Orthostatic Hypotension Research Articles

Autonomic Dysfunction in Patients With Dementia With Lewy Bodies and Its Relationship With Nigrostriatal Denervation.

Diagnosing dementia with Lewy bodies (DLBs) is challenging because of symptom overlap with other neurodegenerative diseases. Although dysautonomia is a recognized supportive diagnostic criterion, its prevalence and extent remain underexplored. We aimed to evaluate autonomic dysfunction in patients with DLB using a comprehensive battery of autonomic function tests (AFTs) and to investigate whether this dysfunction differs between patients with and without nigrostriatal denervation. This prospective cohort study was performed at a Memory Clinic in Rome, Italy. Patients meeting diagnostic criteria for possible DLB were enrolled and underwent AFTs including head-up tilt test (HUTT), Valsalva maneuver, deep breathing, cold face, hand grip (HG), and electrochemical skin conductance. Dopamine transporter SPECT (DaT-SPECT) was performed to assess nigrostriatal transmission. We compared results from AFTs in (1) patients with DLB vs healthy controls (HCs) and (2) patients with DLB with pathologic vs normal DaT-SPECT. Twenty-two patients with DLB (median age: 72.00 [10.00] years, %female: 21.75) and 20 HCs (median age: 69.00 [5.25] years, %female: 40) were enrolled. Only 1 patient (4.5%) showed neurogenic orthostatic hypotension (nOH) at HUTT. However, patients with DLB showed cardiovascular adrenergic dysfunction, represented by lower Valsalva overshoot (r = -0.553, 95% CI -0.773 to -0.214, p = 0.008) and HG Δdiastolic blood pressure (r = -0.703, 95% CI -0.844 to -0.470, p < 0.0001); parasympathetic cardiovagal dysfunction, reflected in the lower Valsalva ratio (r = -0.812, 95% CI -0.912 to -0.622, p < 0.0001) and sinus arrhythmia at deep breathing (r = -0.682, 95% CI -0.837 to -0.426, p < 0.001); and reduced sudomotor function in hands (r = -0.648, 95% CI -0.809 to -0.395, p < 0.001) and feet (r = -0.600, 95% CI -0.781 to -0.327, p < 0.001). Multivariable analyses found that age and sex were not associated with AFTs, but a higher Mini-Mental State Examination score was associated with better Valsalva ratio (B = 0.038, 95% CI 0.010-0.066, p = 0.010). Patients with normal DaT-SPECT had worse HG responses than those with pathologic DaT-SPECT (r = -0.686, 95% CI -0.895 to -0.231, p = 0.029). Despite the absence of overt nOH, patients with DLB show covert dysautonomia encompassing adrenergic, parasympathetic, and sudomotor dysfunction, highlighting the importance of standardized autonomic evaluation. Patients with normal DaT-SPECT exhibited greater peripheral autonomic impairment, reflected by lower HG responses, suggesting diverse α-synuclein pathology trajectories within DLB. Further research is needed to explore autonomic nervous system dysfunctions across different DLB subtypes and stages.

Autonomic Dysfunction and Blood Pressure Variability in Botulinum Intoxication: A Prospective Observational Study from a Single-Center Italian Outbreak

Botulinum neurotoxin (BoNT) intoxication is a rare but severe condition that is characterized by autonomic and neuromuscular dysfunction. This study aimed to evaluate autonomic impairment and blood pressure variability in patients with botulinum intoxication during an outbreak, compared to healthy controls, and to assess their progression over a six-month follow-up period. Methods: Twenty (n = 20) male patients diagnosed with BoNT intoxication and 34 age- and sex-matched healthy controls were enrolled. At baseline, all subjects underwent 24 h ambulatory blood pressure monitoring (ABPM), and clinostatic and orthostatic blood pressure measurements. Autonomic function parameters, including mean systolic blood pressure (SBP), mean diastolic blood pressure (DBP), SBP and DBP variability, SBP and DBP load, pulse pressure (PP), blood pressure variability ratio (BPVR), and morning surge, were analyzed. Follow-up assessments were conducted after six months. Results: Patients with botulinum intoxication exhibited significantly lower SBP, DBP, and blood pressure variability parameters compared to healthy controls. Orthostatic hypotension was present in 55% of patients at baseline, improving to 5% at follow-up. Respiratory failure occurred in 40% of cases, necessitating non-invasive ventilation in 35% and intubation in 20%. At six-month follow-up, mean SBP, DBP, heart rate, and blood pressure variability parameters increased significantly, indicating partial recovery of autonomic control. However, residual abnormalities in autonomic regulation persisted. Conclusions: BoNT intoxication leads to notable autonomic dysfunction, marked by impaired blood pressure regulation and a high prevalence of orthostatic hypotension. Although partial recovery occurs, long-term autonomic impairment persists, highlighting the necessity for ongoing cardiovascular monitoring and further research to accelerate autonomic recovery through targeted therapeutic interventions.

Is silodosin better than tadalafil as a medical expulsive therapy in lower ureter stones?

This meta-analysis aims to compare the efficacy and safety of tadalafil and silodosin as medical expulsive therapy (MET) for lower ureteric stones below 10 mm. The study also assesses the incidence of adverse effects associated with each drug. A comprehensive search of electronic databases was conducted up to October, 2024. The study included randomized controlled trials (RCTs) and cohort studies that compared tadalafil and silodosin in patients with lower ureteric stones (5-10 mm). The primary outcomes assessed were stone expulsion time (SET), stone expulsion rate (SER), and adverse effects. Data were analyzed using a random-effects model for heterogeneity and a fixed-effect model for non-heterogeneity. Eight studies involving 797 patients were included. The pooled analysis showed no significant difference in SET between tadalafil and silodosin (MD = 0.15, 95% CI [-0.28, 0.57], p=0.50), with significant heterogeneity. Similarly, the pooled analysis showed no significant difference in SER between the two drugs (RR = 0.92, 95% CI [0.80 to 1.05], p=0.22), with heterogeneity. However, after excluding one study, silodosin was favored over tadalafil for SER (RR 0.88, 95% CI [0.79 to 0.98], p=0.02). There were no significant differences in headache, backache, or dizziness. Silodosin was associated with a higher incidence of orthostatic hypotension, but this was resolved by excluding one study. A significant difference for abnormal ejaculation favored tadalafil (RR = 0.16, 95% CI [0.09 to 0.29], p=0.01). While the pooled results initially showed no significant difference in SET and SER, silodosin demonstrated a superior stone expulsion rate after adjusting for heterogeneity silodosin showed a trend towards shorter SET. However, silodosin was associated with a higher risk of orthostatic hypotension and abnormal ejaculation. Further high-quality RCTs with larger sample sizes are needed to confirm these findings.

Lateral Medullary Infarction Presenting as Opalski Syndrome Associated with Headache Attributed to Orthostatic Hypotension.

Lateral medullary infarction is rarely associated with Opalski syndrome and autonomic dysfunction. Herein, we present the first case involving a 66-year-old patient with cancer who developed mild dysarthria, left-sided Horner's syndrome and lower limb-dominant ataxic hemiparesis, reduction in right-sided painful thermal sensation, and severe truncal ataxia, followed by orthostatic headache. The Schellong test revealed severe orthostatic hypotension. The patient was diagnosed with Opalski syndrome associated with headache attributed to orthostatic hypotension caused by the cerebral infarction in the caudal part of the lateral medulla oblongata. The patient's headache had poor response to analgesics. However, it resolved with orthostatic hypotension improvement.

Letter to the FDA Proposing Major Changes in the US Clozapine Package Insert Supported by Clozapine Experts Worldwide. Part II: A Review of Fatal Outcomes in US Pharmacovigilance Data and Proposed Changes.

This is the second part of a 2-part article that proposes improving the United States (US) clozapine package insert. Part II focuses on fatal outcomes and the 5 boxed warnings, 4 specifically for clozapine: severe neutropenia, seizure, orthostatic hypotension and myocarditis, and 1 for all antipsychotics (elderly with dementia). US reports to the World Health Organization's global pharmacovigilance database were analyzed from clozapine's introduction to January 15, 2023. The US was the top reporter worldwide for clozapine with 56,003 reports and 9587 associated fatal outcomes. The 4 clozapine boxed warnings were associated with 534 fatal outcomes (218 with severe neutropenia, 131 with seizures, 125 with orthostasis, 36 with myocarditis, 24 with cardiomyopathy, and 0 with mitral valve prolapse). With no boxed warnings, pneumonia was associated with 674 fatal outcomes and increased white blood cell count (a sign of infection) with 596 fatal outcomes. After considering overlaps, pneumonia and increases in white blood cell count explained 900 fatalities, or 9.4% of 9587 fatal outcomes. The Food and Drug Administration continues to focus on severe neutropenia which was associated with only 218 or 2.3% of fatal outcomes, whereas 97.7% of fatal outcomes reported in US clozapine-treated patients had another cause. To help prevent future deaths in clozapine-treated patients, the clozapine package insert should focus on fatal outcomes during infections. Part II offers detailed solutions regarding current boxed warnings and lack of a warning for pneumonia and other infections. The Supplementary Material includes letters of support from 124 non-US clozapine experts from 44 countries/regions who support Parts I and II.

Knowledge of Parkinson’s disease among non-PD specialists: a web-based survey in South China

BackgroundParkinson’s disease (PD) is a prevalent, disabling neurodegenerative disorder. Early diagnosis and treatment of PD remains challenging due to the absence of definitive diagnostic tests and the non-specificity of its clinical manifestations. Initial consultations for PD symptoms often involve specialists who are not specifically trained in PD. Consequently, it is imperative to assess the general knowledge regarding PD among these specialists to develop optimal educational strategies and enhance early recognition and diagnosis of PD.MethodsWe developed a questionnaire covering motor symptoms, non-motor symptoms, prodromal symptoms, risk factors and antiparkinsonian medications based on published guidelines, and conducted the web-based survey via Wenjuan xing (https://www.wjx.cn/) among physicians not specializing in PD in Guangdong Province, China.ResultsA total of 312 respondents, working in 28 diverse departments across 64 hospitals of three different categories, were eligible for data analysis. Notably, 95.2% of the respondents were aware of rest tremor as a motor symptom, yet only 76.9% recognized bradykinesia as a motor symptom. Regarding non-motor symptoms, erectile dysfunction, urinary dysfunction, restless legs, olfactory loss, orthostatic hypotension, rapid eye movement behavior disorder (RBD), lower back pain and diaphoresis, were recognized by less than 50% of the respondents. Additionally, with the exception of subthreshold parkinsonism or abnormal quantitative motor testing, prodromal symptoms such as excessive daytime somnolence, depression (± anxiety), olfactory loss, urinary dysfunction, RBD, and constipation were recognized by 36.5–48.7% of the respondents. First-degree relatives with PD received recognition from 86.5% of the respondents, whereas the remaining risk factors were recognized by 50–60% of the participants. Concerning protective factors for PD, recognition was limited to no more than 23%. Levodopa and dopamine releasers were the most widely recognized antiparkinsonian medications, while the recognition of other medications was below 70%. Variables such as medical degrees, professional titles, hospital categories, and education subjects contributed to statistical differences in PD knowledge.ConclusionAmong non-PD specialists in south China, current knowledge regarding PD, including non-motor symptoms, prodromal symptoms, risk and protective factors, and antiparkinsonian medications, is relatively inadequate. This necessitates targeted education and training to improve their understanding and recognition of PD.

NET-Inhibition with Ampreloxetine, Blood Pressure, and Catecholamines in Patients with Neurogenic Orthostatic Hypotension (S9.001)

NET-Inhibition with Ampreloxetine, Blood Pressure, and Catecholamines in Patients with Neurogenic Orthostatic Hypotension (S9.001)

Focus on blood pressure: sex-specific association with atrial fibrillation, role of gliflozins in hypertension, and new therapeutic targets in hypertension and orthostatic hypotension

Focus on blood pressure: sex-specific association with atrial fibrillation, role of gliflozins in hypertension, and new therapeutic targets in hypertension and orthostatic hypotension

Clinical Assessment of Fluid Status in Adults With Acute Kidney Injury: A Scoping Review

ABSTRACTBackgroundAcute kidney injury refers to sudden, potentially reversible, reduction in kidney function. Hypovolaemia is commonly the major risk factor. When acute kidney injury is established, fluid can accumulate leading to fluid overload. Undertaking a rigorous fluid assessment is vital in the management of a patient in hospital with acute kidney injury, as insufficient or excessive fluid can lead to increased morbidity and mortality.ObjectivesThe aim of this scoping review is to identify which clinical assessments are useful when undertaking fluid assessment in a patient with acute kidney injury, and to identify signs and symptoms of fluid overload or dehydration in patients in hospital with acute kidney injury.DesignThe JBI methodology for scoping reviews was followed and reported using the PRISMA‐ScR checklist. PubMed, CINAHL Plus and SCOPUS were searched for research papers relating to the signs and symptoms or fluid assessments in patients with acute kidney injury.ResultsFifteen research papers were identified with four key areas being: Fluid balance/urine output and weight; early warning scores; clinical signs and symptoms; holistic assessment. The primary studies included in this scoping review have shown that hypovolaemia may be indicated by low blood pressure, orthostatic hypotension, low Mean Arterial Pressure, elevated heart rate, prolonged capillary refill time on the sternum (&gt; 4.5 s) and subjectively reported cold peripheries. With clinical symptoms including dry mouth, increased thirst and dry skin. Accurate documentation of urine output and fluid balance is crucial in determining fluid status.ConclusionThe assessment of fluid should be holistic and include history taking, diagnosis, blood tests and associated clinical signs and symptoms.

Comorbidities and health-related quality of life among rural older community-dwellers in Vietnam.

This study explored the patterns of comorbidities and their impact on health-related quality of life (HRQoL) among elderly individuals living in rural communities in Vietnam. A cross-sectional study was conducted across four communes in Thai Binh province. The demographic characteristics and comorbidities of the participants were evaluated, along with their Euroqol-5 dimensions-5 levels (EQ-5D-5L), using a structured questionnaire supplemented by clinical examinations. A multivariate Tobit regression model was applied to assess the relationship between comorbidities and HRQoL. Results showed that a minority of participants (9.5%) were free of comorbidities. Cataracts were the most common condition (61.0%), followed by osteoarthritis (55.4%), rheumatoid arthritis (46.1%), and dementia (39.0%). The average EQ-5D index was 0.806 (SD = 0.184). Pain/discomfort, difficulties with usual activities, and anxiety/depression contributed most to the reduction in the EQ-5D-5L index. Participants with rheumatoid arthritis (β = - 0.10; 95% CI = - 0.13, - 0.07) and postural hypotension (β = - 0.08; 95% CI = - 0.14, - 0.02) experienced the greatest decrease in EQ-5D index, followed by those with urinary diseases (β = - 0.05; 95% CI = - 0.09, - 0.02) and stroke (β = - 0.05; 95% CI = - 0.09, - 0.01). This study highlights the high prevalence of comorbidities among the elderly in rural Vietnam, with arthritis, postural hypotension, urinary diseases, and stroke being most strongly associated with reduced HRQoL. Regular screening and monitoring of comorbidities are vital to identify individuals who would benefit most from healthcare interventions to enhance HRQoL.

Nocturnal polyuria is common in Parkinson’s and is associated with orthostatic hypotension

Nocturnal polyuria is common in Parkinson’s and is associated with orthostatic hypotension

G-047 Rapid Weight Loss by Semaglutide Causing Severe Orthostatic Hypotension in a CKD Patient With Parkinson's Disease

G-047 Rapid Weight Loss by Semaglutide Causing Severe Orthostatic Hypotension in a CKD Patient With Parkinson's Disease

G-192 Clozapine Induced Orthostatic Hypotension After Sepsis

G-192 Clozapine Induced Orthostatic Hypotension After Sepsis

Guanfacine exposure in paediatric and adolescent patients: A multicentre retrospective review.

To describe the frequency, severity, management and complications of guanfacine exposures in paediatric and adolescent patients referred to a state Poisons Information Centre or presenting to two EDs. A multicentre, retrospective review of guanfacine exposures from July 2017 to October 2023 in patients aged ≤19 years that were discussed with the Victorian Poisons Information Centre or presented to the Royal Children's Hospital or Austin Health EDs, Melbourne. Demographic, clinical, management and outcome data were examined. There were 275 guanfacine exposures reported to the Poisons Information Centre, with a 16-fold increase in exposures over the study period. Of these, 173 (63%) were unintentional therapeutic errors, the majority (103) involving accidental double-dosing. Twenty-four cases presented to either of the study EDs and 38 cases from other hospitals were discussed with a clinical toxicologist. Of these 62 cases with a medical assessment, 32 reported lone guanfacine exposure. Hypotension, bradycardia and drowsiness were present in 9/32, 17/32 and 13/32 cases, respectively. Five (16%) patients received i.v. fluids. No patients required intubation, inotropic or vasopressor support. One patient who was co-exposed to marijuana required atropine. Prolonged orthostatic hypotension was observed in three of 32 cases, lasting a median of 36 h (range 24-42 h). Paediatric guanfacine exposures increased significantly over the study period. Isolated guanfacine ingestions were well tolerated, seldom requiring specific intervention. Clinicians need to be cognisant of the risk of prolonged orthostatic hypotension, and this must be excluded prior to discharge.

CSF Tau Is a Biomarker of Hippocampal Injury in Cryptogenic New-Onset Refractory Status Epilepticus.

Cryptogenic new-onset refractory status epilepticus (cNORSE) is a devastating condition characterized by the de novo onset of status epilepticus with unclear etiology. The identification of relevant early biomarkers in cNORSE is important to elucidate pathophysiology, aid clinical decision-making, and prognosticate outcomes in cNORSE. CSF samples were obtained within 7 days of NORSE onset from an adult cNORSE cohort in a national referral center in South Korea. Nineteen patients with cNORSE were studied: 9 were male (47.4%) and the median age was 35.0 [IQR: 27.0-54.3] years. CSF from 21 patients with other neurological diseases (atypical parkinsonism, postural orthostatic hypotension syndrome, epilepsy, and cerebellar ataxia) was used as controls. Proteomic analysis was conducted using the Olink platform, and potential biomarker candidates were correlated with clinical data and MRI findings. Based on correlation analyses between proteomic data and clinical outcomes, total tau (t-tau) was selected as a potential biomarker. Patients with cNORSE had higher CSF t-tau levels than controls (p < 0.001). Early detection of high CSF t-tau was associated with the presence of hippocampal atrophy in the postacute phase of cNORSE (p = 0.044). The initial elevation of t-tau levels also correlated with a higher number of anti-seizure medications used (p = 0.031) and less improvement in Clinical Assessment Scale in Autoimmune Encephalitis (CASE) scores 1 month after NORSE onset (p = 0.066). T-tau levels were correlated with CSF pro-inflammatory cytokines/chemokines and mediators of neuronal damage. Elevated CSF t-tau levels detected early after cNORSE onset may be a useful marker of initial brain injury and predict subsequent hippocampal atrophy.

Symptoms of Orthostatic Hypotension and Drugs Affecting Autonomic Function are Associated with the Onset of Frailty in Community-Dwelling Persons Aged 80 Years and Above: A Prospective Observational Study.

Both autonomic dysfunction and frailty are common and complex geriatric syndromes with similar negative health outcomes. Both conditions are characterized by a loss of homeostasis that makes individuals more vulnerable to stressors. The primary aim of this study is to examine the association between drugs that affect autonomic function and frailty onset in community-dwelling octogenarians. The secondary aim is to investigate the relationship between autonomic dysfunction and frailty onset in this population. In total, 372 nonfrail adults aged 80 years and above (mean age 83 ± 3 years) from the BUTTERFLY project were prospectively followed for 2 years (mean follow-up of 22 ± 6 months). The association between autonomic dysfunction (defined as neurogenic orthostatic hypotension and symptoms of orthostatic hypotension), the use of medications affecting autonomic function, and frailty status were examined using binary logistic regression analysis. The completely adjusted binary logistic regression model showed that the use of drugs affecting autonomic function was associated with frailty {adjusted odds ratio (aOR) = 1.78 [95% confidence interval (CI) 1.06-3.00], p = 0.030}. Furthermore, symptoms of orthostatic hypotension were related to frailty (aOR = 2.98 [95% CI 1.13-7.88], p = 0.027). Our results show that symptoms of orthostatic hypotension and the use of drugs that affect autonomic function are accompanied with respectively 3-fold and 1.8-fold higher odds of frailty onset in persons aged 80 years and over. Therefore, pharmacological treatment that affects autonomic function should be started with caution and timely discontinued in older persons.

Factors related to non-motor symptoms in moderate to severe parkinson’s disease

Objective: To analyze factors related to non-motor symptoms in patients with moderate to severe Parkinson’s disease. Subjects and Methods: From March 2022 to September 2023, 93 patients with moderate to severe Parkinson’s disease were enrolled in a cross-sectional descriptive study at the Outpatient Department of Bach Mai Hospital. Results: Factors affecting cardiovascular symptoms: Advanced age (≥70 years) and severe disease stage increased the risk of orthostatic hypotension (p &lt; 0.05). Factors affecting sleep disorders (based on NMSS and Epworth scores): Advanced age (≥70 years), disease duration of ≥5 years, and severe disease stage increased the risk of sleep disturbances (p &lt; 0.05). Factors affecting mood disorders (based on NMSS and Geriatric Depression Scale - Short Form scores): Female gender was associated with an increased risk of anxiety and depression. Additionally, a disease duration of ≥5 years and severe disease stage also increased the risk of depression (p &lt; 0.05). Conclusion: Advanced age (≥70 years) and severe disease stage are factors that increase the risk of non-motor symptoms related to cardiovascular function, sleep disorders, and mood disorders.

Risk assessment of the top 50 drugs associated with drug-induced orthostatic hypotension: a disproportionality analysis of the FAERS and JADER databases

To use the FDA Adverse Event Reporting System (FAERS) database to identify drugs associated with orthostatic hypotension. Adverse event reports of orthostatic hypotension from Q1 2004 to Q3 2024 were obtained from the FAERS and JADER databases. We employed algorithms such as the reporting odds ratio (ROR), the proportional reporting ratio (PRR), the Bayesian confidence propagation neural network (BCPNN), and the multi-item gamma Poisson shrinker (MGPS) for signal detection. JADER database was used to validate the findings from FAERS analysis. We identified 15,737 adverse events associated with orthostatic hypotension, involving 15,480 patients for analysis. The patient demographic included 6,745 males (43.5%) and 7,248 females (46.8%), with the largest group comprising adults over 65 years (7,654 cases, 49.4%). The three drugs with the highest ROR risk signals were terazosin [ROR (95% CI): 153.96 (124.57-190.28)], rasagiline [ROR (95% CI): 37.46 (29.99–46.78)], and doxazosin [ROR (95% CI): 37.06 (31.32–43.86)]. Apomorphine, abalopatine and levodopa were associated with the shortest onset time of orthostatic hypotension. Most of the signal detection results from the FAERS database were verified in the JADER database. Drugs associated with orthostatic hypertension still focused on cardiovascular and nervous system drugs. This study employed the FAERS database to identify 33 drugs that may be potentially linked to orthostatic hypotension. Medical workers should remain vigilant regarding the risk of these drugs causing orthostatic hypotension.

Cardiovascular Dysautonomia in Patients with Parkinson's Disease and Hypertension: A Cross-Sectional Pilot Study.

Background/Objectives: Parkinson's disease (PD) and hypertension are often coexistent conditions that interact in entwined ways at various levels. Cardiovascular autonomic dysfunction (CAD), a non-motor feature of PD occurring across all stages, alters blood pressure (BP) regulation. Methods: We conducted a cross-sectional study enrolling patients with PD and primary hypertension, without diabetes mellitus or other causes of secondary CAD, aiming to characterize BP profiles/patterns by ambulatory BP monitoring. We also sought associations between different CAD phenotypes and PD characteristics, disability, and cardiovascular comorbidities. Results: We included 47 patients with a median age of 71 years, PD duration of 9 years, and Movement Disorder Society-sponsored revision of the Unified Parkinson's Disease Rating Scale (MDS-UPDRS) Part III score of 40. Diurnal and nocturnal BP values were within the reference range, but BP load was excessive. Almost one-third had neurogenic orthostatic hypotension (OH) and 80% were non-dippers. The overall burden of non-motor symptoms was significant in these phenotypes. Patients with neurogenic OH were more prone to constipation, anxiety, and urinary problems, whereas gustatory dysfunction, loss of libido, and erectile dysfunction were more frequently reported by non-dippers. No significant differences with regard to cognitive decline were identified in subjects with and without neurogenic OH. Neurogenic OH was symptomatic in 78% of the cases, whereas 56% of those with orthostatic symptoms did not have OH at repeated measurements. Conclusions: Neurogenic OH is an independent predictor of disability in patients with PD and hypertension, after adjusting for PD duration, Hoehn and Yahr stage, levodopa equivalent daily dose (LEDD), and Montreal Cognitive Assessment (MoCA) score.

Pyridostigmine in the management of orthostatic hypotension: a systematic review and meta-analysis

BackgroundCurrent pharmacological approaches for the treatment of orthostatic hypotension (OH) may detrimentally affect supine blood pressure (BP). This side effect is often unacceptable and limits the utility of medical management....