A DIAGNOSIS OF nOH COULD MAKE A DIFFERENCE

Watch as Jim and his care partner describe what they originally thought was causing Jim's neurogenic orthostatic hypotension (nOH) symptoms. Learn how he came to be diagnosed and how they manage the impact of his nOH on everyday life. 

“I started feeling dizzy. I constantly complained about it...the dizziness was limiting my activities. I had to change my whole entire lifestyle.” –Jim, patient with symptomatic nOH

“I started feeling dizzy. I constantly complained about it...the dizziness was limiting my activities. I had to change my whole entire lifestyle.” –Jim, patient with symptomatic nOH

REASONS PATIENTS WITH nOH MAY GO UNDIAGNOSED

1nOH is a rare subtype of orthostatic hypotension that is considered an orphan disease1,2

  • nOH affects many patients with neurodegenerative disorders such as Parkinson's disease (PD), multiple system atrophy, and pure autonomic failure

2Symptoms may be misdiagnosed or attributed to a patient's neurodegenerative disorder1

  • Postural lightheadedness may mimic nOH3
  • Cognitive difficulties, a subtle symptom presenting in about 50% of patients with nOH, may be diagnosed as dementia1,4,5
  • Nonspecific symptoms such as fatigue may resemble a levodopa “off” motor state in PD patients3
  • Cardinal symptoms such as lightheadedness may be absent in some patients1

3Symptomatic episodes may be delayed

  • Some patients may experience symptomatic orthostatic hypotension 3 minutes or longer after standing; this may be indicative of a mild or early form of sympathetic adrenergic failure6
REFERENCES
  1. Low PA. Neurogenic orthostatic hypotension: pathophysiology and diagnosis. Am J Manag Care. 2015;21(suppl 13):s248-s257.
  2. Ha AD, Brown CH, York MK, et al. The prevalence of symptomatic orthostatic hypotension in patients with Parkinson's disease and atypical parkinsonism. Parkinsonism Relat Disord. 2011;17(8):625-628.
  3. Palma JA, Kaufmann H. Epidemiology, diagnosis, and management of neurogenic orthostatic hypotension. Mov Disord Clin Pract. 2017;4(3):298-308.
  4. Low PA, Opfer-Gehrking TL, McPhee BR, et al. Prospective evaluation of clinical characteristics of orthostatic hypotension. Mayo Clin Proc. 1995;70(7):617-622.
  5. Figueroa JJ, Basford JR, Low P. Preventing and treating orthostatic hypotension: as easy as A, B, C. Cleve Clin J Med. 2010;7(5):298-306.
  6. Freeman R, Wieling W, Axelrod FB, et al. Consensus statement on the definition of orthostatic hypotension, neurally mediated syncope and the postural tachycardia syndrome. Clin Auton Res. 2011;21(2):69-72.