Objective: Primary objective: to assess the relationship between falls, orthostatic intolerance and orthostatic hypotension (OH) in patients with Parkinson’s disease (PD). Secondary objective: to assess the BP threshold for development of orthostatic intolerance in PD.

Background: Beyond age-related factors, PD-specific factors, like history of previous falls, dyskinesias and freezing of gait are relevant risk factors for future falls in patients with PD. Previous studies reported controversial results on the relationship between falls, orthostatic hypotension (OH) and orthostatic intolerance in PD.

Methods: 180 patients with PD (111 males, 32 patients with dementia) receiving a tilt table examination in Innsbruck between 2008 and 2013 were retrospectively included. Following information was collected from the clinical recordings of the 6 months preceding and following the tilt table examination: history of falls, L-Dopa fluctuations, deep brain stimulation, cardiovascular disease, anti-hypotensive or anti-hypertensive drugs, syncope, orthostatic intolerance and gait abnormalities.

Results: In the present PD cohort [median age: 71 years (65; 76); median disease duration: 5 years (3; 10); median L-Dopa equivalent daily dose: 545 mg/day (258; 1080)], falls were reported in 46% of patients. At univariate analysis, falls were associated with more advanced age (p 0.001), disease duration (p=0.002), Hoehn & Yahr stage (p0.001), higher L-Dopa daily intake (p=0.002), history of dyskinesias (p=0.02), syncope (p0.001), orthostatic intolerance (p0.001) and gait abnormalities (p=0.001). Multivariate analysis confirmed an association between falls and more advanced age (p=0.02; OR: 1.6, 95% c.i.: 1.1-2.5), Hoehn & Yahr stage (p=0.04, OR: 1.8, 95% c.i.: 1.0-3.1), gait abnormalities (p=0.04, OR: 2.2, 95% c.i.: 1.0-4.8) and orthostatic intolerance (p=0.001, OR: 3.4, 95% c.i.: 1.7-7.0). Mean BP 90 mmHg after 3 minutes of orthostatic challenge predicted symptoms of orthostatic intolerance with 94% specificity and 35% sensitivity.

Conclusions: Here we confirm that advanced age, Hoehn & Yahr stage and history of gait abnormalities are significant risk factors for falls in PD. Orthostatic intolerance, rather than OH itself, conveys a 3.4-fold increased risk of falls in PD. Anti-hypotensive measures may thus prevent falling in PD patients reporting symptomatic OH.

Preliminary results were presented at the 2015 congress of the Austrian Parkinson Society.

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MDS Abstracts - https://www.mdsabstracts.org/abstract/orthostatic-intolerance-and-falls-in-parkinsons-disease/