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Abstract Details

Routine vs. Symptom-Based Screening for Orthostatic Hypotension in Parkinson’s Disease in the Outpatient Clinic
Movement Disorders
P6 - Poster Session 6 (5:00 PM-6:00 PM)
17-009
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. 
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.
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.

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. 

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.
Authors/Disclosures
SUDHIR KUMAR PALAT CHIRAKKARA, MD, MBBS, MRCP(UK)
PRESENTER 		Dr. PALAT CHIRAKKARA has nothing to disclose.
Ergun Y. Uc, MD (University of Iowa) An immediate family member of Dr. Uc has received personal compensation in the range of $500-$4,999 for serving as an officer or member of the Board of Directors for American Board of Pediatrics. The institution of Dr. Uc has received research support from Department of Veterans Affairs. The institution of Dr. Uc has received research support from Department of Defense. The institution of an immediate family member of Dr. Uc has received research support from NIH. The institution of Dr. Uc has received research support from NIH. The institution of Dr. Uc has received research support from NIH. The institution of Dr. Uc has received research support from Parkinson's Foundation. The institution of Dr. Uc has received research support from NIH.
Christina Weber (University of Iowa Hospitals and Clinics) Christina Weber has nothing to disclose.
Cara Iyengar, MSW Mrs. Iyengar has received personal compensation for serving as an employee of Atrium Global assigned to Parkinson's Foundation . The institution of an immediate family member of Mrs. Iyengar has received research support from NIH.
Jeffrey Dawson Jeffrey Dawson has received personal compensation in the range of $500-$4,999 for serving as a Consultant for iotaMotion. Jeffrey Dawson has received personal compensation in the range of $500-$4,999 for serving as an Editor, Associate Editor, or Editorial Advisory Board Member for Congress of Neurological Surgeons. The institution of Jeffrey Dawson has received research support from Department of Veterans Affairs. The institution of Jeffrey Dawson has received research support from NIH.