1
|
Iranzo A, Cochen De Cock V, Fantini ML, Pérez-Carbonell L, Trotti LM. Sleep and sleep disorders in people with Parkinson's disease. Lancet Neurol 2024; 23:925-937. [PMID: 38942041 DOI: 10.1016/s1474-4422(24)00170-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/22/2024] [Revised: 04/02/2024] [Accepted: 04/16/2024] [Indexed: 06/30/2024]
Abstract
Sleep disorders are common in people with Parkinson's disease. These disorders, which increase in frequency throughout the course of the neurodegenerative disease and impair quality of life, include insomnia, excessive daytime sleepiness, circadian disorders, obstructive sleep apnoea, restless legs syndrome, and rapid eye movement (REM) sleep behaviour disorder. The causes of these sleep disorders are complex and multifactorial, including the degeneration of the neural structures that modulate sleep, the detrimental effect of some medications on sleep, the parkinsonian symptoms that interfere with mobility and comfort in bed, and comorbidities that disrupt sleep quality and quantity. The clinical evaluation of sleep disorders include both subjective (eg, questionnaires or diaries) and objective (eg, actigraphy or video polysomnography) assessments. The management of patients with Parkinson's disease and a sleep disorder is challenging and should be individualised. Treatment can include education aiming at changes in behaviour (ie, sleep hygiene), cognitive behavioural therapy, continuous dopaminergic stimulation at night, and specific medications. REM sleep behaviour disorder can occur several years before the onset of parkinsonism, suggesting that the implementation of trials of neuroprotective therapies should focus on people with this sleep disorder.
Collapse
Affiliation(s)
- Alex Iranzo
- Sleep Disorders Unit, Neurology Service, Hospital Clínic de Barcelona, Universitat de Barcelona, Barcelona, Spain; IDIBAPS, Universitat de Barcelona, Barcelona, Spain; CIBERNED, Universitat de Barcelona, Barcelona, Spain.
| | - Valerie Cochen De Cock
- Sleep and Neurology Department, Beau Soleil Clinic, Montpellier, France; EuroMov Digital Health in Motion, University of Montpellier, IMT Mines Ales, Montpellier, France
| | - María Livia Fantini
- Neurophysiology Unit, Neurology Department, Université Clermont Auvergne, CNRS, Institut Pascal, Clermont-Ferrand University Hospital, Clermont-Ferrand, France
| | - Laura Pérez-Carbonell
- Sleep Disorders Centre, Guy's and St Thomas' NHS Foundation Trust, King's College London, London, UK
| | - Lynn Marie Trotti
- Department of Neurology, Emory University School of Medicine, Atlanta, GA, USA; Emory Sleep Center, Emory University School of Medicine, Atlanta, GA, USA
| |
Collapse
|
2
|
Canever JB, Queiroz LY, Soares ES, de Avelar NCP, Cimarosti HI. Circadian rhythm alterations affecting the pathology of neurodegenerative diseases. J Neurochem 2024; 168:1475-1489. [PMID: 37358003 DOI: 10.1111/jnc.15883] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/30/2023] [Revised: 05/27/2023] [Accepted: 06/01/2023] [Indexed: 06/27/2023]
Abstract
The circadian rhythm is a nearly 24-h oscillation found in various physiological processes in the human brain and body that is regulated by environmental and genetic factors. It is responsible for maintaining body homeostasis and it is critical for essential functions, such as metabolic regulation and memory consolidation. Dysregulation in the circadian rhythm can negatively impact human health, resulting in cardiovascular and metabolic diseases, psychiatric disorders, and premature death. Emerging evidence points to a relationship between the dysregulation circadian rhythm and neurodegenerative diseases, suggesting that the alterations in circadian function might play crucial roles in the pathogenesis and progression of neurodegenerative diseases. Better understanding this association is of paramount importance to expand the knowledge on the pathophysiology of neurodegenerative diseases, as well as, to provide potential targets for the development of new interventions based on the dysregulation of circadian rhythm. Here we review the latest findings on dysregulation of circadian rhythm alterations in Parkinson's disease, Alzheimer's disease, Huntington's disease, amyotrophic lateral sclerosis, multiple sclerosis, spinocerebellar ataxia and multiple-system atrophy, focusing on research published in the last 3 years.
Collapse
Affiliation(s)
- Jaquelini Betta Canever
- Postgraduate Program of Neuroscience, Center of Biological Sciences, Federal University of Santa Catarina, Florianópolis, Santa Catarina, Brazil
| | - Letícia Yoshitome Queiroz
- Postgraduate Program of Pharmacology, Department of Pharmacology, Federal University of Santa Catarina, Florianópolis, Santa Catarina, Brazil
| | - Ericks Sousa Soares
- Postgraduate Program of Pharmacology, Department of Pharmacology, Federal University of Santa Catarina, Florianópolis, Santa Catarina, Brazil
| | - Núbia Carelli Pereira de Avelar
- Laboratory of Aging, Resources and Rheumatology, Department of Health Sciences, Federal University of Santa Catarina, Araranguá, Santa Catarina, Brazil
| | - Helena Iturvides Cimarosti
- Postgraduate Program of Neuroscience, Center of Biological Sciences, Federal University of Santa Catarina, Florianópolis, Santa Catarina, Brazil
- Postgraduate Program of Pharmacology, Department of Pharmacology, Federal University of Santa Catarina, Florianópolis, Santa Catarina, Brazil
| |
Collapse
|
3
|
Sun Y, Wei L, Li F, Ling C, Zhai F, Lv Y, Zhou H, Zhang C, Ma J, Chen J, Sun W, Wang Z. Associations of sleep-related variables with reverse dipping patterns of blood pressure in α-synucleinopathies. Parkinsonism Relat Disord 2024; 121:106046. [PMID: 38367532 DOI: 10.1016/j.parkreldis.2024.106046] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/09/2023] [Revised: 02/08/2024] [Accepted: 02/10/2024] [Indexed: 02/19/2024]
Abstract
INTRODUCTION The reverse dipping blood pressure (BP) pattern is very common in α-synucleinopathies. We aimed to explore the associations of sleep-related variables with abnormal BP circadian rhythms in Parkinson's disease (PD) and multiple system atrophy (MSA). METHODS A total of 126 patients, 76 with PD and 50 with MSA, were included. All participants underwent ambulatory BP monitoring and full-night polysomnography (PSG). We analyzed abnormal dipping patterns and sleep-related parameters, including moderate to severe obstructive sleep apnea (OSA), rapid eye movement behavior disorder (RBD), average oxygen saturation (SaO2%), lowest SaO2%, duration of SaO2% <90%, and apnea-hypopnea index (AHI). Binary logistic regression was performed to explore the associations between paraclinical variables, sleep-related variables, and reverse dipping patterns. RESULTS Reverse dipping patterns were predominant in patients with PD (58.5 %) and MSA (68.0 %). Patients with MSA had higher AHI, RBD, and lower average SaO2% than those with PD. Taking both diseases together as a whole group of α-synucleinopathies, logistic regression analysis indicates the Hoehn-Yahr stage (odds ratio [OR] = 2.00 for reverse systolic and 2.34 for reverse diastolic dipping patterns), moderate to severe OSA (OR = 2.71 for reverse systolic and 2.53 for reverse diastolic dipping patterns), average SaO2% (OR = 1.35 for reverse systolic dipping patterns), and male sex (OR = 2.70 for reverse diastolic dipping patterns) were independently associated with reverse dipping patterns. CONCLUSIONS Reverse dipping patterns were common in patients with PD and MSA. Hoehn-Yahr stage, moderate to severe OSA, average SaO2%, and male sex were associated with reverse dipping patterns in α-synucleinopathy.
Collapse
Affiliation(s)
- Yunchuang Sun
- Department of Neurology, Peking University First Hospital, NO.8 Xishiku Street, Xicheng District, Beijing, 100034, China; Beijing Key Laboratory of Neurovascular Disease Discovery, Beijing, 100034, China
| | - Luhua Wei
- Department of Neurology, Peking University First Hospital, NO.8 Xishiku Street, Xicheng District, Beijing, 100034, China
| | - Fan Li
- Department of Neurology, Peking University First Hospital, NO.8 Xishiku Street, Xicheng District, Beijing, 100034, China
| | - Chen Ling
- Department of Neurology, Peking University First Hospital, NO.8 Xishiku Street, Xicheng District, Beijing, 100034, China
| | - Fei Zhai
- Department of Neurology, Shijiazhuang People's Hospital, NO.9 Fangbei Road, Chang'an District, Shijiazhuang City, Hebei province, 050011, China
| | - Yunfeng Lv
- Department of Neurology, Northeast International Hospital, NO.169 ChangJiang South Street, HuangGu District, ShenYang City, Liaoning province, 110031, China
| | - Hong Zhou
- Department of Neurology, Civil Aviation General Hospital, Beijing, 100123, China
| | - Cheng Zhang
- Department of Respiratory and Critical Care Medicine, Peking University First Hospital, NO.8 Xishiku Street, Xicheng District, Beijing, 100034, China
| | - Jing Ma
- Department of Respiratory and Critical Care Medicine, Peking University First Hospital, NO.8 Xishiku Street, Xicheng District, Beijing, 100034, China
| | - Jing Chen
- Department of Neurology, Peking University First Hospital, NO.8 Xishiku Street, Xicheng District, Beijing, 100034, China
| | - Wei Sun
- Department of Neurology, Peking University First Hospital, NO.8 Xishiku Street, Xicheng District, Beijing, 100034, China.
| | - Zhaoxia Wang
- Department of Neurology, Peking University First Hospital, NO.8 Xishiku Street, Xicheng District, Beijing, 100034, China; Beijing Key Laboratory of Neurovascular Disease Discovery, Beijing, 100034, China.
| |
Collapse
|
4
|
Faraci FM, Scheer FA. Hypertension: Causes and Consequences of Circadian Rhythms in Blood Pressure. Circ Res 2024; 134:810-832. [PMID: 38484034 PMCID: PMC10947115 DOI: 10.1161/circresaha.124.323515] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/25/2024] [Accepted: 02/16/2024] [Indexed: 03/19/2024]
Abstract
Hypertension is extremely common, affecting approximately 1 in every 2 adults globally. Chronic hypertension is the leading modifiable risk factor for cardiovascular disease and premature mortality worldwide. Despite considerable efforts to define mechanisms that underlie hypertension, a potentially major component of the disease, the role of circadian biology has been relatively overlooked in both preclinical models and humans. Although the presence of daily and circadian patterns has been observed from the level of the genome to the whole organism, the functional and structural impact of biological rhythms, including mechanisms such as circadian misalignment, remains relatively poorly defined. Here, we review the impact of daily rhythms and circadian systems in regulating blood pressure and the onset, progression, and consequences of hypertension. There is an emphasis on the impact of circadian biology in relation to vascular disease and end-organ effects that, individually or in combination, contribute to complex phenotypes such as cognitive decline and the loss of cardiac and brain health. Despite effective treatment options for some individuals, control of blood pressure remains inadequate in a substantial portion of the hypertensive population. Greater insight into circadian biology may form a foundation for novel and more widely effective molecular therapies or interventions to help in the prevention, treatment, and management of hypertension and its related pathophysiology.
Collapse
Affiliation(s)
- Frank M. Faraci
- Department of Internal Medicine, Francois M. Abboud Cardiovascular Center, Carver College of Medicine, University of Iowa, Iowa City, IA 52242-1081
- Department of Neuroscience and Pharmacology, Francois M. Abboud Cardiovascular Center, Carver College of Medicine, University of Iowa, Iowa City, IA 52242-1081
| | - Frank A.J.L. Scheer
- Division of Sleep Medicine, Harvard Medical School, Brigham and Women's Hospital, Boston, Massachusetts, 02115
- Medical Chronobiology Program, Division of Sleep and Circadian Disorders, Departments of Medicine and Neurology, Brigham and Women's Hospital, Boston, Massachusetts, 02115
| |
Collapse
|
5
|
Fernando CV, Osborn S, Horne M. At-Home Blood Pressure Measurements Provide Better Assessments of Orthostatic Hypotension in Parkinson's Disease. J Pers Med 2023; 13:1324. [PMID: 37763091 PMCID: PMC10532916 DOI: 10.3390/jpm13091324] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/04/2023] [Revised: 08/25/2023] [Accepted: 08/26/2023] [Indexed: 09/29/2023] Open
Abstract
Orthostatic hypotension (OH) is common in Parkinson's Disease (PD). It is intermittent, exacerbated by stressors including meals, medications, and dehydration, and frequently is unrecognized. Although intermittent, assessment is usually by a single "in clinic" BP measurement. This study examines whether 10 home measurements are more sensitive in detecting OH than a single "in clinic" measurement. Participants (44 people with PD and 16 controls) were instructed to measure lying and standing BP at home. BP was measured on five consecutive days upon waking and before bedtime. Symptoms were also assessed using the Movement Disorder Society United Parkinson's Disease Rating Scale and the Non-Motor Questionnaire. While a postural drop in systolic BP (≥20 mmHg) was recorded "in clinic" in thirteen of the forty-four PD participants, a postural drop was found in at least one of the ten home measurements in twenty-eight of the forty-four participants. Morning hypertension and variability in lying systolic BP was more common in these subjects than in those without a postural drop or the controls. A greater number of measurements of lying and standing BP are more likely to reveal orthostatic hypotension, variation in systolic BP, and hypertension than a single office measurement in people with PD.
Collapse
Affiliation(s)
| | - Sarah Osborn
- The Bionics Institute, East Melbourne, VIC 3002, Australia;
| | - Malcolm Horne
- The Bionics Institute, East Melbourne, VIC 3002, Australia;
- Department of Medicine, University of Melbourne, St Vincent’s Hospital, Fitzroy, VIC 3065, Australia
| |
Collapse
|
6
|
Liu JY, Xue J, Wang F, Wang YL, Dong WL. α-Synuclein-Induced Destabilized BMAL1 mRNA Leads to Circadian Rhythm Disruption in Parkinson's Disease. Neurotox Res 2023; 41:177-186. [PMID: 36662411 DOI: 10.1007/s12640-022-00633-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/17/2022] [Revised: 12/07/2022] [Accepted: 12/30/2022] [Indexed: 01/21/2023]
Abstract
Circadian dysfunction is a common non-motor symptom in Parkinson's disease (PD). The potential influence of aggravated α-synuclein (SNCA) on circadian disruption remains unclear. SNCAA53T-overexpressing transgenic mice (SNCAA53T mice) and wild-type (WT) littermates were used in this study. The energy metabolism cage test showed differences in 24-h activity pattern between SNCAA53T and WT mice. When compared with the age-matched littermates, brain and muscle ARNT-like 1 (BMAL1) was downregulated in SNCAA53T mice. BMAL1 was downregulated in PC12 cells overexpressing SNCA. Degradation of BMAL1 protein remained unchanged after overexpression of SNCA, while its mRNA level decreased. miRNA (miR)-155 was upregulated by overexpression of SNCA, and downregulation of BMAL1 was partially reversed by transfection with miR-155 inhibitor. Our findings demonstrated that overexpression of SNCA induced biorhythm disruption and downregulated BMAL1 expression through decreasing stability of BMAL1 mRNA via miR-155.
Collapse
Affiliation(s)
- Jun-Yi Liu
- Department of Neurology, Dushu Lake Hospital Affiliated to Soochow University, Suzhou, 214123, China
| | - Jian Xue
- Department of Neurology, Dushu Lake Hospital Affiliated to Soochow University, Suzhou, 214123, China
- Institute of Neuroscience, Soochow University, Suzhou, 215123, China
| | - Fen Wang
- Institute of Neuroscience, Soochow University, Suzhou, 215123, China
| | - Ya-Li Wang
- Department of Neurology, Suzhou Municipal Hospital (North), Nanjing Medical University, Suzhou, 215008, China.
| | - Wan-Li Dong
- Department of Neurology, Dushu Lake Hospital Affiliated to Soochow University, Suzhou, 214123, China.
| |
Collapse
|
7
|
Tanaka R, Hattori N. Abnormal circadian blood pressure regulation and cognitive impairment in α-synucleinopathies. Hypertens Res 2022; 45:1908-1917. [PMID: 36123397 DOI: 10.1038/s41440-022-01032-w] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/30/2022] [Revised: 08/08/2022] [Accepted: 08/25/2022] [Indexed: 11/09/2022]
Abstract
Circadian blood pressure (BP) rhythm is important for the maintenance of healthy daily life, and its disruption is associated with poor outcomes. Cardiovascular autonomic failure is often observed in older populations but has a greater impact on neurodegenerative disorders such as α-synucleinopathies. These BP abnormalities include orthostatic hypotension (OH), supine hypertension (SH), and a loss of nocturnal BP fall. OH not only causes falls or syncope but is also related to cognitive impairment in α-synucleinopathies. For example, OH doubles or triples the risk for the development of cognitive impairment in Parkinson's disease (PD). The diffuse central and peripheral neuropathology of α-synuclein may contribute to both OH and cognitive impairment. Moreover, repeated cerebral hypoperfusion in OH is thought to be related to cerebrovascular and neuronal damage, which may cause cognitive impairment. SH, which often coexists with OH, is also associated with cognitive impairment through cerebrovascular damage, such as white matter lesions and cerebral microbleeds. The reverse-dipping (riser) pattern on ambulatory BP monitoring is commonly observed in PD (∼56%), regardless of disease duration and severity. It is also related to cognitive impairment and more pronounced when coexisting with OH. These abnormal circadian BP profiles may be synergistically associated with cognitive impairment and poor outcomes in α-synucleinopathies. Although evidence for aggressive control of BP dysregulation improving cognitive impairment and outcomes is limited, regular BP monitoring appears to be important for total management of α-synucleinopathies.
Collapse
Affiliation(s)
- Ryota Tanaka
- Stroke Center and Division of Neurology, Department of Medicine, Jichi Medical University, Yakushiji 3311-1, Shimotsuke-shi, Tochigi, 329-0498, Japan.
| | - Nobutaka Hattori
- Department of Neurology, Juntendo University School of Medicine, Hongo 3311-1, Bunkyo-ku, Tokyo, 113-0011, Japan
| |
Collapse
|
8
|
Bedtime dosing of antihypertensive medications: systematic review and consensus statement: International Society of Hypertension position paper endorsed by World Hypertension League and European Society of Hypertension. J Hypertens 2022; 40:1847-1858. [PMID: 35983870 DOI: 10.1097/hjh.0000000000003240] [Citation(s) in RCA: 28] [Impact Index Per Article: 14.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/25/2022]
Abstract
Antihypertensive drug therapy is one of the most efficient medical interventions for preventing disability and death globally. Most of the evidence supporting its benefits has been derived from outcome trials with morning dosing of medications. Accumulating evidence suggests an adverse prognosis associated with night-time hypertension, nondipping blood pressure (BP) profile and morning BP surge, with increased incidence of cardiovascular events during the first few morning hours. These observations provide justification for complete 24-h BP control as being the primary goal of antihypertensive treatment. Bedtime administration of antihypertensive drugs has also been proposed as a potentially more effective treatment strategy than morning administration. This Position Paper by the International Society of Hypertension reviewed the published evidence on the clinical relevance of the diurnal variation in BP and the timing of antihypertensive drug treatment, aiming to provide consensus recommendations for clinical practice. Eight published outcome hypertension studies involved bedtime dosing of antihypertensive drugs, and all had major methodological and/or other flaws and a high risk of bias in testing the impact of bedtime compared to morning treatment. Three ongoing, well designed, prospective, randomized controlled outcome trials are expected to provide high-quality data on the efficacy and safety of evening or bedtime versus morning drug dosing. Until that information is available, preferred use of bedtime drug dosing of antihypertensive drugs should not be routinely recommended in clinical practice. Complete 24-h control of BP should be targeted using readily available, long-acting antihypertensive medications as monotherapy or combinations administered in a single morning dose.
Collapse
|
9
|
Toba A, Ishikawa J, Harada K. Increased blood pressure variability is associated with probable rapid eye movement sleep behaviour disorder in elderly hypertensive patients. Blood Press 2022; 31:40-46. [DOI: 10.1080/08037051.2022.2055531] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/02/2022]
Affiliation(s)
- Ayumi Toba
- Division of Cardiology, Tokyo Metropolitan Geriatric Hospital and Institute of Gerontology, Tokyo, Japan
| | - Joji Ishikawa
- Division of Cardiology, Tokyo Metropolitan Geriatric Hospital and Institute of Gerontology, Tokyo, Japan
| | - Kazumasa Harada
- Division of Cardiology, Tokyo Metropolitan Geriatric Hospital and Institute of Gerontology, Tokyo, Japan
| |
Collapse
|
10
|
Vallelonga F, Sobrero G, Merola A, Valente M, Giudici M, Di Stefano C, Milazzo V, Burrello J, Burrello A, Veglio F, Romagnolo A, Maule S. Machine learning applied to ambulatory blood pressure monitoring: a new tool to diagnose autonomic failure? J Neurol 2022; 269:3833-3840. [PMID: 35192033 PMCID: PMC9217832 DOI: 10.1007/s00415-022-11020-2] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/09/2021] [Revised: 02/08/2022] [Accepted: 02/08/2022] [Indexed: 10/29/2022]
Abstract
BACKGROUND Autonomic failure (AF) complicates Parkinson's disease (PD) in one-third of cases, resulting in complex blood pressure (BP) abnormalities. While autonomic testing represents the diagnostic gold standard for AF, accessibility to this examination remains limited to a few tertiary referral centers. OBJECTIVE The present study sought to investigate the accuracy of a machine learning algorithm applied to 24-h ambulatory BP monitoring (ABPM) as a tool to facilitate the diagnosis of AF in patients with PD. METHODS Consecutive PD patients naïve to vasoactive medications underwent 24 h-ABPM and autonomic testing. The diagnostic accuracy of a Linear Discriminant Analysis (LDA) model exploiting ABPM parameters was compared to autonomic testing (as per a modified version of the Composite Autonomic Symptom Score not including the sudomotor score) in the diagnosis of AF. RESULTS The study population consisted of n = 80 PD patients (33% female) with a mean age of 64 ± 10 years old and disease duration of 6.2 ± 4 years. The prevalence of AF at the autonomic testing was 36%. The LDA model showed 91.3% accuracy (98.0% specificity, 79.3% sensitivity) in predicting AF, significantly higher than any of the ABPM variables considered individually (hypotensive episodes = 82%; reverse dipping = 79%; awakening hypotension = 74%). CONCLUSION LDA model based on 24-h ABPM parameters can effectively predict AF, allowing greater accessibility to an accurate and easy to administer test for AF. Potential applications range from systematic AF screening to monitoring and treating blood pressure dysregulation caused by PD and other neurodegenerative disorders.
Collapse
Affiliation(s)
- Fabrizio Vallelonga
- Autonomic Unit and Hypertension Unit, Internal Medicine Division, Department of Medical Sciences, University of Turin, via Genova 3, 10126, Turin, Italy.
| | - G Sobrero
- Autonomic Unit and Hypertension Unit, Internal Medicine Division, Department of Medical Sciences, University of Turin, via Genova 3, 10126, Turin, Italy
| | - A Merola
- Department of Neurology, Wexner Medical Center, Ohio State University, Columbus, OH, USA
| | - M Valente
- Autonomic Unit and Hypertension Unit, Internal Medicine Division, Department of Medical Sciences, University of Turin, via Genova 3, 10126, Turin, Italy
| | - M Giudici
- Autonomic Unit and Hypertension Unit, Internal Medicine Division, Department of Medical Sciences, University of Turin, via Genova 3, 10126, Turin, Italy
| | - C Di Stefano
- Autonomic Unit and Hypertension Unit, Internal Medicine Division, Department of Medical Sciences, University of Turin, via Genova 3, 10126, Turin, Italy
| | - V Milazzo
- Autonomic Unit and Hypertension Unit, Internal Medicine Division, Department of Medical Sciences, University of Turin, via Genova 3, 10126, Turin, Italy
| | - J Burrello
- Autonomic Unit and Hypertension Unit, Internal Medicine Division, Department of Medical Sciences, University of Turin, via Genova 3, 10126, Turin, Italy
| | - A Burrello
- Department of Electrical, Electronic and Information Engineering "Guglielmo Marconi" (DEI), University of Bologna, Bologna, Italy
| | - F Veglio
- Autonomic Unit and Hypertension Unit, Internal Medicine Division, Department of Medical Sciences, University of Turin, via Genova 3, 10126, Turin, Italy
| | - A Romagnolo
- Department of Neuroscience "Rita Levi Montalcini", University of Turin, via Cherasco 15, 10124, Turin, Italy
| | - S Maule
- Autonomic Unit and Hypertension Unit, Internal Medicine Division, Department of Medical Sciences, University of Turin, via Genova 3, 10126, Turin, Italy
| |
Collapse
|
11
|
Shen L, Yang X, Lu W, Chen W, Ye X, Wu D. 24-hour ambulatory blood pressure alterations in patients with Parkinson's disease. Brain Behav 2022; 12:e2428. [PMID: 34841724 PMCID: PMC8785618 DOI: 10.1002/brb3.2428] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/17/2021] [Revised: 10/07/2021] [Accepted: 10/12/2021] [Indexed: 11/12/2022] Open
Abstract
OBJECTS Abnormal blood pressure (BP) regulation is a feature of autonomic dysfunction in Parkinson's disease (PD) patients. The present study was to analyze the BP alterations by 24-h ambulatory BP monitoring in PD patients with different disease stages and subtypes. METHODS 32 consecutive patients PD patients and 43 control patients in our hospital from 2017 to 2020 were included. The circadian BP rhythm was divided into three types according to the 24-h ambulatory BP monitoring. Dipping was defined as an average systolic BP (SBP) reduction during night-time of 10%-19%. Reverse dipping was defined as an average increase in night-time SBP values. The differences of the circadian BP rhythm and BP variability (BPV) were analyzed between PD group and the control group, the early PD group and the advanced PD group, as well as the tremor-dominant group and the nontremor-dominant group. RESULTS There was statistical difference in circadian BP rhythm between PD group and control group (p < .05). There were statistical differences in circadian BP rhythm between the early PD group and the advanced PD group (p < .05). The mean values of night-time SBP and diastolic BP (DBP) in the advanced PD group were higher than those in the control group and the early PD group (p < .05). The DBP CV in the advanced PD group was higher than that in the control group and the early PD group (p < .05). There was no significant difference of circadian BP rhythm, mean BP, and BPV between the tremor-dominant and the nontremor-dominant PD group after matching the disease duration. CONCLUSIONS Reverse dipping was more common in PD patients in this study, especially in the advanced PD patients. 24-h ambulatory BP monitoring is an important method to evaluate the BP alterations in PD patients. Clinicians should be alert to reverse dipping in PD patients and intervene to prevent serious clinical events.
Collapse
Affiliation(s)
- Liwei Shen
- Department of Neurology, Shanghai Fifth People's Hospital, Fudan University, Shanghai, China
| | - Xiaoli Yang
- Department of Neurology, Shanghai Fifth People's Hospital, Fudan University, Shanghai, China
| | - Wenmei Lu
- Department of Neurology, Shanghai Fifth People's Hospital, Fudan University, Shanghai, China
| | - Weijie Chen
- Department of Neurology, Shanghai Fifth People's Hospital, Fudan University, Shanghai, China
| | - Xiaofei Ye
- Department of Health Statistics, Naval Medical University, Shanghai, China
| | - Danhong Wu
- Department of Neurology, Shanghai Fifth People's Hospital, Fudan University, Shanghai, China
| |
Collapse
|
12
|
Yeh JT, Chiu TJ, Cheng HM. Reply to "Letter to the Editor for the Review Paper: The association between blood pressure variability with dementia and cognitive function: A systematic review and meta-analysis". J Clin Hypertens (Greenwich) 2021; 24:89-90. [PMID: 34894174 PMCID: PMC8783330 DOI: 10.1111/jch.14410] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/13/2021] [Revised: 11/16/2021] [Accepted: 11/17/2021] [Indexed: 11/30/2022]
Affiliation(s)
- Jiunn-Tyng Yeh
- Department of Medicine, National Yang Ming Chiao Tung University College of Medicine, Taipei, Taiwan
| | - Tzu-Jung Chiu
- Department of Medical Education, Taipei Veterans General Hospital, Taipei, Taiwan
| | - Hao-Min Cheng
- Department of Medicine, National Yang Ming Chiao Tung University College of Medicine, Taipei, Taiwan.,Department of Medical Education, Taipei Veterans General Hospital, Taipei, Taiwan.,Center for Evidence-based Medicine, Taipei Veterans General Hospital, Taipei, Taiwan.,Institute of Public Health, National Yang Ming Chiao Tung University College of Medicine, Taipei, Taiwan.,Institute of Health and Welfare Policy, National Yang Ming Chiao Tung University College of Medicine, Taipei, Taiwan
| |
Collapse
|
13
|
Abstract
Endogenous biological clocks, orchestrated by the suprachiasmatic nucleus, time the circadian rhythms that synchronize physiological and behavioural functions in humans. The circadian system influences most physiological processes, including sleep, alertness and cognitive performance. Disruption of circadian homeostasis has deleterious effects on human health. Neurodegenerative disorders involve a wide range of symptoms, many of which exhibit diurnal variations in frequency and intensity. These disorders also disrupt circadian homeostasis, which in turn has negative effects on symptoms and quality of life. Emerging evidence points to a bidirectional relationship between circadian homeostasis and neurodegeneration, suggesting that circadian function might have an important role in the progression of neurodegenerative disorders. Therefore, the circadian system has become an attractive target for research and clinical care innovations. Studying circadian disruption in neurodegenerative disorders could expand our understanding of the pathophysiology of neurodegeneration and facilitate the development of novel, circadian-based interventions for these disabling disorders. In this Review, we discuss the alterations to the circadian system that occur in movement (Parkinson disease and Huntington disease) and cognitive (Alzheimer disease and frontotemporal dementia) neurodegenerative disorders and provide directions for future investigations in this field.
Collapse
|
14
|
Could New Generations of Sensors Reshape the Management of Parkinson’s Disease? CLINICAL AND TRANSLATIONAL NEUROSCIENCE 2021. [DOI: 10.3390/ctn5020018] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
Parkinson's disease (PD) is a chronic neurologic disease that has a great impact on the patient’s quality of life. The natural course of the disease is characterized by an insidious onset of symptoms, such as rest tremor, shuffling gait, bradykinesia, followed by improvement with the initiation of dopaminergic therapy. However, this “honeymoon period” gradually comes to an end with the emergence of motor fluctuations and dyskinesia. PD patients need long-term treatments and monitoring throughout the day; however, clinical examinations in hospitals are often not sufficient for optimal management of the disease. Technology-based devices are a new comprehensive assessment method of PD patient’s symptoms that are easy to use and give unbiased measurements. This review article provides an exhaustive overview of motor complications of advanced PD and new approaches to the management of the disease using sensors.
Collapse
|
15
|
Vallelonga F, Sobrero G, Giudici M, Valente M, Milazzo V, Di Stefano C, Maule S. Screening indexes for cardiovascular autonomic failure in Parkinson's disease. J Neurol Sci 2021; 428:117571. [PMID: 34265574 DOI: 10.1016/j.jns.2021.117571] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/11/2021] [Revised: 06/20/2021] [Accepted: 07/05/2021] [Indexed: 10/20/2022]
Abstract
Autonomic failure (AF) is a common source of orthostatic hypotension (OH) in Parkinson's disease (PD). The diagnosis of AF is difficult on clinical grounds alone. We used autonomic testing and 24-h BP monitoring (ABPM) in 122 PD patients to evaluate the diagnostic accuracy of AF by (1) the reduced heart rate increase to fall in blood pressure (BP) ratio (ΔHR/ΔSBP), (2) reverse dipping (RD), and (3) increased diurnal systolic BP standard deviation (SD-SBP). Among patients with OH, ΔHR/ΔSBP yielded the best accuracy (85%), with excellent sensitivity (92%) and acceptable specificity (67%). RD and, to a lesser extent, SD-SBP had high specificity (93% and 73%, respectively) but low sensitivity, resulting in overall moderate accuracy (66% and 55%, respectively). In patients with OH, the addition of ABPM indexes to ΔHR/ΔSBP did not result in a significant improvement of accuracy. In patients without OH, RD and SD-SBP may be useful showing an accuracy of 72% and 81%, respectively, with high negative predictive value when both RD and increased SD-SBP are absent. The integration of bedside (∆HR/∆SBP) and ABPM-derived indexes can assist the clinician in screening PD patients for AF and guide referral to autonomic testing.
Collapse
Affiliation(s)
- F Vallelonga
- Autonomic and Hypertension Unit, Department of Medical Sciences, University of Turin, Turin, Italy
| | - G Sobrero
- Autonomic and Hypertension Unit, Department of Medical Sciences, University of Turin, Turin, Italy.
| | - M Giudici
- Autonomic and Hypertension Unit, Department of Medical Sciences, University of Turin, Turin, Italy
| | - M Valente
- Autonomic and Hypertension Unit, Department of Medical Sciences, University of Turin, Turin, Italy
| | - V Milazzo
- Autonomic and Hypertension Unit, Department of Medical Sciences, University of Turin, Turin, Italy
| | - C Di Stefano
- Autonomic and Hypertension Unit, Department of Medical Sciences, University of Turin, Turin, Italy
| | - S Maule
- Autonomic and Hypertension Unit, Department of Medical Sciences, University of Turin, Turin, Italy
| |
Collapse
|
16
|
Characteristics of the 24-h ambulatory blood pressure monitoring in patients with Parkinson's disease - the SFC BP multicentre study in China. J Hypertens 2021; 38:2270-2278. [PMID: 32649630 DOI: 10.1097/hjh.0000000000002536] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
Abstract
OBJECTIVES Cardiovascular dysautonomia can be present at early, late and even prodromal stages of Parkinson's disease. This study aimed to describe the characteristics of 24-h ambulatory blood pressure (BP) monitoring and investigate the frequency of cardiovascular dysautonomia in Parkinson's disease without an abnormal BP history. METHODS Parkinson's disease patients without history of abnormal BP were consecutively enrolled from three Chinese centres, on whom office BP measurement, neurological evaluations and 24-h ambulatory BP monitoring were performed. RESULTS Totally, 101 Parkinson's disease patients (42.6% women) with an average age of 66.6 ± 8.2 years were included in our cohort, and data analysis revealed that 26 (25.74%) patients suffered from orthostatic hypotension, among whom 18 (69.23%) were symptomatic. Patients with orthostatic hypotension compared with those without had significantly higher nocturnal SBP level, and more severe nonmotor symptoms, autonomic dysfunction and cognitive impairment. Further, 54 out of 101 (53.47%) individuals had a reverse dipping pattern in SBP and/or DBP. Reverse dippers had more cases of orthostatic hypotension (P < 0.001), and more severe nonmotor symptoms. SBP dipping ratio of less than -2.98% generated 76.9% of sensitivity, 69.3% of specificity, 46.5% of positive predictive value (PPV), 89.7% of negative predictive value (NPV) and 77.4% of accuracy, while diastolic dipping ratio of less than -1.80% generated 76.9% of sensitivity, 70.7% specificity, 47.6% of PPV, 89.8% of NPV and 77.8% of accuracy for suspecting orthostatic hypotension. CONCLUSION Orthostatic hypotension can occur in one-fourth Parkinson's disease patients without abnormal BP history, and reverse dipping was present in more than half of patients with Parkinson's disease. Reverse dipping pattern was helpful to suspect orthostatic hypotension.
Collapse
|
17
|
Liu Y, Niu L, Liu X, Cheng C, Le W. Recent Progress in Non-motor Features of Parkinson's Disease with a Focus on Circadian Rhythm Dysregulation. Neurosci Bull 2021; 37:1010-1024. [PMID: 34128188 DOI: 10.1007/s12264-021-00711-x] [Citation(s) in RCA: 21] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/25/2020] [Accepted: 03/31/2021] [Indexed: 12/14/2022] Open
Abstract
Parkinson's disease (PD) is the second most common neurodegenerative disease, which manifests with both motor and non-motor symptoms. Circadian rhythm dysregulation, as one of the most challenging non-motor features of PD, usually appears long before obvious motor symptoms. Moreover, the dysregulated circadian rhythm has recently been reported to play pivotal roles in PD pathogenesis, and it has emerged as a hot topic in PD research. In this review, we briefly introduce the circadian rhythm and circadian rhythm-related genes, and then summarize recent research progress on the altered circadian rhythm in PD, ranging from clinical features to the possible causes of PD-related circadian disorders. We believe that future comprehensive studies on the topic may not only help us to explore the mechanisms of PD, but also shed light on the better management of PD.
Collapse
Affiliation(s)
- Yufei Liu
- Liaoning Provincial Key Laboratory for Research on the Pathogenic Mechanisms of Neurological Diseases, the First Affiliated Hospital, Dalian Medical University, Dalian, 116021, China
- Liaoning Provincial Center for Clinical Research on Neurological Diseases, the First Affiliated Hospital, Dalian Medical University, Dalian, 116021, China
| | - Long Niu
- Liaoning Provincial Key Laboratory for Research on the Pathogenic Mechanisms of Neurological Diseases, the First Affiliated Hospital, Dalian Medical University, Dalian, 116021, China
- Liaoning Provincial Center for Clinical Research on Neurological Diseases, the First Affiliated Hospital, Dalian Medical University, Dalian, 116021, China
| | - Xinyao Liu
- Liaoning Provincial Key Laboratory for Research on the Pathogenic Mechanisms of Neurological Diseases, the First Affiliated Hospital, Dalian Medical University, Dalian, 116021, China
- Liaoning Provincial Center for Clinical Research on Neurological Diseases, the First Affiliated Hospital, Dalian Medical University, Dalian, 116021, China
| | - Cheng Cheng
- Liaoning Provincial Key Laboratory for Research on the Pathogenic Mechanisms of Neurological Diseases, the First Affiliated Hospital, Dalian Medical University, Dalian, 116021, China
- Liaoning Provincial Center for Clinical Research on Neurological Diseases, the First Affiliated Hospital, Dalian Medical University, Dalian, 116021, China
| | - Weidong Le
- Liaoning Provincial Key Laboratory for Research on the Pathogenic Mechanisms of Neurological Diseases, the First Affiliated Hospital, Dalian Medical University, Dalian, 116021, China.
- Liaoning Provincial Center for Clinical Research on Neurological Diseases, the First Affiliated Hospital, Dalian Medical University, Dalian, 116021, China.
- Institute of Neurology, Sichuan Academy of Medical Science-Sichuan Provincial Hospital, University of Electronic Science and Technology of China, Chengdu, 610072, China.
| |
Collapse
|
18
|
Zhang Z, Sun X, Wang K, Yu Y, Zhang L, Zhang K, Gu J, Yuan X, Song G. Hydrogen-saturated saline mediated neuroprotection through autophagy via PI3K/AKT/mTOR pathway in early and medium stages of rotenone-induced Parkinson's disease rats. Brain Res Bull 2021; 172:1-13. [PMID: 33838212 DOI: 10.1016/j.brainresbull.2021.04.003] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/02/2021] [Revised: 03/20/2021] [Accepted: 04/02/2021] [Indexed: 02/07/2023]
Abstract
Some cardiovascular symptoms in the early stage of Parkinson's disease (PD) were related to degeneration of the rostral ventrolateral medulla (RVLM) catecholaminergic neurons. To date, little is known about the effects of hydrogen water on early stage of PD. Here, protective actions of hydrogen-saturated saline (HS) on rotenone-induced PD rats, as well as its underlying mechanisms were investigated. HS was used to treat PD rats at three general stages; early, medium and late, which were represented by rotenone induced rats for 0, 7 and 14 days. HS treatment significantly alleviated the cardiovascular and motor symptoms in rotenone-induced PD rats, improved the survival number of RVLM catecholaminergic neurons and nigral dopamine neurons only in early and medium stages of PD rats. Decreased levels of reactive oxygen species (ROS) and alpha-synuclein (α-Syn), transformation of microtubule associated protein 1 light chain 3 (LC3)-I/II and degradation of sequestosome 1 (p62) were detected, as well as increased expression level of autophagy related protein 5 (ATG5) and B-cell lymphoma-2 interacting protein 1 (Beclin-1) in the RVLM and substantia nigra (SN) after HS treatment in early and medium stages of PD rats. In addition, phosphorylation levels of phosphatidylinositol-3-kinase (PI3K), protein kinase B (Akt) and mammalian rapamycin target protein (mTOR) decreased after HS treatment in early and medium stages of PD rats. The results suggested that HS treatment exerted beneficial effects in early and medium stages before motor impairments emerged but not in the late stage of rotenone-induced PD rats. It exerted neuroprotection with RVLM catecholaminergic neurons and nigral dopamine neurons, mediated in part by decreasing levels of ROS and α-Syn through increasing autophagy machinery which were partly via inhibiting PI3K-Akt-mTOR pathway.
Collapse
Affiliation(s)
- Zhaoqiang Zhang
- Department of Physiology, Basic Medical College of Shandong First Medical University & Shandong Academy of Medical Sciences, Taian, 271000, China
| | - Xiao Sun
- Department of Nephrology, Taian City Central Hospital, Taian, 271000, China
| | - Kun Wang
- Postdoctoral Workstation, Taian City Central Hospital, Taian, 271000, China
| | - Yang Yu
- Life Science Research Center, Shandong First Medical University & Shandong Academy of Medical Sciences, Taian, 271000, China
| | - Li Zhang
- Department of Electrocardiogram, Taian Traditional Chinese Medicine Hospital, Taian, 271000, China
| | - Keping Zhang
- Department of Physiology, Basic Medical College of Shandong First Medical University & Shandong Academy of Medical Sciences, Taian, 271000, China
| | - Jinglongfei Gu
- Department of Physiology, Basic Medical College of Shandong First Medical University & Shandong Academy of Medical Sciences, Taian, 271000, China
| | - Xiaofan Yuan
- Department of Physiology, Basic Medical College of Shandong First Medical University & Shandong Academy of Medical Sciences, Taian, 271000, China
| | - Guohua Song
- Life Science Research Center, Shandong First Medical University & Shandong Academy of Medical Sciences, Taian, 271000, China.
| |
Collapse
|
19
|
Blood Pressure Patterns in Patients with Parkinson's Disease: A Systematic Review. J Pers Med 2021; 11:jpm11020129. [PMID: 33671878 PMCID: PMC7918947 DOI: 10.3390/jpm11020129] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/15/2020] [Revised: 02/02/2021] [Accepted: 02/10/2021] [Indexed: 01/23/2023] Open
Abstract
(1) Background: Cardiovascular autonomic dysfunction is a non-motor feature in Parkinson’s disease with negative impact on functionality and life expectancy, prompting early detection and proper management. We aimed to describe the blood pressure patterns reported in patients with Parkinson’s disease, as measured by 24-h ambulatory blood pressure monitoring. (2) Methods: We conducted a systematic search on the PubMed database. Studies enrolling patients with Parkinson’s disease undergoing 24-h ambulatory blood pressure monitoring were included. Data regarding study population, Parkinson’s disease course, vasoactive drugs, blood pressure profiles, and measurements were recorded. (3) Results: The search identified 172 studies. Forty studies eventually fulfilled the inclusion criteria, with 3090 patients enrolled. Abnormal blood pressure profiles were commonly encountered: high blood pressure in 38.13% of patients (938/2460), orthostatic hypotension in 38.68% (941/2433), supine hypertension in 27.76% (445/1603) and nocturnal hypertension in 38.91% (737/1894). Dipping status was also altered often, 40.46% of patients (477/1179) being reverse dippers and 35.67% (310/869) reduced dippers. All these patterns were correlated with negative clinical and imaging outcomes. (4) Conclusion: Patients with Parkinson’s disease have significantly altered blood pressure patterns that carry a negative prognosis. Ambulatory blood pressure monitoring should be validated as a biomarker of PD-associated cardiovascular dysautonomia and a tool for assisting therapeutic interventions.
Collapse
|
20
|
Fifel K, De Boer T. The circadian system in Parkinson's disease, multiple system atrophy, and progressive supranuclear palsy. HANDBOOK OF CLINICAL NEUROLOGY 2021; 179:301-313. [PMID: 34225971 DOI: 10.1016/b978-0-12-819975-6.00019-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/24/2022]
Abstract
Circadian organization of physiology and behavior is an important biologic process that allows organisms to anticipate and prepare for predictable changes in the environment. Circadian disruptions are associated with a wide range of health issues. In patients with neurodegenerative diseases, alterations of circadian rhythms are among the most common and debilitating symptoms. Although a growing awareness of these symptoms has occurred during the last decade, their underlying neuropathophysiologic circuitry remains poorly understood and, consequently, no effective therapeutic strategies are available to alleviate these health issues. Recent studies have examined the neuropathologic status of the different neural components of the circuitry governing the generation of circadian rhythms in neurodegenerative diseases. In this review, we will dissect the potential contribution of dysfunctions in the different nodes of this circuitry to circadian alterations in patients with parkinsonism-linked neurodegenerative diseases (namely, Parkinson's disease, multiple system atrophy, and progressive supranuclear palsy). A deeper understanding of these mechanisms will provide not only a better understanding of disease neuropathophysiology but also holds promise for the development of more effective and mechanisms-based therapies.
Collapse
Affiliation(s)
- Karim Fifel
- International Institute for Integrative Sleep Medicine (WPI-IIIS), University of Tsukuba, Tsukuba, Ibaraki, Japan.
| | - Tom De Boer
- Laboratory for Neurophysiology, Department of Cell and Chemical Biology, Leiden University Medical Center, Leiden, The Netherlands
| |
Collapse
|
21
|
Abstract
Melanopsin retinal ganglion cells (mRGCs) are the third class of retinal photoreceptors with unique anatomical, electrophysiological, and biological features. There are different mRGC subtypes with differential projections to the brain. These cells contribute to many nonimage-forming functions of the eye, the most relevant being the photoentrainment of circadian rhythms through the projections to the suprachiasmatic nucleus of the hypothalamus. Other relevant biological functions include the regulation of the pupillary light reflex, mood, alertness, and sleep, as well as a possible role in formed vision. The relevance of the mRGC-related pathways in the brain is highlighted by the role that the dysfunction and/or loss of these cells may play in affecting circadian rhythms and sleep in many neurodegenerative disorders including Alzheimer's, Parkinson's and Huntington's disease and in aging. Moreover, the occurrence of circadian dysfunction is a known risk factor for dementia. In this chapter, the anatomy, physiology, and functions of these cells as well as their resistance to neurodegeneration in mitochondrial optic neuropathies or their predilection to be lost in other neurodegenerative disorders will be discussed.
Collapse
|
22
|
Sturchio A, Dwivedi AK, Marsili L, Hadley A, Sobrero G, Heldman D, Maule S, Lopiano L, Comi C, Versino M, Espay AJ, Merola A. Kinematic but not clinical measures predict falls in Parkinson-related orthostatic hypotension. J Neurol 2020; 268:1006-1015. [PMID: 32979099 DOI: 10.1007/s00415-020-10240-8] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/19/2020] [Revised: 09/18/2020] [Accepted: 09/21/2020] [Indexed: 01/24/2023]
Abstract
OBJECTIVE We sought to test the hypothesis that technology could predict the risk of falls in Parkinson's disease (PD) patients with orthostatic hypotension (OH) with greater accuracy than in-clinic assessment. METHODS Twenty-six consecutive PD patients with OH underwent clinical (including home-like assessments of activities of daily living) and kinematic evaluations of balance and gait as well as beat-to-beat blood pressure (BP) monitoring to estimate their association with the risk of falls. Fall frequency was captured by a diary collected prospectively over 6 months. When applicable, the sensitivity, specificity, and diagnostic accuracy were measured using the area under the receiver operating characteristics curve (AUC). Additional in-clinic assessments included the OH Symptom Assessment (OHSA), the OH Daily Activity Score (OHDAS), and the Movement Disorder Society Unified Parkinson's Disease Rating Scale (MDS-UPDRS). RESULTS The prevalence of falls was 53.8% over six months. There was no association between the risk of falls and test of gait and postural stability (p ≥ 0.22) or home-like activities of daily living (p > 0.08). Conversely, kinematic data (waist sway during time-up-and-go, jerkiness, and centroidal frequency during postural sway with eyes-opened) predicted the risk of falls with high sensitivity and specificity (> 80%; AUC ≥ 0.81). There was a trend for higher risk of falls in patients with orthostatic mean arterial pressure ≤ 75 mmHg. CONCLUSIONS Kinematic but not clinical measures predicted falls in PD patients with OH. Orthostatic mean arterial pressure ≤ 75 mmHg may represent a hemodynamic threshold below which falls become more prevalent, supporting the aggressive deployment of corrective measures.
Collapse
Affiliation(s)
- Andrea Sturchio
- Department of Neurology, Gardner Family Center for Parkinson's Disease and Movement Disorders, University of Cincinnati, Cincinnati, OH, USA
- University of Pavia, Pavia, Italy
- Neurology Unit, Varese ASST Sette Laghi, Ospedale di Circolo, Varese, Italy
| | - Alok K Dwivedi
- Division of Biostatistics and Epidemiology, Department of Molecular and Translational Medicine, Texas Tech University Health Sciences Center, El Paso, TX, USA
| | - Luca Marsili
- Department of Neurology, Gardner Family Center for Parkinson's Disease and Movement Disorders, University of Cincinnati, Cincinnati, OH, USA
| | - Aaron Hadley
- Great Lakes NeuroTechnologies, Cleveland, OH, USA
| | - Gabriele Sobrero
- Department of Neurology, Gardner Family Center for Parkinson's Disease and Movement Disorders, University of Cincinnati, Cincinnati, OH, USA
- Ambulatorio per le Disautonomie e l'Ipotensione Ortostatica, AOU Città della Salute e della Scienza di Torino, Turin, Italy
| | | | - Simona Maule
- Ambulatorio per le Disautonomie e l'Ipotensione Ortostatica, AOU Città della Salute e della Scienza di Torino, Turin, Italy
| | - Leonardo Lopiano
- Department of Neuroscience "Rita Levi Montalcini", University of Torino, Turin, Italy
| | - Cristoforo Comi
- Department of Translational Medicine, University of Piemonte Orientale, Novara, Italy
| | - Maurizio Versino
- Neurology Unit, Varese ASST Sette Laghi, Ospedale di Circolo, Varese, Italy
- DMC, University of Insubria, Varese, Italy
| | - Alberto J Espay
- Department of Neurology, Gardner Family Center for Parkinson's Disease and Movement Disorders, University of Cincinnati, Cincinnati, OH, USA
| | - Aristide Merola
- Department of Neurology, Wexner Medical Center, Ohio State University, Columbus, OH, USA.
| |
Collapse
|
23
|
|