Table 3.

Characteristics of NOH in synucleinopathies

1. In PD, DLB, and PAF, the NOH is predominantly due to sympathetic denervation of peripheral neurons. In MSA, there is a loss of the central sympathetic neurons.

1. NOH is a prominent and disabling feature in all synucleinopathies and it is a sign of bad prognosis.

2. In synucleinopathies, there is a generalized autonomic dysfunction. MSA shows severe dysautonomia. In PD, DLB, and PAF, the dysautonomia is less severe.

3. MSA, PD, DLB, and PAF patients may show supine hypertension associated with NOH.

4. NOH may precede for several years the motor manifestations of PD and MSA and the cognitive decline of DLB.

5. Ambulatory BP monitoring is useful to detect daytime BP fluctuations, postprandial hypotension, and nocturnal nondipping or reverse dipping pattern.

Abbreviations: BP, blood pressure; DLB, dementia with Lewy bodies; NOH, neurogenic orthostatic hypotension; PAF, pure autonomic failure; PD, Parkinson’s disease; MSA, multiple system atrophy.