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Routine vs. Symptom-Based Screening for Orthostatic Hypotension in Parkinson’s Disease in the Outpatient Clinic (P6-17.009)
Abstract   Peer reviewed

Routine vs. Symptom-Based Screening for Orthostatic Hypotension in Parkinson’s Disease in the Outpatient Clinic (P6-17.009)

Ergun Uc, Christina Weber, Cara Iyengar and Jeffrey Dawson
Neurology, Vol.106(11_Supplement_1)
06/09/2026
DOI: 10.1212/WNL.0000000000216940

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Abstract

Objective To determine if routine screening for orthostatic hypotension (OH) by obtaining orthostatic vitals leads to improved rates of OH diagnosis in Parkinson’s disease (PD) patients compared to screening only when symptomatic, and to determine the association between OH and PD symptom severity. Background OH in PD is associated with increased morbidity and falls. However, obtaining orthostatic vitals can be time-consuming and logistically difficult in the workflow of a busy clinic, and they are not routinely measured at each outpatient visit unless patients display orthostatic symptoms such as syncope or lightheadedness. Design/Methods A convenience sample of patients with PD without a known diagnosis of OH from an academic movement disorders clinic were administered a published OH symptom screening questionnaire (Gibbons et al., J Neurol 2017; PMID: 28050656), MoCA, and MDS-UPDRS. OH was defined as a reduction in systolic blood pressure of at least 20 mm Hg or a reduction in diastolic blood pressure of at least 10 mm Hg within the first 3 minutes of standing per CDC’s Stopping Elderly Accidents, Deaths & Injuries (STEADI) protocol. Results Out of 81 participants (median age 71.0, Hoehn-Yahr stage 2), 29.6% had objective OH (2/3 of OH met criteria for neurogenic OH) and 56.7% had positive questionnaire. While 1/3rd of OH patients had negative symptom screening, 2/3rd of positively screened patients did not have OH. The questionnaire had low accuracy (53.09%) and specificity (47.4%), low-moderate sensitivity (66.7%) for detecting OH. Patients with objective OH had worse motor scores and tended to score lower on MoCA. The severity of orthostatic changes correlated with older age and worse motor severity. Conclusions Orthostatic symptom screening was not sufficient to predict OH in PD in a clinically meaningful manner. However, our results suggest that orthostatic vitals should be considered in older patients with worse motor and cognitive impairment regardless of orthostatic symptoms.

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