Clinical Relevance of Orthostatic Hypotension in Neurodegenerative Disease.
The autonomic nervous system appears to be uniquely susceptible to degeneration in disorders of α-synuclein pathology. Clinically, autonomic dysfunction in these disorders manifests as neurogenic orthostatic hypotension (nOH), a condition that results in substantial morbidity and mortality. nOH results from pathology affecting either the central autonomic pathways or peripheral autonomic nerve fibers. Determining the localization and pathophysiology of nOH is critical in effectively managing this disorder and selecting appropriate treatment options. In this review, we discuss the pathophysiology of nOH with respect to the various α-synuclein-related neurodegenerative conditions. We highlight the associated clinical features, including gait instability, rapid eye movement behavior disorder, and hyposmia. We also review the current pharmacologic treatment options for nOH. Overall, the goals of therapy are to improve symptoms and prevent syncope and falls. Non-pharmacologic interventions should be introduced first, followed by carefully selected pharmacologic therapies. Treatment decisions should be directed by an understanding of the underlying pathophysiology, as well as the comorbidities and potential contributing factors present in each individual patient.
Department of Neurology, Vanderbilt University Medical Center, 1161 21st Avenue South A-0118, Nashville, TN, 37232-2551, USA. katherine.mcdonell@vanderbilt.edu.
Katherine E
KE
McDonell
Division of Clinical Pharmacology, Department of Medicine, Vanderbilt University School of Medicine, Nashville, TN, USA.
Cyndya A
CA
Shibao
Department of Neurology, Vanderbilt University Medical Center, 1161 21st Avenue South A-0118, Nashville, TN, 37232-2551, USA.
Daniel O
DO
Claassen
D001342:Autonomic Nervous System Diseases / Q000150:complications; D003071:Cognition; D005684:Gait; D006801:Humans; D007024:Hypotension, Orthostatic / Q000150:complications*; D019636:Neurodegenerative Diseases / Q000150:complications*; D011788:Quality of Life
Autonomic failure; Neurodegeneration; Neurogenic orthostatic hypotension; Pathophysiology; Pharmacology