Symptoms of autonomic failure in Parkinson?s disease: prevalence and impact on daily life

Magerkurth, C.; Schnitzer, Rita; Braune, Stefan

doi:10.1007/s10286-005-0253-z

Cited by 189 publications

(127 citation statements)

References 27 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: 71%

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: 71%

Assessment of spontaneous cardiovascular oscillations in Parkinson's disease

Valenza

Orsolini

Diciotti

et al. 2016

Biomedical Signal Processing and Control

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“…762 In one survey, 58% of patients with PD reported constipation. 763 The importance of constipation in PD was noted by Parkinson who commented that the bowels "which had been all along torpid, now, in most cases, demand stimulating medicines of very considerable power. "…”

Section: Impulse Dyscontrol and Dopamine Dysregulation Disordersmentioning

confidence: 99%

The scientific and clinical basis for the treatment of Parkinson disease (2009)

Olanow¹,

Stern²,

Sethi³

2009

Neurology

771

658

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Parkinson disease (PD) is an age-related neurodegenerative disorder that affects as many as 1-2% of persons aged 60 years and older. With the aging of the population, the frequency of PD is expected to increase dramatically in the coming decades. Current therapy is largely based on a dopamine replacement strategy, primarily using the dopamine precursor levodopa. However, chronic treatment is associated with the development of motor complications, and the disease is inexorably progressive. Further, advancing disease is associated with the emergence of features such as freezing, falling, and dementia which are not adequately controlled with dopaminergic therapies. Indeed, it is now appreciated that these nondopaminergic features are common and the major source of disability for patients with advanced disease. Many different therapeutic agents and treatment strategies have been evaluated over the past several years to try and address these unmet medical needs, and many promising approaches are currently being tested in the laboratory and in the clinic. As a result, there are now many new therapies and strategic approaches available for the treatment of the different stages of PD, with which the treating physician must be familiar in order to provide patients with optimal care. This monograph provides an overview of the management of PD patients, with an emphasis on pathophysiology, and the results of recent clinical trials. It is intended to provide physicians with an understanding of the different treatment options that are available for managing the different stages of the disease and the scientific rationale of the different approaches. 1 PD is the second most common neurodegenerative disorder, with an average age at onset of about 60 years. An estimated 5 million people throughout the world have PD, with 1 million individuals each in the United States and in Europe with the disorder. PD affects approximately 0.3% of the population and 1% to 2% of those older than 60 years.2 With the aging of the population and the substantial increase in the number of at-risk individuals older than 60 years, it is anticipated that the prevalence of PD will increase dramatically in the coming decades.

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“…SYMPTOMATIC AND ASYMPTOMATIC orthostatic hypotension (OH) is present in 30 -60% of patients with Parkinson's disease (PD) (15) and negatively correlated with quality of life (32). In elderly, OH is associated with cardiovascular morbidity and mortality (31,33).…”

mentioning

confidence: 99%

Lower vascular tone and larger plasma volume in Parkinson's disease with orthostatic hypotension

Groothuis

Esselink

Seeger³

et al. 2011

Journal of Applied Physiology

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Here, we test the role of two other possible factors: 1) a reduced peripheral vasoconstriction (which may contribute because PD includes a generalized sympathetic denervation); and 2) an inadequate plasma volume (which may explain why plasma volume expansion can manage orthostatic hypotension in PD). We included 11 PD patients with orthostatic hypotension (PD ϩ OH), 14 PD patients without orthostatic hypotension (PD Ϫ OH), and 15 agematched healthy controls. Leg blood flow was examined using duplex ultrasound during 60°head-up tilt. Leg vascular resistance was calculated as the arterial-venous pressure gradient divided by blood flow. In a subset of 9 PD ϩ OH, 9 PD Ϫ OH, and 8 controls, plasma volume was determined by indicator dilution method with radiolabeled albumin ( 125 I-HSA). The basal leg vascular resistance was significantly lower in PD ϩ OH (0.7 Ϯ 0.3 mmHg·ml Ϫ1 ·min) compared with PD Ϫ OH (1.3 Ϯ 0.6 mmHg·ml Ϫ1 ·min, P Ͻ 0.01) and controls (1.3 Ϯ 0.5 mmHg·ml Ϫ1 ·min, P Ͻ 0.01). Leg vascular resistance increased significantly during 60°head-up tilt with no significant difference between the groups. Plasma volume was significantly larger in PD ϩ OH (3,869 Ϯ 265 ml) compared with PD Ϫ OH (3,123 Ϯ 377 ml, P Ͻ 0.01) and controls (3,204 Ϯ 537 ml, P Ͻ 0.01). These results indicate that PD ϩ OH have a lower basal leg vascular resistance in combination with a larger plasma volume compared with PD Ϫ OH and controls. Despite the increase in leg vascular resistance during 60°h ead-up tilt, PD ϩ OH are unable to maintain their blood pressure.Parkinson's disease; orthostatic hypotension; leg vascular resistance; plasma volume; head-up tilt SYMPTOMATIC AND ASYMPTOMATIC orthostatic hypotension (OH) is present in 30 -60% of patients with Parkinson's disease (PD) (15) and negatively correlated with quality of life (32). In elderly, OH is associated with cardiovascular morbidity and mortality (31, 33). The pathophysiology of OH in PD remains incompletely understood. Until now, the focus has been primarily on impairment of central mediated vasoconstrictor mechanisms. PD patients have a reduced baroreflex cardiovagal function, denervation of the heart, low norepinephrine levels, and no increment in norepinephrine levels during orthostatic challenges (14, 39). However, baroreflex failure and cardiac sympathetic denervation contribute to but cannot fully explain OH in PD (14, 16). During orthostatic challenges peripheral vasoconstriction contributes to maintain blood pressure via a central mediated vasoconstrictor mechanism, i.e., baroreflex, and local vasoconstrictor mechanisms, such as the venoarteriolar axon reflex (21) and the myogenic response (11). Since in PD a generalized rather than a central sympathetic denervation is present (40), central and local mediated peripheral vasoconstriction might be affected and, thereby, might play an important role in the pathophysiology of OH in PD.Furthermore, a lower plasma volume may be another contributing factor to OH in PD. This assumption is based on the important role of the s...

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Symptoms of autonomic failure in Parkinson?s disease: prevalence and impact on daily life

Cited by 189 publications

References 27 publications

Assessment of spontaneous cardiovascular oscillations in Parkinson's disease

Assessment of spontaneous cardiovascular oscillations in Parkinson's disease

The scientific and clinical basis for the treatment of Parkinson disease (2009)

Lower vascular tone and larger plasma volume in Parkinson's disease with orthostatic hypotension

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