Affiliations: Department of Neurology, Boston University School of Medicine, Boston, MA, USA | Braintree Rehabilitation Hospital, Braintree, MA, USA | Boston University School of Medicine, Boston, MA, USA | Sargent College, Boston University, Boston, MA, USA
Note:  Correspondence to: Anna Depold Hohler, MD, Department of Neurology, 725 Albany Street, 7th Floor, Boston, MA 02118, USA. Tel.: +1 617 638 8456; Fax: +1 617 638 8465; E-mail: [email protected]
Abstract: 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. Conclusion: Our data suggest that monitoring and correcting the OH of patients with PD or AP improves their gross motor, balance, and cognitive function.
Keywords: Parkinson's disease, Parkinsonism, orthostatic hypotension, motor function, cognitive function