Time- and frequency-domain parameters of heart rate variability and sympathetic skin response in Parkinson’s disease

Abstract

The autonomic nervous system (ANS) is regularly affected in Parkinson's disease (PD). Information on autonomic dysfunction can be derived from e.g. altered heart rate variability (HRV) and sympathetic skin response (SSR). Such parameters can be quantified easily and measured repeatedly which might be helpful for evaluating disease progression and therapeutic outcome. In this 2-center study, HRV and SSR of 45 PD patients and 26 controls were recorded. HRV was measured during supine metronomic breathing and analyzed in time- and frequency-domains. SSR was evoked by repetitive auditory stimulation. Various ANS parameters were compared (1) between patients and healthy controls, (2) to clinical scales (Unified Parkinson's disease rating scale, Mini-Mental State Examination, Becks Depression Inventory), and (3) to disease duration. Root mean square of successive differences (RMSSD) and low frequency/high frequency (LF/HF) ratio differed significantly between PD and controls. Both, HRV and SSR parameters showed low or no association with clinical scores. Time-domain parameters tended to be affected already at early PD stages but did not consistently change with longer disease duration. In contrast, frequency-domain parameters were not altered in early PD phases but tended to be lower (LF, LF/HF ratio), respectively higher (HF) with increasing disease duration. This report confirms previous results of altered ANS parameters in PD. In addition, it suggests that (1) these ANS parameters are not relevantly associated with motor, behavioral, and cognitive changes in PD, (2) time-domain parameters are useful for the assessment of early PD, and (3) frequency-domain parameters are more closely associated with disease duration.

Heart rate variability to differentiate essential tremor from early-stage tremor-dominant Parkinson's disease

“…There is ample evidence that cardiac autonomic dysfunction is an early finding in patients with LBD such as PD and DLB [15]. Several recent studies have found that HRV is more profound in patients with PD than in controls [15,16]; however, most of the PD patients enrolled had advanced stage disease and were taking medication (mean disease duration > 3…”

“…Several recent studies have found that HRV is more profound in patients with PD than in controls [15,16]; however, most of the PD patients enrolled had advanced stage disease and were taking medication (mean disease duration > 3…”

“…Heart rate variability (HRV), as determined by electrocardiography (ECG), is a simple and non-invasive method used to investigate cardiac autonomic abnormalities [10]. HRV is reduced in PD, DLB or RBD [11][12][13][14][15][16], and predictive of PD development in elderly [17,18], suggesting the utility of HRV as an early diagnostic tool in LBD. However, HRV has not been compared between ET and TDPD.…”

Heart rate variability shows different cardiovascular modulation in Parkinson’s disease patients with tremor dominant subtype compared to those with akinetic rigid dominant subtype

“…Among the NMS, autonomic cardiovascular disorders have been associated with significant morbidity and mortality and with variable manifestations in patients affected by PD (Goldstein 2003), although the definite correlations with different subtypes of PD are not clear. In this context, analysis of heart rate variability (HRV) represents a not invasive and established tool in assessing cardiovascular autonomic modulation in different extrapyramidal disorders, especially in PD patients (Friedrich et al 2008;Valappil et al 2010;Maetzler et al 2014).…”

Sympathetic skin response and heart rate variability in predicting autonomic disorders in patients with Parkinson disease

“…The wave is considered to originate from sweat glands’ synchronized activation in response to discharges by efferent sympathetic nerve fibers. Though 1 study found SSR responses were not elicited only in a minority of individuals, and without related difference between PD patients and controls, [18] another study found that the SSR might provide valuable information on cholinergic sympathetic function in patients with PD. [19] In our study, we found that there was significant difference between PD and control groups in terms of the SSR ( P  < 0.01), significant prolonged SSR latencies and decreased SSR amplitudes from bilateral hands and both feet, and the absent lower limb SSR was determined in advanced PD patients.…”