Autonomic dysfunction in parkinsonian disorders: assessment and pathophysiology

Asahina, Masato; Vichayanrat, Ekawat; Low, David A.; Iodice, Valeria; Mathias, Christopher J.

doi:10.1136/jnnp-2012-303135

Cited by 111 publications

(91 citation statements)

References 89 publications

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“…PD is frequently associated with symptoms of Autonomic Nervous System (ANS) dysfunction and/or failure [26], including cardiovascular, sexual, bladder, gastrointestinal, and sudo-motor abnormalities [2]. These clinical evidences are in agreement with the results of pathological studies demonstrating how the degenerative process in PD involves subcortical structures, brainstem and medullary autonomic centres as well as post-ganglionic sympathetic fibers [30].…”

Section: Introductionsupporting

confidence: 78%

“…While cardiovascular dysautonomia has traditionally been associated with the later stages of PD, it has recently become evident that it can occur at any disease stage, and that its onset can even precede the appearance of motor symptoms [2,18,50]. Previous studies have reported a variable prevalence of cardiovascular autonomic dysfunction in PD, ranging from 23% to 80% as determined by studies which included cohorts of between 20 and 91 patients [3, 29,35].…”

Section: Introductionmentioning

confidence: 99%

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Assessment of spontaneous cardiovascular oscillations in Parkinson's disease

Valenza

Orsolini

Diciotti

et al. 2016

Biomedical Signal Processing and Control

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Parki so 's disease PD has ee reported to i ol e postga glio i s patheti failure and a wide spectrum of autonomic dysfunctions including cadiovascular, sexual, bladder, gastrointestinal and sudo-motor abnormalities. While these symptoms may have a significant impact on daily activities, as well as quality of life, the evaluation of autonomic nervous system (ANS) dysfunctions relies on a large and expensive battery of autonomic tests only accessible in highly specialized laboratories. In this paper we aim to devise a comprehensive computational assessment of disease-related heartbeat dynamics based on instantaneous, time-varying estimates of spontaneous (resting state) cardiovascular oscillations in PD. To this end, we combine standard ANS-related heart rate variability (HRV) metrics with measures of instantaneous complexity (dominant Lyapunov exponent and entropy) and higher-order statistics (bispectra). Such measures are computed over 600-s recordings acquired at rest in 29 healthy subjects and 30 PD patients. The only significant group-wise differences were found in the variability of the dominant Lyapunov exponent. Also, the best PD vs. healthy controls classification performance (balanced accuracy: 73.47%) was achieved only when retaining the time-varying, non-stationary structure of the dynamical features, whereas classification performance dropped significantly (balanced accuracy: 61.91%) when excluding variability-related features. Additionally, both linear and nonlinear model features correlated with both clinical and neuropsychological assessments of the considered patient population.Our results demonstrate the added value and potential of instantaneous measures of heartbeat dynamics and its variability in characterizing PD-related disabilities in motor and cognitive domains.3

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Section: Introductionsupporting

confidence: 78%

Section: Introductionmentioning

confidence: 99%

Assessment of spontaneous cardiovascular oscillations in Parkinson's disease

Valenza

Orsolini

Diciotti

et al. 2016

Biomedical Signal Processing and Control

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“…The similar heart rate responses to orthostasis and exercise in the INC and DEC groups might suggest that the ability to increase/maintain cardiac output was not the likely mechanism contributing to the impaired blood pressure control in the DEC group, consistent with other autonomic failure disorders that display a preserved cardiac output, yet impaired blood pressure, response to exercise [14,15]. That said, stroke volume (and cardiac output) was not assessed in the present study, cardiac sympathetic denervation is common in Parki so 's disease [1], and an impaired cardiac contractility during exercise has also been reported in PD patients with cardiac sympathetic denervation [11] suggesting that an impaired cardiac output response may have occurred in the DEC group. In contrast, it is possible that the control of total peripheral resistance is impaired in the DEC group.…”

Section: Discussionmentioning

confidence: 57%

“…The proposed mechanisms of cardiovascular autonomic dysfunction in Parki so 's disease generally involve lewy body accumulation and cell loss in various key areas of the autonomic nervous system, such as, autonomic regulatory areas including the hypothalamus, medulla, locus coeruleus and raphe, pre-ganglionic parasympathetic and sympathetic regions including the dorsal vagal motor nuclei of the glossopharyngeal and vagal nerves, autonomic and sympathetic ganglia, as well as post-ganglionic sympathetic denervation [1] that ultimately affect control of blood pressure through baroreflex impairment and loss of sympathetic innervation.…”

Section: Discussionmentioning

confidence: 99%

“…Non-motor features are i reasi gl re og ised i Parki so 's disease, including dysfunction of the autonomic nervous system, which can have a significant impact on quality of life [1]. Cardiovascular autonomic dysfunction can result in precipitous reductions in blood pressure, particularly during various daily activities, such as the upright posture (e.g., orthostatic hypotension), and various symptoms, e.g., cognitive impairment, fatigue and fainting [2].…”

Section: Introductionmentioning

confidence: 99%

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Exercise hemodynamics in Parkinson's disease and autonomic dysfunction

Low

Vichayanrat

Iodice

2014

Parkinsonism & Related Disorders

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ArticleLJMU has developed LJMU Research Online for users to access the research output of the University more effectively. Copyright © and Moral Rights for the papers on this site are retained by the individual authors and/or other copyright owners. Users may download and/or print one copy of any article(s) in LJMU Research Online to facilitate their private study or for non-commercial research. You may not engage in further distribution of the material or use it for any profit-making activities or any commercial gain.The version presented here may differ from the published version or from the version of the record. Please see the repository URL above for details on accessing the published version and note that access may require a subscription. ResultsGroup mean systolic blood pressure (SBP) fell during pre-exercise standing (-39±29 mmHg, P<0.001, 17 patients had orthostatic hypotension (OH)), while heart rate (HR) increased (+13±7 beats.min-1, P<0.001). SBP (P<0.001) increased during exercise with a wide variation in responses. SBP increased in 13 patients (INC; +30±14 mmHg) and either did not change or decreased in 10 patients (DEC -12±11 mmHg, P<0.001 vs INC). The increase in HR was not different between sub-groups (30±12 vs 25±10 beats.min-1, INC vs. DEC, P=0.29). The size of the pre-exercise stand SBP reduction was greater in DEC vs INC (-64±23 (10 out of 10 had OH) vs -19±16 mmHg (7 out of 13 had OH), respectively, P<0.001). The HR elevation was not different between sub-groups (13±8 vs 13±4 beats.min-1, DEC vs INC, P=0.94). Post-exercise SBP/DBP were lower for both sub-groups compared to pre-exercise and the standing SBP reduction post-exercise was not greater relative to pre-exercise in either sub-group. ConclusionExercise-induced hypotension can occur in Parkinson's disease patients with autonomic failure with the magnitude of the exercise response being related to the severity of autonomic dysfunction. Exercise does not appear to worsen OH in this sample of Parkinson's patients.

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Association of Autonomic Dysfunction With Disease Progression and Survival in Parkinson Disease

Tur²,

et al. 2017

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IMPORTANCE Evidence suggests that development of autonomic dysfunction (AutD) may negatively affect disease course and survival in patients with synucleinopathies. However, the few available studies on Parkinson disease (PD) have conflicting results, comprise a small number of patients, have short follow-up periods, and lack pathologic confirmation of the diagnosis.OBJECTIVE To examine the association of time of onset of AutD with disease progression and survival in PD. DESIGN, SETTING, AND PARTICIPANTSThis retrospective review of clinical data from 100 consecutive patients with an autopsy-confirmed diagnosis of PD from the archives of the Queen Square Brain Bank in London, United Kingdom, from January 1, 2006, to June 3, 2016, included patients with PD regularly seen by hospital specialists (neurologists or geriatricians) in the United Kingdom throughout their disease until death. Patients with dementia before or within 1 year after onset of motor symptoms, monogenic forms of PD, comorbidities that affect autonomic function, a coexisting neuropathologic diagnosis, or insufficient clinical information were excluded. MAIN OUTCOMES AND MEASURESSurvival and time from diagnosis to specific disease milestones were calculated to assess disease progression. Autonomic dysfunction was defined as autonomic failure at autonomic function testing or 2 of the following symptoms: urinary symptoms, constipation, upper gastrointestinal tract dysfunction, orthostatic hypotension, sweating abnormalities, or erectile dysfunction. Multivariable Cox proportional hazards regression models on the risk of a disease milestone and death were used.RESULTS A total of 100 patients (60 [60.0%] male; mean [SD] age at diagnosis, 63.9 [10.3] years; mean [SD] disease duration, 14.6 [7.7] years) were studied. Autonomic dysfunction developed in 85 patients (mean [SD] time from diagnosis, 6.7 [7.7] years) and was associated with older age at diagnosis, male sex, poor initial levodopa treatment response, and postural instability and gait difficulty motor PD subtype in linear regression analysis, but staging of α-synuclein pathologic changes was unrelated. Earlier AutD increased the risk of reaching the first milestone (hazard ratio, 0.86; 95% CI, 0.83-0.89; P < .001) and shortened survival (hazard ratio, 0.92; 95% CI, 0.88-0.96; P < .001). Older age at diagnosis and poorer levodopa treatment response were the other factors associated with shorter survival in adjusted multivariate analysis. CONCLUSIONS AND RELEVANCEEarlier AutD is associated with a more rapid development of disease milestones and shorter survival in patients with PD.

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Autonomic dysfunction in parkinsonian disorders: assessment and pathophysiology

Cited by 111 publications

References 89 publications

Assessment of spontaneous cardiovascular oscillations in Parkinson's disease

Assessment of spontaneous cardiovascular oscillations in Parkinson's disease

Exercise hemodynamics in Parkinson's disease and autonomic dysfunction

Association of Autonomic Dysfunction With Disease Progression and Survival in Parkinson Disease

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