic nervous system ( referred to as neurogenic OH [nOH]). The neurogenic form of OH is commonly associated with neurodegenerative disorders that affect the central or peripheral autonomic nervous system, such as Parkinson disease (PD), multiple system atrophy (MSA), and pure autonomic failure, or it may be secondary to conditions such as diabetic peripheral neuropathy [1,2,3,4,5,6]. Additional symptoms can include visual disturbances, fatigue, generalized weakness, cognitive dysfunction, neck pain or discomfort in the suboccipital and paracervical region (i.e., in a “coat hanger” configuration), and orthostatic dyspnea [1, 5]
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