To determine how often orthostatic hypotension (OH) occurred in the early stages of Parkinson’s disease (Hoehn and Yahr stages 1 and 2) and to describe accompanying clinical features.

Autonomic dysfunction is common in Parkinson’s disease (PD) and can be present in prodromal stages. OH is a common feature of dysautonomia, occurring in 30-60% of patients with PD. Despite this frequency, OH remains under-recognized in PD and the presence of early OH may lead clinicians to suspect an alternative diagnosis of Multiple System Atrophy.

In this retrospective chart review, we identified patients seen by a movement disorders specialist at the University of Rochester over a one-year period with diagnoses of PD and OH. Patients with prior diagnoses of dementia, stroke, or atypical parkinsonian disorder were excluded.  Demographic data, clinical characteristics of motor and non-motor features, and Hoehn and Yahr (H&Y) stage at initial visit and OH diagnosis visit were abstracted.

Of the 75 patients meeting inclusion criteria, 72.9% of PD patients with OH had early-stage PD (H&Y 1 and 2). The average H&Y stage at time of OH diagnosis was 2.4 (M= 2 ± 0.77). The average time from onset of motor symptoms to diagnosis of OH was 7.04 years. (M= 7 ±4.2).  Of those with early PD and OH, 40.9% reported orthostatic lightheadedness at initial visit. Patients with subjective orthostatic lightheadedness at initial visit were more likely to report gait dysfunction as initial motor symptom (p=0.01) and to report subjective cognitive impairment at initial visit (p=0.05) than those without subjective orthostatic lightheadedness.

Orthostatic hypotension may be present in the early stages of Parkinson’s disease and should not necessarily prompt consideration of alternative diagnosis. This population of patients may be more likely to present with gait dysfunction and to report subjective cognitive impairment.