Prevalence and Prescribed Treatments of Orthostatic Hypotension in Institutionalized Patients with Parkinson’s Disease

Article type: Research Article

Authors: Hommel, ALAJ^a | Faber, MJ^b | Weerkamp, NJ^c | van Dijk, JG^d | Bloem, BR^{e; *} | Koopmans, RT^{f; g}

Affiliations: [a] Radboud University Medical Center, Donders Institute for Brain, Cognition and Behaviour, Nijmegen, The Netherlands, Groenhuysen Organisation, Roosendaal, The Netherlands | [b] Radboud University Medical Center, Radboud Institute for Health Sciences, IQ Healthcare, Nijmegen, The Netherlands | [c] Department of Neurology, Bronovo Medical Center, The Hague, The Netherlands | [d] Department of Neurology, Leiden University Medical Center, Leiden, The Netherlands | [e] Radboud University Medical Center, Donders Institute for Brain, Cognition and Behaviour, Department of Neurology, Nijmegen, The Netherlands | [f] Radboud University Medical Center, Department of Primary and Community care, Centre for Family Medicine, Geriatric Care and Public health, Nijmegen, The Netherlands | [g] Joachim & Anna, Center for Specialized Geriatric Care, Nijmegen

Correspondence: [*] Correspondence to: Prof. Bastiaan R. Bloem, Radboud University Medical Center, Department of Neurology, PO Box 9101, 6500 HB Nijmegen, The Netherlands. Tel.: +31 0 24 361 5202; Fax: +31 0 24 354 1122; E-mail: bas.bloem@radboudumc.nl.

Abstract: Background: Orthostatic hypotension (OH) in Parkinson’s disease (PD) is a common non-motor sign that can be hard to recognize and treat. OH prevalence and treatment in institutionalized PD-patients remains unknown. Objective: The aim of this study was to explore the prevalence and prescribed treatments of OH in institutionalized patients with PD. Method: A cross-sectional study of nursing homes in the south-east of the Netherlands identified 64 residents with PD (inclusion criteria: MMSE >18). Assessments included blood pressure measurement, both supine and in the upright position (after 1 minute and after 3 minutes of standing), and 2 questions on cardiovascular items including falls of the validated Non-Motor Symptom Scale (NMSS). OH was defined according to the consensus guidelines. OH was considered as ‘probably symptomatic’ if patients had a concomitant frequency score >1 on the selected NMSS items, and ‘probably asymptomatic’ for a frequency score of 0. If OH was not present, but patients had a frequency score >1, OH was considered as ‘possibly symptomatic’. Results: The prevalence of OH was 51.6%, almost equally divided into probably symptomatic and probably asymptomatic cases. Another 20.6% had possibly symptomatic OH. Importantly, only two patients with symptomatic OH had an OH diagnosis noted in their medical records. Five received domperidone, one received fludrocortison and none received midodrine. Conclusion: One half of institutionalized PD patients had OH, of whom half were probably symptomatic. OH was rarely noted in the medical records, suggesting underdiagnosis. Finally, OH was rarely treated, suggesting undertreatment.

Keywords: Parkinson’s disease, nursing home, long-term care, orthostatic hypotension, orthostatic intolerance

DOI: 10.3233/JPD-160853

Journal: Journal of Parkinson's Disease, vol. 6, no. 4, pp. 805-810, 2016