ORTHOSTATIC HYPOTENSION AS A NON-MOTOR SYMPTOM OF PARKINSON’S DISEASE

Abstract

The objective of our research was to raise awareness of neurologists about orthostatic hypotension (OH) in Parkinson’s disease (PD) and to explore the current approach to the problem. Materials and methods. This work was performed by searching for current information on OH in PD, reflecting the pathophysiology, classification, symptoms, diagnosis, and treatment. PubMed and Google Scholar resources were used to write the review. Results. An important task in the management of patients with PD is diagnostic and treatment of OH due to the negative impact of the syndrome on somatic, psychological and cognitive status. According to recent data, the prevalence of OH among PD patients is 30-50% [1] with no association with the stage of the disease [2]. OH in PD is neurogenic (NOH); it results from neurodegenerative damage to the central and peripheral structures of the sympathetic nervous system, which leads to reduced postganglionic release of epinephrine [3]. It is often asymptomatic, as a result of compensatory tolerance mechanisms [1]. In about of 50% of patients [4], OH is associated with supine hypertension [2] and may have a connection with REM-sleep disorders [5]. Classification features of OH include: onset period under orthostatic stress, the relationship of OH to different parts of the cardiac cycle, mechanism of pathophysiology, clinical course, presence of symptoms and clinical severity [20, 31, 32]. OH symptoms usually occur during orthostatic stress. They include dizziness, blurred vision, cognitive slowing, syncope, coat-hanger pain, difficulty breathing, leg buckling or leg weakness, general weakness and fatigue [1, 5, 17, 18]. Bedside orthostatic test with blood pressure measurement at the 1st, 3rd and 5th minutes of standing and ambulatory blood pressure monitoring (ABPM) are used for diagnosis [6]. The treatment strategy is to evaluate the medications taken by the patient and obligatory inclusion of non-pharmacological treatment. Pharmacological treatment for supine hypertension and OH is only given if necessary [1, 2]. Conclusions. OH is a widespread non-motor symptom of PD [1], which should be timely diagnosed and treated because of the negative impact on quality of life with increased risk of death and injuries due to falls [31, 32, 33]. The relationship between OH and other non-motor symptoms of PD should be further explored, and optimal therapeutic strategies for different functional classes and a combination of non-pharmacological and pharmacological treatments for OH should be found as well.