The influence of the type, duration, severity and levodopa treatment of Parkinson's disease on cardiovascular autonomic responses

Abstract

The influence of the type, duration, severity and levodopa treatment of Parkinson's disease on autonomic involvement has been assessed. The Valsalva manoeuvre, deep breathing, handgrip and orthostatic tests were performed in 50 patients with Parkinson's disease and in a control group of 30 healthy subjects. No attempt was made to classify further patients with parkinsonian features into groups such as the Shy-Drager syndrome or multiple system atrophy. All test results were significantly smaller in patients than in healthy subjects. The diastolic pressure increase during handgrip was significantly smaller in akinetic-rigid than in tremor-akinetic-rigid type patients. The Valsalva ratio and orthostatic test results were significantly smaller in patients with longer duration than in those with shorter duration of disease. All test results except those of the orthostatic test were significantly smaller in patients with the more severe form than in those with the less severe form of disease. Comparing test results of levodopa-treated and -untreated patients no significant differences were found. Our studies in parkinsonian patients suggest that (1) sympathetic impairment is more pronounced in akinetic-rigid than in tremor-akinetic-rigid type patients; (2) sympathetic impairment occurs early, whereas parasympathetic impairment develops later; (3) sympathetic and parasympathetic impairment parallels the severity of disease; (4) orthostatic parameters are more duration-sensitive than severity-sensitive; (5) chronic levodopa treatment does not markedly influence cardiovascular autonomic responses.

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

“…An overall disease related progressive involvement of the autonomic nervous system became evident only in the significantly inverse correlations between Hoehn & Yahr rating and blood pressure values during passive tilt and active standing. Comparing the correlation coefficients and levels of significance between disease duration, Hoehn & Yahr stage, daily levodopa dose and orthostatic blood pressure response, the latter appeared to be predominantly determined by the non-pharmacological clinical variables supporting previous reports [8,11,12,24].…”

Gastrointestinal dysfunction in Parkinson's Disease

“…Constipation has been identified as a rather frequent symptom in patients with Parkinson's disease ever since the first description of the disease [19][20][21][22][23][24][25][26][27][28][29][30]. Today, constipation is considered the most common manifestation of autonomic dysfunction in this disease occurring at a prevalence in the range of 70 to 80% [20][21][22][23][31][32][33][34][35].…”

Autonomic dysfunctions in idiopathic Parkinson's disease

“…There is no area within the autonomic nervous system that goes unaffected in the course of parkinsonism [5]. Data on the incidence of autonomic incompetence in idiopathic parkinsonian syndrome (iPS) vary between 14 and 80 % depending on the collective studied and the method used [5,[8][9][10]. Subjective handicaps in everyday life related to disturbances of the autonomic nervous system are described in more than 50 % of the patients suffering from idiopathic Parkinson's syndrome [5].…”