Prevalence and factors related to orthostatic hypotension and orthostatic intolerance in recently-diagnosed, drug-naïve Parkinson?s disease patients

PEREZ LLORET SANTIAGO; QUARRACINO C; OTERO-LOSADA M; CAPANI F

NIza

Congreso; 23th International Congress of Parkinson?s Disease and Movement Disorders; 2019

International Parkinson and Movement Disorders Society

Purpose. We explored the prevalence and factors related to orthostatic syndromes in recently diagnosed drug-naïve Parkinson´s disease (PD) patients.Methods. We included 217 drug-naïve PD patients and 108 sex- and age-matched non-parkinsonian controls devoid of diabetes, alcoholism, polyneuropathy, amyloidosis and hypotension-inducing drugs from the Parkinson?s Progression Markers Initiative (PPMI) prospective cohort study. Orthostatic symptoms were evaluated using the Scale for Outcomes in PD-Autonomic (SCOPA-AUT) scale. Ioflupane I123 single-photon emission computerized tomography was used to evaluate striatal dopamine active transporter (DaT) levels. Blood pressure was assessed in the dorsal decubitus position and 1-3 min after standing up. Orthostatic hypotension (OH) and postural orthostatic tachycardia syndrome (POTS) were defined by international consensus. Orthostatic sensitivity (OS) was defined as the presence of orthostatic symptoms in the absence of POTS or OH.Results. Compared with non-parkinsonian controls, PD patients experienced a mild decrease in systolic blood pressure fall upon orthostasis (p=0.082). The prevalence of OH was 11.1% in PD and 5.6% in controls (p=0.109). Only one case of POTS was detected in the latter. Prevalence of OS was higher in PD patients than in controls (31.3% vs.13.3% respectively, p=0.003). Logistic regression revealed OH and OS related to lower striatal DaT levels and higher SCOPA-Aut gastrointestinal score.Conclusions. Cardiovascular dysautonomia was common in recently diagnosed drug-naïve PD patients. Only OS prevalence was actually higher in PD compared with non-parkinsonian controls. Unlike motor or functional disability indicators, markers of dopaminergic striatal deficit and gastrointestinal dysfunction were associated with OH and OS.