Dizziness

03/19/2010

Dizziness and its relationship to Parkinson’s 

Dizziness is sometimes used to describe a feeling of imbalance or insecurity when standing. Dizziness on standing can have multiple causes including those below:

  1. Lightheadedness from low blood pressure
  2. Imbalance or postural instability  when standing causing you to feel dizzy or unstable
  4. Anxiety
    5. Confusion or sedation often descrided as feeling ‘dizziy inside my head”
  5. Vertigo or inner ear problems

Dizziness from low blood pressure most commonly, is due to a condition called orthostatic hypotension, which is a drop in blood pressure that occurs when you move from a lying or sitting position into a standing position

“When we stand, blood pools in the lower legs, our vessels work to squeeze the blood back to the heart, and the heart rate increases so that our blood pressure does not drop,” said cardiologist Rachael Wyman, M.D., of Eastside Cardiology Associates in Kirkland, WA. “If one of these steps does not work adequately, blood pressure will drop when standing.” Orthostatic hypotension can be caused by heart problems, problems in blood circulation, or problems with neurologic control of these functions, referred to as autonomic dysfunction

Orthostatic hypotension secondary to autonomic dysfunction is not uncommon in Parkinson’s, with more than half of patients experiencing this problem at one time or another.

As Parkinson’s advances, the risk of orthostatic hypotension increases. And some medications used to treat the motor symptoms of Parkinson’s can worsen the problem. Your doctor can tell you which drugs lend to orthostatic hypotension, as well as those that can be taken to increase blood pressure.

Another common cause of orthostatic hypotension is low blood volume, which can stem from dehydration.

“Many people with Parkinson’s don’t drink enough fluids, or they limit Dizziness and its relationship to Parkinson’s the amount they drink because of swallowing problems,” said nutritionist Marilyn Ward, R.D, CDE, of Evergreen Hospital Medical Center in Kirkland. “As we get older we can’t rely on our thirst as a reminder to drink. By the time we feel thirsty, we may already be dehydrated,” Ward said. Ms Ward offers the following tips but also reminds us to check with our doctors before making any change:

  • One way to increase fluid intake is to drink a large glass of water or juice every time you take your pills or urinate.
  • Put water where you can easily see it to remind yourself to drink regularly.
  • Drinks with high levels of salt include electrolyte beverages like Gatorade and vegetable juices like tomato and V-8. (Keep in mind that many electrolyte or sport drinks are high in sugar and should be avoided if you have diabetes.) Soups are also a good source of both fluid and salt.
  • Eating smaller, more frequent meals can also help, as the symptoms of orthostatic hypotension can be worse after large meals.
  • See a nutritionist or swallowing specialist if you are having trouble or need guidance with diet. And always speak to your doctor before making any changes to your diet or fluid intake.

 If orthostatic hypotension is severe and not explained by these conditions alone, a cardiac evaluation or testing for other problems such as diabetes may be needed. Heart-pumping function can be evaluated with an echocardiogram or ultrasound, and an EKG can be done to assess heart rate and rhythm

Here are a few additional things you can do to reduce the effects of orthostatic hypotension: ?? Use compression stockings to reduce blood pooling in your legs.

  • Stand slowly and wait a few moments before starting to walk. 
  • If possible, elevate the head of your bed by 5 to 20 degrees. 
  • Ask your doctor or physical therapist for exercises for balance. 
  • Avoid alcohol and high temperature environments like hot tubs. 

If serious problems continue, see your primary care doctor or a cardiologist for additional testing.

 Rachel Wyman, M.D., FACC, and Marilyn Ward, R.D., CDE