Hengzhang Ma, Zhixiong Zheng, Caihua Chen, Mingyuan Xu, Qiaohui Zhu, Shenkun He
A bedside OH screen identifies a clinically heterogeneous inpatient group that is not confined to advanced disease, and a third of it is detectable only at 1 min. Because all participants were screen-positive, these comparisons describe that group and cannot establish that the screening result marks burden independently of stage.
BACKGROUND: Orthostatic hypotension (OH) is common in Parkinson's disease (PD), but what is known of its clinical associations comes from ambulatory or population-based cohorts assessed under protocolised or tilt-table conditions. The patients whom a routine bedside screen identifies on a general ward have not been described.
OBJECTIVE: To characterise the modified Hoehn-Yahr (H-Y) stage distribution of hospitalized PD patients with a positive bedside OH screen, and to describe how clinical burden is distributed across stage within that group.
METHODS: Retrospective cross-sectional analysis of 125 consecutive adults admitted to a Chinese tertiary neurology department (January 2021 to March 2025) with idiopathic PD and a positive bedside OH screen, defined as a fall of ≥20 mmHg systolic or ≥10 mmHg diastolic at 1 or at 3 min upright. No OH-negative comparator was available. The primary outcome was the H-Y stage distribution; secondary outcomes were motor severity (MDS-UPDRS Part III), motor complications, fracture history, physician-documented sleep disturbance and length of stay. Stage groups were compared using rank-based tests with effect sizes, with multivariable and Firth penalized logistic regression for the two principal binary outcomes.
RESULTS: Screen-positive inpatients spanned the whole H-Y spectrum: 42.4% (95% CI 34.1-51.2) were at H-Y 1.0-2.0, before postural instability. One third (33.6%, 95% CI 25.9-42.3) met the criterion at 1 min only and would not have been detected by a 3-min-only rule. Motor severity rose steeply across stage (median MDS-UPDRS Part III 18, 35 and 62.5; ε 2 = 0.65), as did motor complications (ε 2 = 0.52), fracture history (5.3%, 37.9%, 30.0%) and length of stay (ε 2 = 0.10). Physician-documented sleep disturbance instead peaked at the middle stage (30.3%, 58.6%, 45.0%), persisting after adjustment (odds ratio 2.44, 95% CI 1.01-5.92).
CONCLUSION: A bedside OH screen identifies a clinically heterogeneous inpatient group that is not confined to advanced disease, and a third of it is detectable only at 1 min. Because all participants were screen-positive, these comparisons describe that group and cannot establish that the screening result marks burden independently of stage.