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Posture hypotension is defined as a drop in systolic blood pressure (SBP) from lie-down to standing at least 20 mmhg or 20 mmhg (DBP).
in Parkinson's disease (PD), the overall prevalence of OH is estimated at 30%.
Although the incidence of OH can rise to 65% as the disease progresses, especially with dementia, the use of methods to treat the disease is still rare, with only about 0.5% of patients treated, according to a seven-year prospective population study.
as with psychotic and dopamine resistance movement symptoms, dementia and OH are important inflection points for diseases, and the resulting disability indicates that specific treatments for the advanced Parkinson's disease (PDD) stage need to be improved.
is that OH can cause cognitive impairment of PDD independently.
, OH patients had worse cognitive function when sitting than lying on their backs, possibly due to reduced brain perfusion pressure.
Alberto J. Espay of the University of Cincinnati and others have looked at whether OH has an effect on the cognitive improvement of rivastigmine, a cognitive improvement drug, in people with Parkinson's disease (PDD).
they included 1,047 PDD patients in a randomized controlled trial to compare the efficacy of kabaratin with a placebo at week 24 (n s 501), and in week 76 (n s 546) to compare the efficacy of kabaratin patches and kabaratin capsules (capsules).
oh positive (OH plus) is defined as a change in posture, systolic pressure (SBP) ≥20mmhg or throospressur (DBP) ≥10, otherwise OH negative (OH -).
main endpoints were the 24th week Alzheimer's Assessment Scale - Cognitive Weight Scale (ADAS-Cog) and the 76th Week Matisse Dementia Assessment Scale (MDRS).
was treated with intent therapy (intention-to-treat) in week 24, and cases were observed at week 76, consistent with the original analysis.
results: In the placebo group of OH plus, the overall safety of the remaining groups was comparable to that of OH-, except for the high rate of fainting (9.2%).
the placebo regulation of the ADAS-Cog score in week 24: OH s group was 5.6 ± 1.2, OH-group was 1.9 ± 0.9 (p s 0.0165).
in oh-plus subjects, kabaratin capsules had a higher change in MDRS at 76 weeks (10.6 ± 2.9 vs.1.5 ± 3.0, p s 0.031) compared to the patch.
week 24, after Kabalatin treatment, the overall OH prevalence rate was lower than that of placebo (28.3% vs. 44.6%, p s 0.0476).
the main significance of this study was the discovery that kabalatin had greater cognitive benefits for patients with OH-accompanied PDD, perhaps by improving the effects of hypotension.
original origin: Espay, AJ, Marsili, L., Mahajan, A., Sturchio, A., Pathan, R., Pilotto, A., ... & Gomez ‐ Mancilla, B. (2021). Rivastigmine in Parkinson's Disease Dementia with Orthostatic Hypotension. Annals of neurology , 89 (1), 91-98.<!--5f39ae17-8c62-4a45-bc43-b32064c9388a: W3siYmxvY2tJZCI6IjYyNjgtMTYxMDIyMjIzMDIxMiIsImJsb2NrVHlwZSI6InBhcmFncmFwaCIsInN0eWxlcyI6eyJhbGlnbiI6ImxlZnQiLCJpbmRlbnQiOjAsInRleHQtaW5kZW50IjowLCJsaW5lLWhlaWdodCI6MS43NSwiYmFjay1jb2xvciI6IiIsInBhZGRpbmciOiIifSwidHlwZSI6InBhcmFncmFwaCIsInJpY2hUZXh0Ijp7ImRhdGEiOlt7ImNoYXIiOiJBIn0seyJjaGFyIjoibiJ9LHsiY2hhciI6Im4ifSx7ImNoYXIiOiJhIn0seyJjaGFyIjoibCJ9LHsiY2hhciI6InMifSx7ImNoYXIiOiIgIn0seyJjaGFyIjoibyJ9LHsiY2hhciI6ImYif Sx7ImNoYXIiOiIgIn0seyJjaGFyIjoiTiJ9LHsiY2hhciI6ImUifSx7ImNoYXIiOiJ1In0seyJjaGFyIjoiciJ9LHsiY2hhciI6Im8ifSx7ImNoYXIiOiJsIn0seyJjaGFyIjoibyJ9LHsiY2hhciI6ImcifSx7ImNoYXIiOiJ5In0seyJjaGFyIjoiOiIsInN0eWxlcyI6eyJiYWNrLWNvbG9yIjoiI2ZmZmZmZiJ9fSx7ImNoYXIiOiIgIiwic3R5bGVzIjp7ImJhY2stY29sb3IiOiIjZmZmZmZmIn19LHsiY2hhciI6IuS8tCIsInN0eWxlcyI6eyJiYWNrLWNvbG9yIjoiI2ZmZmZmZiJ9fSx7ImNoYXIiOiLmnIkiLCJzdHlsZXMiOnsiYmFjay1jb2xvciI6Ii NmZmZmZmYifX0seyJjaGFyIjoi5L2TIiwic3R5bGVzIjp7ImJhY2stY29sb3IiOiIjZmZmZmZmIn19LHsiY2hhciI6IuS9jSIsInN0eWxlcyI6eyJiYWNrLWNvbG9yIjoiI2ZmZmZmZiJ9fSx7ImNoYXIiOiLmgKciLCJzdHlsZXMiOnsiYmFjay1jb2xvciI6IiNmZmZmZmYifX0seyJjaGFyIjoi5L2OIiwic3R5bGVzIjp7ImJhY2stY29sb3IiOiIjZmZmZmZmIn19LHsiY2hhciI6IuihgCIsInN0eWxlcyI6eyJiYWNrLWNvbG9yIjoiI2ZmZmZmZiJ9fSx7ImNoYXIiOiLljosiLCJzdHlsZXMiOnsiYmFjay1jb2xvciI6IiNmZmZmZmYifX0seyJjaGFyIjo i55qEIiwic3R5bGVzIjp7ImJhY2stY29sb3IiOiIjZmZmZmZmIn19LHsiY2hhciI6IuW4lSIsInN0eWxlcyI6eyJiYWNrLWNvbG9yIjoiI2ZmZmZmZiJ9fSx7ImNoYXIiOiLph5EiLCJzdHlsZXMiOnsiYmFjay1jb2xvciI6IiNmZmZmZmYifX0seyJjaGFyIjoi5qOuIiwic3R5bGVzIjp7ImJhY2stY29sb3IiOiIjZmZmZmZmIn19LHsiY2hhciI6IueXhSIsInN0eWxlcyI6eyJiYWNrLWNvbG9yIjoiI2ZmZmZmZiJ9fSx7ImNoYXIiOiLnl7QiLCJzdHlsZXMiOnsiYmFjay1jb2xvciI6IiNmZmZmZmYifX0seyJjaGFyIjoi5ZGGIiwic3R5bGVzIjp7ImJh Y2stY29sb3IiOiIjZmZmZmZmIn19LHsiY2hhciI6IuaCoyIsInN0eWxlcyI6eyJiYWNrLWNvbG9yIjoiI2ZmZmZmZiJ9fSx7ImNoYXIiOiLogIUiLCJzdHlsZXMiOnsiYmFjay1jb2xvciI6IiNmZmZmZmYifX0seyJjaGFyIjoi77yMIiwic3R5bGVzIjp7ImJhY2stY29sb3IiOiIjZmZmZmZmIn19LHsiY2hhciI6IuWNoSIsInN0eWxlcyI6eyJiYWNrLWNvbG9yIjoiI2ZmZmZmZiJ9fSx7ImNoYXIiOiLlt7QiLCJzdHlsZXMiOnsiYmFjay1jb2xvciI6IiNmZmZmZmYifX0seyJjaGFyIjoi5ouJIiwic3R5bGVzIjp7ImJhY2stY29sb3IiOiIjZmZmZmZmI n19LHsiY2hhciI6IuaxgCIsInN0eWxlcyI6eyJiYWNrLWNvbG9yIjoiI2ZmZmZmZiJ9fSx7ImNoYXIiOiLlj68iLCJzdHlsZXMiOnsiYmFjay1jb2xvciI6IiNmZmZmZmYifX0seyJjaGFyIjoi5pS5Iiwic3R5bGVzIjp7ImJhY2stY29sb3IiOiIjZmZmZmZmIn19LHsiY2hhciI6IuWWhCIsInN0eWxlcyI6eyJiYWNrLWNvbG9yIjoiI2ZmZmZmZiJ9fSx7ImNoYXIiOiLlhbYiLCJzdHlsZXMiOnsiYmFjay1jb2xvciI6IiNmZmZmZmYifX0seyJjaGFyIjoi6K6kIiwic3R5bGVzIjp7ImJhY2stY29sb3IiOiIjZmZmZmZmIn19LHsiY2hhciI6IuefpSIsIn N0eWxlcyI6eyJiYWNrLWNvbG9yIjoiI2ZmZmZmZiJ9fSx7ImNoYXIiOiLlip8iLCJzdHlsZXMiOnsiYmFjay1jb2xvciI6IiNmZmZmZmYifX0seyJjaGFyIjoi6IO9Iiwic3R5bGVzIjp7ImJhY2stY29sb3IiOiIjZmZmZmZmIn19XSwiaXNSaWNoVGV4dCI6dHJ1ZSwia2VlcExpbmVCcmVhayI6dHJ1ZX19LHsiYmxvY2tJZCI6IjQ0NjUtMTYxMDIyMzgyMTg3MyIsImJsb2NrVHlwZSI6InBhcmFncmFwaCIsInN0eWxlcyI6eyJiYWNrLWNvbG9yIjoiIiwiYWxpZ24iOiJsZWZ0IiwiaW5kZW50IjowLCJ0ZXh0LWluZGVudCI6MCwibGluZS1oZWlnaHQiOjE uNzUsInBhZGRpbmciOiIifSwidHlwZSI6InBhcmFncmFwaCIsInJpY2hUZXh0Ijp7ImRhdGEiOlt7ImNoYXIiOiLCoCIsInN0eWxlcyI6eyJiYWNrLWNvbG9yIjoiI2ZmZmZmZiJ9fV0sImlzUmljaFRleHQiOnRydWUsImtlZXBMaW5lQnJlYWsiOnRydWV9fSx7ImJsb2NrSWQiOiIzMDc2LTE2MTAyMjM4MjE4NzQiLCJibG9ja1R5cGUiOiJwYXJhZ3JhcGgiLCJzdHlsZXMiOnsiYmFjay1jb2xvciI6IiIsImFsaWduIjoibGVmdCIsImluZGVudCI6MCwidGV4dC1pbmRlbnQiOjAsImxpbmUtaGVpZ2h0IjoxLjc1LCJwYWRkaW5nIjoiIn0sInR5cGUiOiJw YXJhZ3JhcGgiLCJyaWNoVGV4dCI6eyJkYXRhIjpbXSwiaXNSaWNoVGV4dCI6dHJ1ZSwia2VlcExpbmVCcmVhayI6dHJ1ZX19LHsiYmxvY2tJZCI6IjYwMjItMTYxMDIyMzgyMDk0MSIsImJsb2NrVHlwZSI6InBhcmFncmFwaCIsInN0eWxlcyI6eyJhbGlnbiI6ImxlZnQiLCJp
