High Prevalence of Neurogenic Orthostatic Hypotension in Mexican Neurodegenerative Patients: A Pilot Cohort
Daniel Rebolledo1, Sandra Yaneth Robles Bernal2, Francisco Luna-Rangel3, Benjamin Torres-Octavo4, Karla Cardenas-Soto4, Daniel Martinez-Ramirez5
1No Apply, 2No apply, Private Clinical Practice, 3Tecnologico de Monterrey, 4Neurology and Psychiatry, Instituto Nacional de Ciencias Medicas y Nutricion Salvador Zubiran, 5Oncare
Objective:
To describe the prevalence of neurogenic orthostatic hypotension in Mexican patients with neurodegenerative diseases using standardized autonomic testing.
Background:
Neurogenic orthostatic hypotension (nOH) is a hallmark of autonomic failure in neurodegenerative diseases. It manifests as a non-motor symptom impacting motor progression and exacerbations. While synucleinopathies are well-studied for nOH alongside motor and cognitive features, data on autonomic dysfunction in other conditions, particularly in Mexico are unknown.
Design/Methods:
Between January 1 and September 1, 2025, we evaluated Mexican patients referred for new-onset nOH or with established neurodegenerative diagnoses who developed new nOH symptoms. Participants (n=20; 13 males, 7 females; mean age 69.5 years) were predominantly Hispanic (n=14) and from diverse regions, including Mexico State (n=7) and Mexico City (n=5). All underwent standardized autonomic function tests, including smell sense and cognitive evaluation.
Results:
A total of n=20 patients were included in our study. Diagnosis included: Pure autonomic failure (n=1, 5%), Parkinson disease (n=7, 35%), dementia with Lewy bodies (n=7, 35%), Huntington disease (n=2, 10%), and adult-onset leukodystrophy (n=3, 15%). Autonomic testing revealed early nOH in 10 (50%), late nOH in n=5 (25%), and supine hypertension in n=9 (45%). Delta heart rate/systolic blood pressure ratio (HR/SBP ratio) was 0.04 at 3 minutes and 0.21 at 10 minutes. Valsalva maneuver showed absent late phase II and phase IV overshoot in n=13 (65%). Mean hand and foot temperatures were 29.9°C and 29.0°C, respectively. Mean UPSIT and MoCA scores were 21 and 24, respectively. Mean post-void residual volume was 60 mL, with urinary retention in n=12 (60%).
Conclusions:
In this pilot cohort, nOH prevalence was 75% and neurogenic supine hypertension occurred in 45% of cases, with autonomic involvement across sporadic and genetic neurodegenerative diseases. These findings underscore the importance of autonomic evaluation in all patients with neurodegenerative diseases in Latin America otherwise the initial or final diagnosis.
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