Orthostatic Hypotension in Neurodegenerative Diseases

Orthostatic hypotension (OH), a geriatric syndrome, is due to the disruption of coordination of the cardiovascular structures, musculoskeletal system, endocrine, and nervous system. When OH results from neurodegenerative processes, it is called as neurogenic OH (nOH). Considered as one of the clinical outcomes of autonomic dysfunction caused by a neurodegenerative process, nOH may be due to peripheral causes, such as peripheral autonomic disorders, or it may develop as a result of diseases affecting the central nervous system, such as dementia of Lewy body, Parkinson disease, multi system atrophy, and pure autonomic failure. Furthermore, prescribed for the treatment of the neurodegenerative diseases, many drugs may aggravate the disease course by developing postural hypotension. In addition to synucleinopathies, the frequency of OH is also high in Alzheimer’s disease and vascular dementia. Additionally, vitamin deficiencies, such as vitamin B12 and folic acid deficiency, may result in nOH by causing peripheral neuropathy. In the treatment of nOH, the goal is not to normalize the blood pressurewhen standing up, but to protect the patient from the mortality and morbidity caused by low blood pressure and increase the quality of life.