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Wan H, Chen H, Zhang M, Feng T, Wang Y. Cerebral microbleeds is associated with dementia in Parkinson's disease. Acta Neurol Belg 2023; 123:407-413. [PMID: 35672560 DOI: 10.1007/s13760-022-01918-z] [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] [Subscribe] [Scholar Register] [Received: 08/05/2021] [Accepted: 03/07/2022] [Indexed: 11/01/2022]
Abstract
INTRODUCTION Emerging evidence suggests that cerebral small vessel disease (CSVD) may worsen cognitive functions in Parkinson's disease (PD). However, the effect of microbleeds on cognitive function in patients with PD remains unknown. This study explored the association between the presence, number and location of microbleeds with dementia in PD patients. METHODS This cross-sectional study included 431 patients with PD from Beijing Tiantan Hospital from May 2016 to August 2019. Cognition assessments (MMSE, MoCA) were performed for these patients. MRI imaging sequences were obtained and reviewed independently by two well-trained readers who were blind to all clinical data. Spearman's correlation analysis and logistic regression model analysis were further used for the assessments. RESULTS An association between cerebral microbleeds with cognitive ability and dementia in PD patients was revealed. A significance was observed between the total number of microbleeds and two widely used scores of cognitive assessments (Spearman R = - 0.120 to MMSE with a p = 0.016, and - 0.117 to MoCA with a p = 0.020). In detail, infratentorial microbleeds were associated with the level of cognition in PD patients (Spearman R = - 0.099 to MMSE with a p = 0.049, and - 0.116 to MoCA with a p = 0.021). Furthermore, logistic regression analysis results also confirmed such correlations between the number of microbleeds and cognitive ability after adjusting for age, cholesterol level, Hamilton Anxiety Scale, Hamilton Depression Scale, and white matter hyperintensity Fazekas score (OR 3.28, p = 0.035, 95% CI 1.090-9.892). CONCLUSIONS The occurrence of microbleeds, especially in the infratentorial locations, may worsen the cognitive function of PD patients and result in dementia. Management of cerebral vascular disease could be beneficial to patients with PD.
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Affiliation(s)
- Huijuan Wan
- Department of Neurology, Beijing Tiantan Hospital, Capital Medical University, 119 South 4th Ring West Road, Fengtai District, Beijing, 100070, China
- China National Clinical Research Center for Neurological Diseases (NCRC-ND), Beijing, China
- Advanced Innovation Center for Human Brain Projection, Capital Medical University, Beijing, China
- Department of Neurology, First Affiliated Hospital, Xiamen University, Xiamen, China
| | - Huimin Chen
- Department of Neurology, Beijing Hospital, National Center of Gerontology, Institute of Geriatric Medicine, Chinese Academy of Medical Sciences, Beijing, China
| | - Meimei Zhang
- Department of Neurology, Beijing Tiantan Hospital, Capital Medical University, 119 South 4th Ring West Road, Fengtai District, Beijing, 100070, China
- China National Clinical Research Center for Neurological Diseases (NCRC-ND), Beijing, China
- Advanced Innovation Center for Human Brain Projection, Capital Medical University, Beijing, China
| | - Tao Feng
- Department of Neurology, Beijing Tiantan Hospital, Capital Medical University, 119 South 4th Ring West Road, Fengtai District, Beijing, 100070, China.
- China National Clinical Research Center for Neurological Diseases (NCRC-ND), Beijing, China.
- Advanced Innovation Center for Human Brain Projection, Capital Medical University, Beijing, China.
| | - Yilong Wang
- Department of Neurology, Beijing Tiantan Hospital, Capital Medical University, 119 South 4th Ring West Road, Fengtai District, Beijing, 100070, China.
- China National Clinical Research Center for Neurological Diseases (NCRC-ND), Beijing, China.
- Advanced Innovation Center for Human Brain Projection, Capital Medical University, Beijing, China.
- Beijing Key Laboratory of Translational Medicine for Cerebrovascular Disease, Beijing, China.
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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.
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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
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Li W, Gao B, Du W, Jiang Y, Yang J, Hu R, Liu Y, Liu N, Zhang Y, Song Q, Miao Y. Iron deposition heterogeneity in extrapyramidal system assessed by quantitative susceptibility mapping in Parkinson’s disease patients with type 2 diabetes mellitus. Front Aging Neurosci 2022; 14:975390. [PMID: 36177478 PMCID: PMC9513156 DOI: 10.3389/fnagi.2022.975390] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/22/2022] [Accepted: 08/01/2022] [Indexed: 11/13/2022] Open
Abstract
Purpose Excessive brain iron depositions were found in both patients with Parkinson’s disease (PD) and those with type 2 diabetes mellitus (T2DM). The present study aimed to explore iron deposition and heterogeneity in the extrapyramidal system in PD patients with T2DM using quantitative susceptibility mapping (QSM) and further to reveal the effect of T2DM on the changes in brain iron in patients with PD. Materials and methods A total of 38 PD patients with T2DM (PDDM), 30 PD patients without T2DM (PDND), and 20 asymptomatic control subjects (CSs) were recruited for this study. All subjects underwent multiple MRI sequences involving enhanced gradient echo T2 star weighted angiography (ESWAN). The magnetic sensitivity values (MSV) and volume of the whole nuclei (MSVW, VW) and high iron region (MSVRII, VRII) were measured on the bilateral caudate nucleus (CN), the putamen (PUT), the globus pallidus (GP), the substantia nigra (SN), the red nucleus (RN) and the dentate nucleus (DN). Clinical and laboratory data were recorded, especially for the Hoehn and Yahr (H-Y) stage, the Montreal Cognitive Assessment (MoCA), the Mini-Mental State Examination (MMSE), the Hamilton Depression Rating Scale (HAMD), and the Hamilton Anxiety Rating Scale (HAMA). All QSM data were compared between PDDM and PDND groups and correlated with clinical and laboratory data. Results Compared to the PDND group, the VRII/VW of the left CN was significantly increased in the PDDM group. Significantly higher MSVW and MSVRII were also found in the PDDM group, including bilateral SN of MSVW, right PUT, and bilateral CN, GP, and SN of MSVRII. The H-Y stage of the PDDM group was significantly higher than that of the PDND group. The MSVRII of bilateral RN of the PDDM group was positively correlated with the HAMA scores. HDL, DBP, and SBP levels were associated with MSVRII of right CN in the PDDM group. Conclusion T2DM could aggravate the disease severity and anxiety in patients with PD. The iron distribution of deep gray matter nuclei in PD patients with T2DM was significantly heterogeneous, which was related to blood pressure and blood lipids.
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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: 2] [Impact Index Per Article: 0.7] [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.
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Tanaka R, Yamashiro K, Ogawa T, Oyama G, Nishioka K, Umemura A, Shimo Y, Hattori N. The absence of orthostatic heart rate increase is associated with cognitive impairment in Parkinson's disease. PLoS One 2020; 15:e0240491. [PMID: 33057432 PMCID: PMC7561175 DOI: 10.1371/journal.pone.0240491] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/18/2020] [Accepted: 09/27/2020] [Indexed: 02/08/2023] Open
Abstract
Orthostatic hypotension (OH) frequently accompanies autonomic dysfunction and is an important risk factor for cognitive impairment in Parkinson’s disease (PD). While OH is usually diagnosed based on an orthostatic blood pressure drop, the association between the heart rate response and cognitive impairment remains unclear. We retrospectively analyzed 143 cases of clinically diagnosed PD to determine the association between the absence of a heart rate response and cognitive impairment in PD with OH. Among the patients with OH, neurogenic OH was diagnosed in cases without a heart rate increase, while all other patients were diagnosed with non-neurogenic OH. Dementia was found in 23 of 143 PD cases (16.1%) in this cohort. The presence of OH was an independent risk factor for dementia in PD in addition to the disease severity, years of education and beta-blockers use. Neurogenic OH was significantly associated with dementia compared to the no OH group (hazard ratio [HR] 7.3, 95% confidence interval [CI] 2.2–24.6, P<0.01), an association that was preserved after adjusting for age, gender and other covariant factors. However, no such association was observed for non-neurogenic OH (HR 2.9, 95%CI 0.8–10.9, P = 0.12). While the cognitive impairment was significantly worse in the neurogenic OH group than the no-OH group, the groups were otherwise similar. The blood pressure decrease was significantly lower in both OH groups than in the no-OH group, despite no significant differences between the OH groups. Our finding showed that OH without a heart rate response was an important predictor of cognitive impairment in PD.
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Affiliation(s)
- Ryota Tanaka
- Stroke Center, Jichi Medical University Hospital, Division of Neurology, Department of Medicine, Jichi Medical University, Tochigi, Japan
- Department of Neurology, Juntendo University, Tokyo, Japan
- * E-mail: (RT); (NH)
| | - Kazuo Yamashiro
- Department of Neurology, Juntendo University Urayasu Hospital, Chiba, Japan
| | - Takashi Ogawa
- Department of Neurology, Juntendo University, Tokyo, Japan
| | - Genko Oyama
- Department of Neurology, Juntendo University, Tokyo, Japan
| | - Kenya Nishioka
- Department of Neurology, Juntendo University, Tokyo, Japan
| | - Atsushi Umemura
- Department of Neurosurgery, Juntendo University, Tokyo, Japan
| | - Yasushi Shimo
- Department of Neurology, Juntendo University Nerima Hospital, Tokyo, Japan
| | - Nobutaka Hattori
- Department of Neurology, Juntendo University, Tokyo, Japan
- * E-mail: (RT); (NH)
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Chokesuwattanaskul A, Cheungpasitporn W, Thongprayoon C, Vallabhajosyula S, Bathini T, Mao MA, Cato LD, Chokesuwattanaskul R. Impact of Circadian Blood Pressure Pattern on Silent Cerebral Small Vessel Disease: A Systematic Review and Meta-Analysis. J Am Heart Assoc 2020; 9:e016299. [PMID: 32476573 PMCID: PMC7429026 DOI: 10.1161/jaha.119.016299] [Citation(s) in RCA: 20] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/22/2022]
Abstract
Background Abnormal circadian blood pressure (BP) variations during sleep, specifically the non‐dipping (<10% fall in nocturnal BP) and reverse‐dipping patterns (rise in nocturnal BP), have been associated with an increased risk of cardiovascular events and target organ damage. However, the relationship between abnormal sleep BP variations and cerebral small vessel disease markers is poorly established. This study aims to assess the association between non‐dipping and reverse‐dipping BP patterns with markers of silent cerebral small vessel disease. Methods and Results MEDLINE, Embase, and Cochrane Databases were searched from inception through November 2019. Studies that reported the odds ratios (ORs) for cerebral small vessel disease markers in patients with non‐dipping or reverse‐dipping BP patterns were included. Effect estimates from the individual studies were extracted and combined using the random‐effect, generic inverse variance method of DerSimonian and Laird. Twelve observational studies composed of 3497 patients were included in this analysis. The reverse‐dipping compared with normal dipping BP pattern was associated with a higher prevalence of white matter hyperintensity with a pooled adjusted OR of 2.00 (95% CI, 1.13–2.37; I2=36%). Non‐dipping BP pattern compared with normal dipping BP pattern was associated with higher prevalence of white matter hyperintensity and asymptomatic lacunar infarction, with pooled ORs of 1.38 (95% CI, 0.95–2.02; I2=52%) and 2.33 (95% CI, 1.30–4.18; I2=73%), respectively. Limiting to only studies with confounder‐adjusted analysis resulted in a pooled OR of 1.38 (95% CI, 0.95–2.02; I2=52%) for white matter hyperintensity and 1.44 (95% CI, 0.97–2.13; I2=0%) for asymptomatic lacunar infarction. Conclusions The non‐dipping and reverse‐dipping BP patterns are associated with neuroimaging cerebral small vessel disease markers.
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Affiliation(s)
- Anthipa Chokesuwattanaskul
- Division of Neurology Faculty of Medicine Chulalongkorn University and King Chulalongkorn Memorial Hospital Bangkok Thailand.,King Chulalongkorn Memorial Hospital Thai Red Cross Society Bangkok Thailand
| | | | | | | | - Tarun Bathini
- Department of Internal Medicine University of Arizona Tucson AZ
| | - Michael A Mao
- Department of Internal Medicine Mayo Clinic Jacksonville FL
| | - Liam D Cato
- University Hospitals Birmingham NHS Foundation Trust Birmingham United Kingdom
| | - Ronpichai Chokesuwattanaskul
- King Chulalongkorn Memorial Hospital Thai Red Cross Society Bangkok Thailand.,Department of Medicine Faculty of Medicine Chulalongkorn University and King Chulalongkorn Memorial Hospital Bangkok Thailand
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The impact of supine hypertension on target organ damage and survival in patients with synucleinopathies and neurogenic orthostatic hypotension. Parkinsonism Relat Disord 2020; 75:97-104. [PMID: 32516630 DOI: 10.1016/j.parkreldis.2020.04.011] [Citation(s) in RCA: 35] [Impact Index Per Article: 8.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/26/2019] [Revised: 03/27/2020] [Accepted: 04/19/2020] [Indexed: 12/30/2022]
Abstract
INTRODUCTION In addition to neurogenic orthostatic hypotension (nOH), patients with synucleinopathies frequently have hypertension when supine. The long-term consequences of both abnormalities are difficult to disentangle. We aimed to determine if supine hypertension is associated with target organ damage and worse survival in patients with nOH. METHODS Patients with nOH due to multiple system atrophy (MSA), Parkinson disease (PD), or pure autonomic failure (PAF) were classified into those with or without supine hypertension (systolic BP of at least 140 mmHg or diastolic BP of at least 90 mmHg). Organ damage was assessed by measuring cerebral white matter hyperintensities (WMH), left ventricular hypertrophy (LVH), and renal function. We prospectively followed patients for 30 months (range: 12-66 months) and recorded incident cardiovascular events and all-cause mortality. RESULTS Fifty-seven patients (35 with probable MSA, 14 with PD and 8 with PAF) completed all evaluations. In addition to nOH (average fall 35 ± 21/17 ± 14 mmHg, systolic/diastolic, mean ± SD), 38 patients (67%) had supine hypertension (systolic BP > 140 mmHg). Compared to those without hypertension, patients with hypertension had higher blood urea nitrogen levels (P = 0.005), lower estimated glomerular filtration rate (P = 0.008), higher prevalence of LVH (P = 0.040), and higher WMH volume (P = 0.019). Longitudinal follow-up of patients for over 2 years (27.1 ± 14.5 months) showed that supine hypertension was independently associated with earlier incidence of cardiovascular events and death (HR = 0.25; P = 0.039). CONCLUSIONS Supine hypertension in patients with nOH was associated with an increased risk for target organ damage, cardiovascular events, and premature death. Defining management strategies and safe blood pressure ranges in patients with nOH remains an important research question.
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Hiorth YH, Pedersen KF, Dalen I, Tysnes OB, Alves G. Orthostatic hypotension in Parkinson disease: A 7-year prospective population-based study. Neurology 2019; 93:e1526-e1534. [PMID: 31527282 DOI: 10.1212/wnl.0000000000008314] [Citation(s) in RCA: 35] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/07/2019] [Accepted: 05/16/2019] [Indexed: 11/15/2022] Open
Abstract
OBJECTIVE To determine the frequency, evolution, and associated features of orthostatic hypotension (OH) over 7 years of prospective follow-up in a population-based, initially drug-naive Parkinson disease (PD) cohort. METHODS We performed repeated lying and standing blood pressure measurements in 185 patients with newly diagnosed PD and 172 matched normal controls to determine the occurrence of (1) OH using consensus-based criteria and (2) clinically significant OH (mean arterial pressure in standing position ≤75 mm Hg). We applied generalized estimating equations models for correlated data to investigate associated features of these 2 outcomes in patients with PD. RESULTS OH was more common in patients with PD than controls at all visits, with the relative risk increasing from 3.0 (95% confidence interval [CI] 1.6-5.8; p < 0.001) at baseline to 4.9 (95% CI 2.4-10.1; p < 0.001) after 7 years. Despite a high cumulative prevalence of OH (65.4%) and clinically significant OH (29.2%), use of antihypotensive drugs was very rare (0.5%). OH was independently associated with older age (odds ratio [OR] 1.06 per year; 95% CI 1.03-1.10), lower Mini-Mental State Examination score (OR 0.91 [0.85-0.97] per unit), and longer follow-up time (OR 1.12 [1.03-1.23] per year). Clinically significant OH was associated with the same characteristics, in addition to higher levodopa equivalent dosage (OR 1.16 [1.07-1.25] per 100 mg). CONCLUSIONS In this population-based study, we found OH to be a very frequent but undertreated complication in early PD, with associations to both disease-specific symptoms and drug treatment. Our findings suggest that clinicians should more actively assess and manage OH abnormalities in PD.
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Affiliation(s)
- Ylva Hivand Hiorth
- From the Department of Physical Medicine and Rehabilitation (Y.H.H.), The Norwegian Centre for Movement Disorders (Y.H.H., K.F.P., G.A.), Department of Neurology (K.F.P., G.A.), and Department of Research, Section of Biostatistics (I.D.), Stavanger University Hospital; Department of Clinical Medicine (O.-B.T.), University of Bergen; Department of Neurology (O.-B.T.), Haukeland University Hospital, Bergen; and Department of Chemistry, Bioscience and Environmental Engineering (G.A.), University of Stavanger, Norway.
| | - Kenn Freddy Pedersen
- From the Department of Physical Medicine and Rehabilitation (Y.H.H.), The Norwegian Centre for Movement Disorders (Y.H.H., K.F.P., G.A.), Department of Neurology (K.F.P., G.A.), and Department of Research, Section of Biostatistics (I.D.), Stavanger University Hospital; Department of Clinical Medicine (O.-B.T.), University of Bergen; Department of Neurology (O.-B.T.), Haukeland University Hospital, Bergen; and Department of Chemistry, Bioscience and Environmental Engineering (G.A.), University of Stavanger, Norway
| | - Ingvild Dalen
- From the Department of Physical Medicine and Rehabilitation (Y.H.H.), The Norwegian Centre for Movement Disorders (Y.H.H., K.F.P., G.A.), Department of Neurology (K.F.P., G.A.), and Department of Research, Section of Biostatistics (I.D.), Stavanger University Hospital; Department of Clinical Medicine (O.-B.T.), University of Bergen; Department of Neurology (O.-B.T.), Haukeland University Hospital, Bergen; and Department of Chemistry, Bioscience and Environmental Engineering (G.A.), University of Stavanger, Norway
| | - Ole-Bjørn Tysnes
- From the Department of Physical Medicine and Rehabilitation (Y.H.H.), The Norwegian Centre for Movement Disorders (Y.H.H., K.F.P., G.A.), Department of Neurology (K.F.P., G.A.), and Department of Research, Section of Biostatistics (I.D.), Stavanger University Hospital; Department of Clinical Medicine (O.-B.T.), University of Bergen; Department of Neurology (O.-B.T.), Haukeland University Hospital, Bergen; and Department of Chemistry, Bioscience and Environmental Engineering (G.A.), University of Stavanger, Norway
| | - Guido Alves
- From the Department of Physical Medicine and Rehabilitation (Y.H.H.), The Norwegian Centre for Movement Disorders (Y.H.H., K.F.P., G.A.), Department of Neurology (K.F.P., G.A.), and Department of Research, Section of Biostatistics (I.D.), Stavanger University Hospital; Department of Clinical Medicine (O.-B.T.), University of Bergen; Department of Neurology (O.-B.T.), Haukeland University Hospital, Bergen; and Department of Chemistry, Bioscience and Environmental Engineering (G.A.), University of Stavanger, Norway
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Autonomic dysfunction in Parkinson disease and animal models. Clin Auton Res 2019; 29:397-414. [PMID: 30604165 DOI: 10.1007/s10286-018-00584-7] [Citation(s) in RCA: 22] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/17/2018] [Accepted: 12/11/2018] [Indexed: 12/17/2022]
Abstract
Parkinson disease has traditionally been classified as a movement disorder, despite patients' accounts of diverse symptoms stemming from impairments in numerous body systems. Today, Parkinson disease is increasingly recognized by clinicians and scientists as a complex neurodegenerative disorder featuring both motor and nonmotor manifestations concomitant with pathology throughout all major branches of the nervous system. Dysfunction of the autonomic nervous system, or dysautonomia, is a common feature of Parkinson disease. It produces signs and symptoms that severely affect patients' quality of life, such as blood pressure dysregulation, hyperhidrosis, and constipation. Treatment options for dysautonomia are limited to symptom alleviation because the cause of these symptoms and Parkinson disease overall are still unknown. Animal models provide a platform to interrogate mechanisms of Parkinson disease-related autonomic nervous system dysfunction and test novel treatment strategies. Several animal models of Parkinson disease are available, each with different effects on the autonomic nervous system. This review critically analyses key dysautonomia signs and symptoms and associated pathology in Parkinson disease patients and relevant findings in animal models. We focus on the cardiovascular system, adrenal medulla, skin/thermoregulation, bladder, pupils, and gastrointestinal tract, to assess the contribution of animal models to the understanding of Parkinson disease autonomic dysfunction.
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