To Manage Parkinson’s Disease, Understand the Full Picture

Parkinson’s disease (PD) is one of the most common neurodegenerative diseases in the elderly, second only to Alzheimer’s disease.1 Affecting over 6 million people worldwide,2 a projected 930,0003 of whom live in the U.S with approximately 60,000 new cases4 diagnosed each year, it is a complex and oftentimes frustrating condition to manage, both for the patient and for the care partners. With symptoms like tremors at rest, loss of balance and difficulty moving,5 it is essential to understand as much as possible about PD.

Michael Soileau, MD, Neurologist and Movement Disorder Specialist at Texas Movement Disorder Specialists, says one non-motor aspect of PD that can fly under the radar is neurogenic orthostatic hypotension, or nOH. “nOH is a condition that can go hand-in-hand with Parkinson’s disease and can lead to further disability. Patients need to know that there are possible treatments that could help improve their symptoms.” Dr. Soileau goes on to say, “However, most do not mention these symptoms to their physician until they become severe. It is only when these nOH-specific symptoms are diagnosed and discussed, that they can be treated accordingly.”

According to the National Institutes of Health, nOH is prevalent in 40% to 60% of people with Parkinson’s with approximately 20% of those people being symptomatic.6 It is a dysfunction in a person’s autonomic nervous system which causes their blood pressure to drop significantly when trying to stand or when changing positions, causing them to feel dizzy or lightheaded. For some, they feel as if their legs will buckle underneath them.

The upside is that there are specific signs to look for when evaluating for nOH, as well as management techniques and medications available to help. For patients and caregivers, keep the following in mind:

  • Recognize the Symptoms of nOH: If you or a loved one are living with PD, be on the lookout for symptoms like lightheadedness, dizziness, or blurred vision upon standing, as they may be potential signs of nOH. A symptom checker is available at www.nohmatters.com, under the nOH symptoms tab.
  • Jot Down Your Symptoms: Take notice and write down when, where, and how often the symptoms take place. For instance, were you sitting down for a long period of time and then tried to stand? How many times in a week did you experience the symptoms? Does your blood pressure reading change when you change positions? Capturing the details will help your physician recognize potential patterns. A symptom tracker is available at www.nohmatters.com, under nOH resources.
  • Talk to Your Doctor: Don’t assume that the symptoms you have been experiencing are “just” side effects of PD. Take all the information you have recorded and share it with your doctor to have a productive conversation about diagnosis and management. A doctor discussion guide is also available at www.nohmatters.com, under nOH resources.

nOH is a manageable condition and screening is available. For more information, visit www.nohmatters.com for details on managing the condition, finding a specialist in your area, and learning from others who are living with the condition.

References

  1. Han Z, Tian R, Ren P, et al. Parkinson’s disease and Alzheimer’s disease: a Mendelian randomization study. BMC Medical Genetics. 2018;19(Suppl 1):215. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6311900/. Published December 31, 2018. Accessed April 22, 2020.
  2. GBD 2015 Disease and Injury Incidence and Prevalence Collaborators. 1990-2015: a systematic analysis for the Global Burden of Disease Study 2015. Lancet. 2016;388(10053):1545–1602.
  3. Marras C, Beck JC, Bower JH, et al. Prevalence of Parkinson’s disease across North America. Nature News. https://www.nature.com/articles/s41531-018-0058-0. Published July 10, 2018. Accessed April 20, 2020.
  4. DeMaagd G, Philip A. Parkinson’s Disease and Its Management: Part 1: Disease Entity, Risk Factors, Pathophysiology, Clinical Presentation, and Diagnosis. Pharmacy & Therapeutics. 2015;40(8):504-510, 532. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4517533/. Published August 2015. Accessed April 22, 2020.
  5. Jankovic J. Parkinson’s disease: clinical features and diagnosis. Journal of Neurology, Neurosurgery & Psychiatry. 2008;79:368-376. https://jnnp.bmj.com/content/79/4/368. Published April 1, 2008. Accessed April 21, 2020.
  6. Isaacson SH, Skettini J. Neurogenic orthostatic hypotension in Parkinson’s disease: evaluation, management, and emerging role of droxidopa. Vascular Health and Risk Management. 2014;10:169-176. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3979788/. Published April 3, 2014. Accessed April 20, 2020.

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