PT - JOURNAL ARTICLE AU - Andrea Pilotto AU - Alberto Romagnolo AU - Jasmine A Tuazon AU - Joaquin A Vizcarra AU - Luca Marsili AU - Maurizio Zibetti AU - Michela Rosso AU - Federico Rodriguez-Porcel AU - Barbara Borroni AU - Maria Cristina Rizzetti AU - Carlo Rossi AU - Darwin Vizcarra-Escobar AU - Jennifer R Molano AU - Leonardo Lopiano AU - Roberto Ceravolo AU - Mario Masellis AU - Alberto J Espay AU - Alessandro Padovani AU - Aristide Merola TI - Orthostatic hypotension and REM sleep behaviour disorder: impact on clinical outcomes in α-synucleinopathies AID - 10.1136/jnnp-2019-320846 DP - 2019 Nov 01 TA - Journal of Neurology, Neurosurgery & Psychiatry PG - 1257--1263 VI - 90 IP - 11 4099 - http://jnnp.bmj.com/content/90/11/1257.short 4100 - http://jnnp.bmj.com/content/90/11/1257.full SO - J Neurol Neurosurg Psychiatry2019 Nov 01; 90 AB - Objective Review the effect of orthostatic hypotension (OH) and rapid-eye-movement sleep behavioural disorder (RBD) on survival, cognitive impairment and postural stability, and discuss pathogenic mechanisms involved in the association of these two common non-motor features with relevant clinical outcomes in α-synucleinopathies.Methods We searched PubMed (January 2007–February 2019) for human studies of OH and RBD evaluating cognitive impairment, postural instability, and survival in Parkinson’s disease (PD), dementia with Lewy bodies (DLB), multiple system atrophy (MSA) and pure autonomic failure (PAF). Included studies were analysed for design, key results and limitations as per the Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines.Results OH and RBD showed a positive association with cognitive impairment in PD and DLB, conflicting association in PAF, and no association in MSA. OH was correlated with incident falls and postural instability in PD and DLB but not in MSA. The association between RBD and postural instability was inconclusive; positive in five studies, negative in seven. OH, but not RBD, correlated with reduced survival in PD, DLB and MSA. The combination of OH and RBD was associated with cognitive impairment and more rapid progression of postural instability.Conclusions OH and RBD yielded individual and combined negative effects on disability in α-synucleinopathies, reflecting a ‘malignant’ phenotype of PD with early cognitive impairment and postural instability. Underlying mechanisms may include involvement of selected brainstem cholinergic and noradrenergic nuclei.