Treating orthostatic hypotension in patients with Parkinson's disease and atypical Parkinsonism improves function.
BACKGROUND
Patients with idiopathic Parkinson's disease (PD) or atypical Parkinsonism (AP) often present with orthostatic hypotension (OH) as a result of the dysautonomia associated with the disease or as a side effect of the dopaminergic medications used to treat it. Our recent study suggested that OH negatively impacts gross motor, balance, and cognitive functions in patients with PD.


OBJECTIVE
To determine if correcting the orthostatic hypotension (OH) of patients with PD or AP improves their gross motor, balance, and cognitive functions.


METHODS
Forty patients with PD or AP were assessed before and after correcting their OH using a staged approach with a goal of SBP >80 when standing and SBP <180 when laying. Step 1 of treatment included reducing antihypertensive medications, as possible, maintaining hydration with 1500cc/day, decreasing dietary salt, wearing high compression stockings, and keeping the head of bed elevated at 30 degrees when supine. If SBP <80 with standing after step 1, then treatment was started with fludrocortisone and/or midodrine.


RESULTS
Patients' OH was managed as part of a rehabilitation program. Tests such as the Motor and Cognitive Functional Independence Measures, Berg Balance Scale, Two Minute Walking test, and the Finger Tapping test showed significant improvements (p < 0.05) in their gross motor, walking, balance and cognitive function with our OH management plan. No significant differences between admission and discharge were found in the Timed Up and Go test.


CONCLUSIONS
Our data suggest that monitoring and correcting the OH of patients with PD or AP improves their gross motor, balance, and cognitive function.
Department of Neurology, Boston University School of Medicine, Boston, MA, USA. hohlera@hotmail.com
Anna D
AD
Hohler
Diana Elena
DE
Amariei
Douglas I
DI
Katz
T Joy
TJ
DePiero
Valerie B
VB
Allen
Suzanne
S
Boyle
Heidi Alison
HA
Phenix
Tara Ashley
TA
DeAngelis
Carrie Denise
CD
Geibel
Karla M
KM
Smith
Marie
M
Saint-Hilaire
Terry
T
Ellis
D001794:Blood Pressure; D005260:Female; D006801:Humans; D007024:Hypotension, Orthostatic / Q000209:etiology* / Q000534:rehabilitation*; D008297:Male; D010300:Parkinson Disease / Q000150:complications* / Q000628:therapy*; D011597:Psychomotor Performance; D016138:Walking