The Impact of Neurogenic Orthostatic Hypotension on Patients and Caregivers

Guest: Daniel Claassen, MD, MS <br> <p>Neurogenic orthostatic hypotension (nOH) is a subset of orthostatic hypotension and is prevalent in patients with autonomic dysfunction.^1,2 The cardinal symptoms of nOH include dizziness and lightheadedness,³ but frequently could include syncope, cognitive slowing, generalized weakness, coat-hanger (neck and shoulder) headache, fatigue, orthostatic dyspnea, blurred vision, and orthostatic angina.³ According to the Harris Poll conducted among nOH patients and their caregivers, the symptoms of nOH have a negative impact on activities of daily living. The symptoms are often minimized, poorly recognized/evaluated, or inadequately discussed and addressed.⁴</p> <p>Patients with nOH may experience symptoms that can make daily tasks a challenge.^1,5 The frequency and severity of symptomatic episodes can be unpredictable,⁶ and it is this unpredictability of events that contributes to a vicious cycle of nOH.¹ In this cycle, fear of symptomatic events and falls may lead patients to reduce physical activity.^1,5</p> <p>References:</p> <ol> <li>Palma JA, Kaufmann H. Epidemiology, diagnosis, and management of neurogenic orthostatic hypotension. <em>Mov Disord Clin Pract</em>. 2017;4(3):298-308.</li> <li>Freeman R, Wieling W, Axelrod FB, et al. Consensus statement on the definition of orthostatic hypotension, neurally mediated syncope and the postural tachycardia syndrome. <em>Clin Auton Res</em>. 2011;21(2):69-72.</li> <li>Freeman R. Neurogenic orthostatic hypotension. <em>N Engl J Med</em>. 2008;358(6):615-624.</li> <li>Claassen DO, Adler ...