Orthostatic hypotension as an early finding in Parkinson's disease.
Patients with Parkinson's disease (PD) commonly have clinically significant orthostatic hypotension (OH). In such patients PD+OH might be confused with multiple system atrophy (MSA), in which OH is a frequent finding, or with pure autonomic failure (PAF), if OH preceded clinical manifestations of the movement disorder. This study addressed whether OH can occur as an early finding in PD+OH. Historical data were analyzed from 35 patients with PD+OH evaluated at the NIH. OH was considered early if the patient had OH before, concurrent with, or starting within 1 year after onset of a symptomatic movement disorder. MSA was excluded by myocardial 6-[(18)F]fluorodopamine-derived radioactivity more than 2 standard deviations below the normal mean. Among the 35 PD+OH patients, 21 (60 %) had documentation of OH as an early finding. In 4 such patients, OH had preceded parkinsonism, and in 4 others, OH had dominated the early clinical picture, even after cessation of levodopa treatment for the movement disorder. In PD, OH can occur early in the disease, occasionally preceding or overshadowing the movement disorder.
Clinical Neurocardiology Section, National Institute of Neurological Disorders and Stroke, National Institutes of Health, Building 10/Room 6N252, 10 Center Drive, MSC-1620, Bethesda, MD 20892, USA. goldsteind@ninds.nih.gov
David S
DS
Goldstein
D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D000978:Antiparkinson Agents / Q000627:therapeutic use; D001341:Autonomic Nervous System / Q000503:physiopathology; D003937:Diagnosis, Differential; D005260:Female; D006801:Humans; D007024:Hypotension, Orthostatic / Q000150:complications* / Q000175:diagnosis* / Q000503:physiopathology; D007980:Levodopa / Q000627:therapeutic use; D008297:Male; D008875:Middle Aged; D009069:Movement Disorders / Q000150:complications / Q000175:diagnosis / Q000503:physiopathology; D019578:Multiple System Atrophy / Q000150:complications / Q000175:diagnosis / Q000503:physiopathology; D010300:Parkinson Disease / Q000150:complications* / Q000175:diagnosis* / Q000188:drug therapy / Q000503:physiopathology; D013997:Time Factors
D000978:Antiparkinson Agents; D007980:Levodopa