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Conti M, Garasto E, Bovenzi R, Ferrari V, Mercuri NB, Di Giuliano F, Cerroni R, Pierantozzi M, Schirinzi T, Stefani A, Rocchi C. Insular and limbic abnormal functional connectivity in early-stage Parkinson's disease patients with autonomic dysfunction. Cereb Cortex 2024; 34:bhae270. [PMID: 38967041 DOI: 10.1093/cercor/bhae270] [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: 04/02/2024] [Revised: 06/05/2024] [Accepted: 06/17/2024] [Indexed: 07/06/2024] Open
Abstract
Autonomic symptoms in Parkinson's disease result from variable involvement of the central and peripheral systems, but many aspects remain unclear. The analysis of functional connectivity has shown promising results in assessing the pathophysiology of Parkinson's disease. This study aims to investigate the association between autonomic symptoms and cortical functional connectivity in early Parkinson's disease patients using high-density EEG. 53 early Parkinson's disease patients (F/M 18/35) and 49 controls (F/M 20/29) were included. Autonomic symptoms were evaluated using the Scales for Outcomes in Parkinson's disease-Autonomic Dysfunction score. Data were recorded with a 64-channel EEG system. We analyzed cortical functional connectivity, based on weighted phase-lag index, in θ-α-β-low-γ bands. A network-based statistic was used to perform linear regression between Scales for Outcomes in Parkinson's disease-Autonomic Dysfunction score and functional connectivity in Parkinson's disease patients. We observed a positive relation between the Scales for Outcomes in Parkinson's disease-Autonomic Dysfunction score and α-functional connectivity (network τ = 2.8, P = 0.038). Regions with higher degrees were insula and limbic lobe. Moreover, we found positive correlations between the mean connectivity of this network and the gastrointestinal, cardiovascular, and thermoregulatory domains of Scales for Outcomes in Parkinson's disease-Autonomic Dysfunction. Our results revealed abnormal functional connectivity in specific areas in Parkinson's disease patients with greater autonomic symptoms. Insula and limbic areas play a significant role in the regulation of the autonomic system. Increased functional connectivity in these regions might represent the central compensatory mechanism of peripheral autonomic dysfunction in Parkinson's disease.
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Affiliation(s)
- Matteo Conti
- Neurology Unit, Department of Systems Medicine, University of Rome "Tor Vergata", Via Montpellier 1, 00133 Rome, Italy
| | - Elena Garasto
- Neurology Unit, Department of Systems Medicine, University of Rome "Tor Vergata", Via Montpellier 1, 00133 Rome, Italy
| | - Roberta Bovenzi
- Neurology Unit, Department of Systems Medicine, University of Rome "Tor Vergata", Via Montpellier 1, 00133 Rome, Italy
| | - Valerio Ferrari
- Neurology Unit, Department of Systems Medicine, University of Rome "Tor Vergata", Via Montpellier 1, 00133 Rome, Italy
| | - Nicola B Mercuri
- Neurology Unit, Department of Systems Medicine, University of Rome "Tor Vergata", Via Montpellier 1, 00133 Rome, Italy
| | - Francesca Di Giuliano
- Neuroradiology Unit, Department of Biomedicine and Prevention, University of Rome "Tor Vergata", Via Montpellier 1, 00133 Rome, Italy
| | - Rocco Cerroni
- Neurology Unit, Department of Systems Medicine, University of Rome "Tor Vergata", Via Montpellier 1, 00133 Rome, Italy
- UOSD Parkinson Centre, Tor Vergata University Hospital, Viale Oxford 81, 00133 Rome, Italy
| | - Mariangela Pierantozzi
- Neurology Unit, Department of Systems Medicine, University of Rome "Tor Vergata", Via Montpellier 1, 00133 Rome, Italy
| | - Tommaso Schirinzi
- Neurology Unit, Department of Systems Medicine, University of Rome "Tor Vergata", Via Montpellier 1, 00133 Rome, Italy
| | - Alessandro Stefani
- Neurology Unit, Department of Systems Medicine, University of Rome "Tor Vergata", Via Montpellier 1, 00133 Rome, Italy
- UOSD Parkinson Centre, Tor Vergata University Hospital, Viale Oxford 81, 00133 Rome, Italy
| | - Camilla Rocchi
- Neurology Unit, Department of Systems Medicine, University of Rome "Tor Vergata", Via Montpellier 1, 00133 Rome, Italy
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Candia-Rivera D, Chavez M, De Vico Fallani F. Measures of the coupling between fluctuating brain network organization and heartbeat dynamics. Netw Neurosci 2024; 8:557-575. [PMID: 38952808 PMCID: PMC11168717 DOI: 10.1162/netn_a_00369] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/27/2023] [Accepted: 02/19/2024] [Indexed: 07/03/2024] Open
Abstract
In recent years, there has been an increasing interest in studying brain-heart interactions. Methodological advancements have been proposed to investigate how the brain and the heart communicate, leading to new insights into some neural functions. However, most frameworks look at the interaction of only one brain region with heartbeat dynamics, overlooking that the brain has functional networks that change dynamically in response to internal and external demands. We propose a new framework for assessing the functional interplay between cortical networks and cardiac dynamics from noninvasive electrophysiological recordings. We focused on fluctuating network metrics obtained from connectivity matrices of EEG data. Specifically, we quantified the coupling between cardiac sympathetic-vagal activity and brain network metrics of clustering, efficiency, assortativity, and modularity. We validate our proposal using open-source datasets: one that involves emotion elicitation in healthy individuals, and another with resting-state data from patients with Parkinson's disease. Our results suggest that the connection between cortical network segregation and cardiac dynamics may offer valuable insights into the affective state of healthy participants, and alterations in the network physiology of Parkinson's disease. By considering multiple network properties, this framework may offer a more comprehensive understanding of brain-heart interactions. Our findings hold promise in the development of biomarkers for diagnostic and cognitive/motor function evaluation.
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Affiliation(s)
- Diego Candia-Rivera
- Sorbonne Université, Paris Brain Institute (ICM), CNRS UMR 7225, INRIA Paris (Nerv Team), INSERM U1127, AP-HP Hôpital Pitié-Salpêtrière, Paris, France
| | - Mario Chavez
- Sorbonne Université, Paris Brain Institute (ICM), CNRS UMR 7225, INRIA Paris (Nerv Team), INSERM U1127, AP-HP Hôpital Pitié-Salpêtrière, Paris, France
| | - Fabrizio De Vico Fallani
- Sorbonne Université, Paris Brain Institute (ICM), CNRS UMR 7225, INRIA Paris (Nerv Team), INSERM U1127, AP-HP Hôpital Pitié-Salpêtrière, Paris, France
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Muñoz-Mata BG, Dorantes-Méndez G, Piña-Ramírez O. Classification of Parkinson's disease severity using gait stance signals in a spatiotemporal deep learning classifier. Med Biol Eng Comput 2024:10.1007/s11517-024-03148-2. [PMID: 38884852 DOI: 10.1007/s11517-024-03148-2] [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: 02/14/2023] [Accepted: 06/03/2024] [Indexed: 06/18/2024]
Abstract
Parkinson's disease (PD) is a degenerative nervous system disorder involving motor disturbances. Motor alterations affect the gait according to the progression of PD and can be used by experts in movement disorders to rate the severity of the disease. However, this rating depends on the expertise of the clinical specialist. Therefore, the diagnosis may be inaccurate, particularly in the early stages of PD where abnormal gait patterns can result from normal aging or other medical conditions. Consequently, several classification systems have been developed to enhance PD diagnosis. In this paper, a PD gait severity classification algorithm was developed using vertical ground reaction force (VGRF) signals. The VGRF records used are from a public database that includes 93 PD patients and 72 healthy controls adults. The work presented here focuses on modeling each foot's gait stance phase signals using a modified convolutional long deep neural network (CLDNN) architecture. Subsequently, the results of each model are combined to predict PD severity. The classifier performance was evaluated using ten-fold cross-validation. The best-weighted accuracies obtained were 99.296(0.128)% and 99.343(0.182)%, with the Hoehn-Yahr and UPDRS scales, respectively, outperforming previous results presented in the literature. The classifier proposed here can effectively differentiate gait patterns of different PD severity levels based on gait signals of the stance phase.
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Affiliation(s)
- Brenda G Muñoz-Mata
- Facultad de Ciencias, Universidad Autónoma de San Luis Potosí, Av. Parque Chapultepec 1570, San Luis Potosí, 78295, San Luis Potosí, México
| | - Guadalupe Dorantes-Méndez
- Facultad de Ciencias, Universidad Autónoma de San Luis Potosí, Av. Parque Chapultepec 1570, San Luis Potosí, 78295, San Luis Potosí, México.
| | - Omar Piña-Ramírez
- Departamento de Bioinformática y Análisis Estadísticos, Instituto Nacional de Perinatología "Isidro Espinosa de los Reyes", Montes Urales 800, Ciudad de México, 11000, Ciudad de México, México
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Ratajska AM, Etheridge CB, Lopez FV, Kenney LE, Rodriguez K, Schade RN, Gertler J, Bowers D. The Relationship Between Autonomic Dysfunction and Mood Symptoms in De Novo Parkinson's Disease Patients Over Time. J Geriatr Psychiatry Neurol 2024; 37:242-252. [PMID: 37831611 PMCID: PMC10990848 DOI: 10.1177/08919887231204542] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/15/2023]
Abstract
BACKGROUND Autonomic dysfunction is prevalent in Parkinson's disease (PD) and can worsen quality of life. We examined: (a) whether specific autonomic symptoms were more strongly associated with anxiety or depression in PD and (b) whether overall autonomic dysfunction predicted mood trajectories over a 5-year period. METHODS Newly diagnosed individuals with PD (N = 414) from the Parkinson's Progression Markers Initiative completed self-report measures of depression, anxiety, and autonomic symptoms annually. Cross-sectional linear regressions examined relationships between specific autonomic subdomains (gastrointestinal, cardiovascular, thermoregulatory, etc.) and mood. Multilevel modeling examined longitudinal relationships with total autonomic load. RESULTS Gastrointestinal symptoms were associated with both higher anxiety (b = 1.04, 95% CI [.55, 1.53], P < .001) and depression (b = .24, 95% CI [.11, .37], P = .012), as were thermoregulatory symptoms (anxiety: b = 1.06, 95% CI [.46, 1.65], P = .004; depression: b = .25, 95% CI [.09, .42], P = .013), while cardiovascular (b = .36, 95% CI [.10, .62], P = .012) and urinary symptoms (b = .10, 95% CI [.01, .20], P = .037) were associated only with depression. Longitudinally, higher total autonomic load was associated with increases in both depression (b = .01, 95% CI [.00, .02], P = .015) and anxiety (b = .04, 95% CI [.01, .06], P < .001) over time, as well as occasion-to-occasion fluctuations (depression: b = .08, 95% CI [.05, .10], P < .001; anxiety: b = .24, 95% CI [.15, .32], P < .001). CONCLUSION Findings suggest autonomic dysfunction, particularly gastrointestinal and thermoregulatory symptoms, may be an indicator for elevated anxiety/depression and a potential treatment target early on in PD.
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Affiliation(s)
- Adrianna M. Ratajska
- Department of Clinical and Health Psychology, University of Florida, Gainesville, FL, USA
| | - Connor B. Etheridge
- Department of Neurology, Norman Fixel Institute for Neurological Diseases, University of Florida, Gainesville, FL, USA
| | - Francesca V. Lopez
- Department of Clinical and Health Psychology, University of Florida, Gainesville, FL, USA
| | - Lauren E. Kenney
- Department of Clinical and Health Psychology, University of Florida, Gainesville, FL, USA
| | - Katie Rodriguez
- Department of Clinical and Health Psychology, University of Florida, Gainesville, FL, USA
| | - Rachel N. Schade
- Department of Clinical and Health Psychology, University of Florida, Gainesville, FL, USA
| | - Joshua Gertler
- Department of Clinical and Health Psychology, University of Florida, Gainesville, FL, USA
| | - Dawn Bowers
- Department of Clinical and Health Psychology, University of Florida, Gainesville, FL, USA
- Department of Neurology, Norman Fixel Institute for Neurological Diseases, University of Florida, Gainesville, FL, USA
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Panassollo TRB, Lord S, Rashid U, Taylor D, Mawston G. The effect of chronotropic incompetence on physiologic responses during progressive exercise in people with Parkinson's disease. Eur J Appl Physiol 2024:10.1007/s00421-024-05492-5. [PMID: 38683403 DOI: 10.1007/s00421-024-05492-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/30/2023] [Accepted: 04/18/2024] [Indexed: 05/01/2024]
Abstract
PURPOSE Heart rate (HR) response is likely to vary in people with Parkinson's disease (PD), particularly for those with chronotropic incompetence (CI). This study explores the impact of CI on HR and metabolic responses during cardiopulmonary exercise test (CPET) in people with PD, and its implications for exercise intensity prescription. METHODS Twenty-eight participants with mild PD and seventeen healthy controls underwent CPET to identify the presence or absence of CI. HR and metabolic responses were measured at submaximal (first (VT1) and second (VT2) ventilatory thresholds), and at peak exercise. Main outcome measures were HR, oxygen consumption (VO2), and changes in HR responses (HR/WR slope) to an increase in exercise demand. RESULTS CI was present in 13 (46%) PD participants (PDCI), who during CPET, exhibited blunted HR responses compared to controls and PD non-CI beyond 60% of maximal workload (p ≤ 0.05). PDCI presented a significantly lower HR at VT2, and peak exercise compared to PD non-CI and controls (p ≤ 0.001). VO2 was significantly lower in PDCI than PD non-CI and controls at VT2 (p = 0.003 and p = 0.036, respectively) and at peak exercise (p = 0.001 and p = 0.023, respectively). CONCLUSION Although poorly understood, the presence of CI in PD and its effect on HR and metabolic responses during incremental exercise is significant and important to consider when programming aerobic exercises.
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Affiliation(s)
| | - Sue Lord
- School of Clinical Sciences, Auckland University of Technology, 90 Akoranga Drive, Northcote, 0627, Auckland, New Zealand
| | - Usman Rashid
- Centre for Chiropractic Research, New Zealand College of Chiropractic, 6 Harrison Road, Mount Wellington, 1060, Auckland, New Zealand
| | - Denise Taylor
- School of Clinical Sciences, Auckland University of Technology, 90 Akoranga Drive, Northcote, 0627, Auckland, New Zealand
| | - Grant Mawston
- School of Clinical Sciences, Auckland University of Technology, 90 Akoranga Drive, Northcote, 0627, Auckland, New Zealand
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Candia‐Rivera D, Vidailhet M, Chavez M, De Vico Fallani F. A framework for quantifying the coupling between brain connectivity and heartbeat dynamics: Insights into the disrupted network physiology in Parkinson's disease. Hum Brain Mapp 2024; 45:e26668. [PMID: 38520378 PMCID: PMC10960553 DOI: 10.1002/hbm.26668] [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: 10/04/2023] [Revised: 03/07/2024] [Accepted: 03/12/2024] [Indexed: 03/25/2024] Open
Abstract
Parkinson's disease (PD) often shows disrupted brain connectivity and autonomic dysfunctions, progressing alongside with motor and cognitive decline. Recently, PD has been linked to a reduced sensitivity to cardiac inputs, that is, cardiac interoception. Altogether, those signs suggest that PD causes an altered brain-heart connection whose mechanisms remain unclear. Our study aimed to explore the large-scale network disruptions and the neurophysiology of disrupted interoceptive mechanisms in PD. We focused on examining the alterations in brain-heart coupling in PD and their potential connection to motor symptoms. We developed a proof-of-concept method to quantify relationships between the co-fluctuations of brain connectivity and cardiac sympathetic and parasympathetic activities. We quantified the brain-heart couplings from electroencephalogram and electrocardiogram recordings from PD patients on and off dopaminergic medication, as well as in healthy individuals at rest. Our results show that the couplings of fluctuating alpha and gamma connectivity with cardiac sympathetic dynamics are reduced in PD patients, as compared to healthy individuals. Furthermore, we show that PD patients under dopamine medication recover part of the brain-heart coupling, in proportion with the reduced motor symptoms. Our proposal offers a promising approach to unveil the physiopathology of PD and promoting the development of new evaluation methods for the early stages of the disease.
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Affiliation(s)
- Diego Candia‐Rivera
- Sorbonne Université, Paris Brain Institute (ICM), Inria Paris, CNRS UMR7225, INSERM U1127, AP‐HP Hôpital Pitié‐SalpêtrièreParisFrance
| | - Marie Vidailhet
- Sorbonne Université, Paris Brain Institute (ICM)—Team “Movement Investigations and Therapeutics” (MOV'IT), CNRS UMR7225, INSERM U1127, AP‐HP Hôpital Pitié‐SalpêtrièreParisFrance
| | - Mario Chavez
- Sorbonne Université, Paris Brain Institute (ICM), Inria Paris, CNRS UMR7225, INSERM U1127, AP‐HP Hôpital Pitié‐SalpêtrièreParisFrance
| | - Fabrizio De Vico Fallani
- Sorbonne Université, Paris Brain Institute (ICM), Inria Paris, CNRS UMR7225, INSERM U1127, AP‐HP Hôpital Pitié‐SalpêtrièreParisFrance
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7
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Andréasson M, Nickander J, Ståhlberg M, Fedorowski A, Svenningsson P. Chronotropic Incompetence in Parkinson's Disease: A Possible Marker of Severe Disease Phenotype? JOURNAL OF PARKINSON'S DISEASE 2024; 14:557-563. [PMID: 38517804 DOI: 10.3233/jpd-230256] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 03/24/2024]
Abstract
Autonomic dysfunction is a prevalent feature of Parkinson's disease (PD), mediated by disease involvement of the autonomic nervous system. Chronotropic incompetence (CI) refers to inadequate increase of heart rate in response to elevated metabolic demand, partly dependent on postganglionic sympathetic tone. In a retrospective study, PD patients with/without CI were identified. We show that PD with CI was associated with a higher levodopa equivalent daily dose and Hoehn and Yahr stage, 5±2 years after motor onset. Our data support a putative role of CI as a clinical marker of a more severe disease phenotype, possibly reflecting more widespread alpha-synuclein pathology.
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Affiliation(s)
- Mattias Andréasson
- Center for Neurology, Academic Specialist Center, Stockholm, Sweden
- Department of Neurology, Karolinska University Hospital, Stockholm, Sweden
- Department of Clinical Neuroscience, Karolinska Institutet, Stockholm, Sweden
| | - Jannike Nickander
- Department of Clinical Physiology, Karolinska University Hospital, and Karolinska Institutet, Stockholm, Sweden
| | - Marcus Ståhlberg
- Department of Cardiology, Karolinska University Hospital, Solna, Stockholm, Sweden
- Department of Medicine, Karolinska Institutet, Solna, Stockholm, Sweden
| | - Artur Fedorowski
- Department of Cardiology, Karolinska University Hospital, Solna, Stockholm, Sweden
- Department of Medicine, Karolinska Institutet, Solna, Stockholm, Sweden
| | - Per Svenningsson
- Center for Neurology, Academic Specialist Center, Stockholm, Sweden
- Department of Neurology, Karolinska University Hospital, Stockholm, Sweden
- Department of Clinical Neuroscience, Karolinska Institutet, Stockholm, Sweden
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8
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Clement G, Cavillon G, Vuillier F, Bouhaddi M, Béreau M. Unveiling autonomic failure in synucleinopathies: Significance in diagnosis and treatment. Rev Neurol (Paris) 2024; 180:79-93. [PMID: 38216420 DOI: 10.1016/j.neurol.2023.12.004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/27/2023] [Revised: 12/19/2023] [Accepted: 12/20/2023] [Indexed: 01/14/2024]
Abstract
Autonomic failure is frequently encountered in synucleinopathies such as multiple system atrophy (MSA), Parkinson's disease (PD), Lewy body disease, and pure autonomic failure (PAF). Cardiovascular autonomic failure affects quality of life and can be life threatening due to the risk of falls and the increased incidence of myocardial infarction, stroke, and heart failure. In PD and PAF, pathogenic involvement is mainly post-ganglionic, while in MSA, the involvement is mainly pre-ganglionic. Cardiovascular tests exploring the autonomic nervous system (ANS) are based on the analysis of continuous, non-invasive recordings of heart rate and digital blood pressure (BP). They assess facets of sympathetic and parasympathetic activities and provide indications on the integrity of the baroreflex arc. The tilt test is widely used in clinical practice. It can be combined with catecholamine level measurement and analysis of baroreflex activity and cardiac variability for a detailed analysis of cardiovascular damage. MIBG myocardial scintigraphy is the most sensitive test for early detection of autonomic dysfunction. It provides a useful measure of post-ganglionic sympathetic fiber integrity and function and is therefore an effective tool for distinguishing PD from other parkinsonian syndromes such as MSA. Autonomic cardiovascular investigations differentiate between certain parkinsonian syndromes that would otherwise be difficult to segregate, particularly in the early stages of the disease. Exploring autonomic failure by gathering information about residual sympathetic tone, low plasma norepinephrine levels, and supine hypertension can guide therapeutic management of orthostatic hypotension (OH).
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Affiliation(s)
- G Clement
- Service de neurologie électrophysiologie clinique, CHU de Besançon, 3, boulevard Alexandre-Fleming, 25030 Besançon cedex, France; Centre expert Parkinson, CHU de Besançon, 3, boulevard Alexandre-Fleming, 25030 Besançon cedex, France.
| | - G Cavillon
- Service de neurologie électrophysiologie clinique, CHU de Besançon, 3, boulevard Alexandre-Fleming, 25030 Besançon cedex, France; Centre expert Parkinson, CHU de Besançon, 3, boulevard Alexandre-Fleming, 25030 Besançon cedex, France
| | - F Vuillier
- Laboratoire d'anatomie, UFR santé, université de Franche-Comté, 19, rue Ambroise-Paré, 25030 Besançon cedex, France
| | - M Bouhaddi
- Laboratoire de physiologie-explorations fonctionnelles, CHU de Besançon, 3, boulevard Alexandre-Fleming, 25030 Besançon cedex, France
| | - M Béreau
- Service de neurologie électrophysiologie clinique, CHU de Besançon, 3, boulevard Alexandre-Fleming, 25030 Besançon cedex, France; Centre expert Parkinson, CHU de Besançon, 3, boulevard Alexandre-Fleming, 25030 Besançon cedex, France
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Abdelnaby R, Moawad MHED, Shabib AS, Mohamed KA, Ebrahim MA, Aboutaleb AM, Gaber DE, Serour AS, Shamim MA, Elberry MH, Bedewi MA, Elsayed M, Walter U. Sonographic vagus nerve atrophy in Parkinson's disease: Myth or fact? A systematic review and meta-analysis of recent evidence answers. Parkinsonism Relat Disord 2023; 112:105451. [PMID: 37236044 DOI: 10.1016/j.parkreldis.2023.105451] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/11/2023] [Revised: 05/12/2023] [Accepted: 05/20/2023] [Indexed: 05/28/2023]
Abstract
BACKGROUND Parkinson's disease (PD) is a major cause of disability. We aimed to assess the benefit of ultrasonography of the vagus nerve (VN) to compare between PD and healthy controls as well as to deliver reference values of nerve cross sectional area (CSA). MATERIALS AND METHODS We performed a systematic search on Medline (PubMed), Scopus, Embase, and Web of Science, up till July 25, 2022. After article selection and screening, we performed a quality assessment using the Newcastle-Ottawa Scale. Furthermore, a statistical analysis and subgroup analysis was performed. RESULTS Eleven studies were included with a total of 809 participants (409 PD patients and 400 controls). A statistically significant difference in the CSA of the right and left VN between PD patients and healthy controls was observed, indicating the atrophy of VN in PD patients (p < 0.00001). The subgroup meta-analysis for average measurements of VN CSA showed insignificant heterogeneity for age (I2 = 48.67%, p = 0.058), level of measurements (I2 = 57.91%, p = 0.05), and disease duration (I2 = 27.1%, p = 0.241). CONCLUSION Our meta-analysis showed a sonographically detectable degree of neuronal damage in PD, which correlates with VN atrophy with high confidence. Therefore, we believe this is a potential marker for vagus neuronal lesions. Future studies are required to assess the potential clinical correlation.
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Affiliation(s)
- Ramy Abdelnaby
- Department of Neurology, RWTH Aachen University, Aachen, Germany.
| | - Mostafa Hossam El Din Moawad
- Faculty of Pharmacy, Alexandria University, Alexandria, Egypt; Faculty of Medicine, Suez Canal University, Ismailia, Egypt.
| | | | | | | | | | | | | | - Muhammad A Shamim
- Department of Pharmacology, All India Institute of Medical Sciences, Jodhpur, India.
| | - Mostafa H Elberry
- Virology and Immunology Unit, Cancer Biology Department, National Cancer Institute, Cairo University, Cairo, Egypt.
| | - Mohamed Abdelmohsen Bedewi
- Department of Internal Medicine, College of Medicine, Prince Sattam Bin Abdulaziz University, Al-kharj, Kingdom of Saudi Arabia.
| | - Mohamed Elsayed
- Department of Psychiatry and Psychotherapy III, University of Ulm, Ulm, Germany; Department of Psychiatry, School of Medicine and Health Sciences, Carl von Ossietzky University Oldenburg, Oldenburg, Germany.
| | - Uwe Walter
- Department of Neurology, Rostock University Medical Center, and the German Center of Neurodegenerative Diseases, Research Site Rostock, Rostock, Germany.
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Sturchio A, Espay AJ. The theoretical problems of "prodrome" and "phenoconversion" in neurodegeneration. HANDBOOK OF CLINICAL NEUROLOGY 2023; 192:155-167. [PMID: 36796940 DOI: 10.1016/b978-0-323-85538-9.00002-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 02/16/2023]
Abstract
The recognition of and approach to prodromal symptoms, those which manifest before a diagnosis can be ascertained at the bedside, are of increasing interest in neurodegenerative research. A prodrome is conceived of as an early window into a disease, a critical time when putative disease-modifying interventions may be best suited for examination. Several challenges affect research in this area. Prodromal symptoms are highly prevalent in the population, can be nonprogressive for years or decades, and exhibit limited specificity in predicting conversion versus nonconversion into a neurodegenerative category within a time window feasible for most longitudinal clinical studies. In addition, there is a large range of biological alterations subsumed within each prodromal syndrome, forced to converge into the unifying nosology of each neurodegenerative disorder. Initial prodromal subtyping efforts have been developed but given the scarcity of prodrome-to-disease longitudinal studies, it is not yet clear whether any prodromal subtype can be predicted to evolve into the corresponding subtype of manifesting disease - a form of construct validity. As current subtypes generated from one clinical population are not faithfully replicated to others, it is likely that, lacking biological or molecular anchors, prodromal subtypes may only be applicable to the cohorts within which they were developed. Furthermore, as clinical subtypes have not aligned with a consistent pattern of pathology or biology, such might also be the fate of prodromal subtypes. Finally, the threshold defining the change from prodrome to disease for most neurodegenerative disorders remains clinical (e.g., a motor change in gait becoming noticeable to a clinician or measurable with portable technologies), not biological. As such, a prodrome can be viewed as a disease state not yet overt to a clinician. Efforts into identifying biological subtypes of disease, regardless of clinical phenotype or disease stage, may best serve future disease-modifying therapeutic strategies deployed not for a prodromal symptom but for a defined biological derangement as soon as it can be determined to lead to clinical changes, prodromal or not.
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Affiliation(s)
- Andrea Sturchio
- James J. and Joan A. Gardner Family Center for Parkinson's disease and Movement Disorders, Department of Neurology, University of Cincinnati, Cincinnati, OH, United States; Department of Clinical Neuroscience, Neuro Svenningsson, Karolinska Institutet, Stockholm, Sweden.
| | - Alberto J Espay
- James J. and Joan A. Gardner Family Center for Parkinson's disease and Movement Disorders, Department of Neurology, University of Cincinnati, Cincinnati, OH, United States.
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Xie L, Chen D, Zhu X, Cheng C. Efficacy and safety of probiotics in Parkinson's constipation: A systematic review and meta-analysis. Front Pharmacol 2023; 13:1007654. [PMID: 36703760 PMCID: PMC9871263 DOI: 10.3389/fphar.2022.1007654] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/02/2022] [Accepted: 12/21/2022] [Indexed: 01/12/2023] Open
Abstract
Background: Parkinson's disease (PD) is the most common neurodegenerative disease closely related to the immune system, among whose prodromes constipation is a representative symptom. Recent Randomized Controlled Trials (RCTs) have proved that probiotics can be used to effectively treat PD constipation, but the results are inconsistent. We performed a meta-analysis to assess the efficacy and safety of probiotic therapy on Parkinson's constipation. Methods: Questions about the research focus were constructed based on the Participants, Intervention, Comparison and Outcomes (PICO) Criteria. We searched electronic databases such as PubMed, Web of Science, EMBASE, Scopus, EBSCO, Cochrane and Google Scholar until March 2022 for eligible literatures. Our primary endpoints were stool frequency, stool consistency, the number of laxatives uses, UPDRS-III scores and adverse events. Results: 12 eligible studies (n = 818 patients) met the inclusion and endpoint criteria. Meta-analysis results showed that constipation symptoms were improved after probiotic treatment, including an increased stool frequency (WMD = 0.94, 95% CI:0.53 to 1.34; OR = 3.22, 95% CI:1.97-5.29), an improved stool consistency (WMD = 1.46, 95% CI:0.54-2.37), a reduced use of laxatives (WMD = -0.72, 95%CI: -1.04 to-0.41), and also a reduced Parkinson's UPDRS-III score (WMD = -6.58, 95%CI: -12.02 to -1.14); there was no significant difference in total adverse events (OR = 0.82, 95%CI:0.39-1.72). Conclusion: Our analysis suggests that probiotics can be used to improve the constipation and motor symptoms for patients with Parkinson's constipation, possibly by reducing the inflammatory response and improving gut-brain axis neuron function, whose safety also proved to be good.
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Kapoor S, Saluja A, Margekar SL, Agarwal M, Mondal S, Dhamija RK. Neurogenic Supine Hypertension and Cardiovascular Autonomic Dysfunction in Patients with Parkinson's Disease. Ann Indian Acad Neurol 2023; 26:33-38. [PMID: 37034036 PMCID: PMC10081556 DOI: 10.4103/aian.aian_476_22] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/28/2022] [Revised: 08/22/2022] [Accepted: 09/22/2022] [Indexed: 11/06/2022] Open
Abstract
Background Natural history and disease progression in patients with Idiopathic Parkinson's Disease (PD) is quite heterogeneous. Autonomic dysfunction occurs commonly among Idiopathic PD patients. Heart rate variability and ambulatory blood pressure monitoring are used to assess cardiac autonomic dysfunction. The prevalence and magnitude of supine hypertension in Indian PD patients has not been studied to date. The present study aimed to record cardiovascular autonomic functions and supine hypertension in PD patients and to correlate them with the age of onset, duration and severity of the disease, and non-motor symptom burden. Material and Methods The cross-sectional study involved 60 PD patients. Webster rating scale was used to determine the disease severity. Non-motor symptom burden was assessed using the Non-Motor Symptom Scale (NMSS). Ambulatory blood pressure monitoring and heart rate variability parameters determined cardiac autonomic function. Supine hypertension was defined as Systolic Blood Pressure (SBP) ≥150 mmHg and/or DBP ≥90 mmHg. Less than 10% decrease or even increase in blood pressure during the night were classified as non-dippers. Pearson coefficient was used appropriately to establish correlation. P ≤ 0.05 was considered significant. Results Age of onset was 61.2 ± 8.7 years and duration of disease was 1.7 ± 1.1 years. Mean Webster and non-motor symptom scores were 12.7 ± 4.4 and 15.5 ± 8.0, respectively. About 50 patients (83%) were non-dipper, while 32 (53%) had supine hypertension. Low Frequency oscillations (LF) (r = 0.28), High Frequency oscillations (HF) (r = 0.29), Standard Deviation NN intervals (SDNN) (0.26), and Root Mean Squared Successive Differences of NN intervals (RMSSD) (r = 0.28) correlated significantly with non-motor symptoms scale. LF (r = -0.39), HF (r = -0.43), SDNN (-0.40), RMSSD (r = -0.41), NN50 (r = -0.38), PNN50 (r = -0.42), mean SBP (r = 0.26), and mean DBP (r = 0.33) correlated significantly with disease duration. PNN50 (r = -0.255), mean SBP (r = -0.29), and mean DBP (r = -0.27) correlated significantly with age at onset. Conclusion Awareness regarding neurogenic supine hypertension is needed as it occurs commonly among Indian PD patients. Heart rate variability (HRV) parameters and ambulatory blood pressure are of significant help in the detection of early cardiovascular autonomic dysfunction and correlate significantly with disease duration and non-motor symptom burden among PD patients.
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Affiliation(s)
- Sunil Kapoor
- Department of Medicine, Lady Hardinge Medical College and Associated Hospitals, New Delhi, India
| | - Alvee Saluja
- Department of Neurology, Lady Hardinge Medical College and Associated Hospitals, New Delhi, India
| | - Shubha Laxmi Margekar
- Department of Medicine, Lady Hardinge Medical College and Associated Hospitals, New Delhi, India
| | - Mayank Agarwal
- Department of Physiology, Lady Hardinge Medical College and Associated Hospitals, New Delhi, India
| | - Sunita Mondal
- Department of Physiology, Lady Hardinge Medical College and Associated Hospitals, New Delhi, India
| | - Rajinder K. Dhamija
- Department of Neurology, Lady Hardinge Medical College and Associated Hospitals, New Delhi, India
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Non-motor manifestation of Parkinson's disease: a cross-sectional study in a teaching hospital in Jordan. THE EGYPTIAN JOURNAL OF NEUROLOGY, PSYCHIATRY AND NEUROSURGERY 2022. [DOI: 10.1186/s41983-022-00559-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022] Open
Abstract
Abstract
Background
Parkinson's disease (PD) is the most common degenerative movement disorder. It is featured by motor manifestations and up till now the clinical diagnosis is based on them. Since the progress in the symptomatic treatment of PD and the longer survival of patients, non-motor manifestations (NMM) were more recognized and considered to be significant. The importance of NMM is that they reflect the more diffuse pathology of PD and may represent an opportunity of earlier diagnosis and treatment. Here in this cross-sectional study, we try to estimate the frequency of such manifestations in PD patients in the country. Using slightly modified PD non-motor (28 of 30 responses) questionnaire (NMS Quest), we studied the incidence of NMM in 100 PD patients attending one major teaching hospital and compared their occurrence in 130 age- and gender-matched non-PD controls.
Results
Out of 100 PD patients (40% females) mean age 67.4 ± 12 with disease duration of 7.3 ± 5.8, range < 1–33.2 years), and 130 control subjects (48.5% females), mean age 65.0 ± 7.0. PD patients had 8.6 ± 5.3 NMM while controls had 3.4 ± 3.3 NMM, respectively (p < 0.00001 t test). Constipation, urgency, insomnia, sad feeling, panic, light headedness and recent memory impairment were the most prevalent NMM in PD compared to controls, while nocturia, restless legs, encopresis and falling were not different in the two groups. The number of NMM ranged from 0 to 21 in PD patients with 50% having ≥ 8 manifestations. The number of NMM did not correlate with age, gender, or disease duration as defined by the classical motor symptoms. Frequency of 23 of these 28 manifestations differed significantly in PD patients compared to controls.
Conclusions
This study confirms that NMM in Jordanian PD patients are very common as reported in other populations. This signifies the universal prevalence of such NMM reflecting their important impact on their daily life and their relevant contribution to better understanding of this disease.
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Abstract
The global burden of Parkinson's disease (PD) has increased from 2.5 to 6.1 million since the 1990s. This is expected to rise as the world population ages and lives longer. With the current consensus on the existence of a prediagnostic phase of PD, which can be divided into a preclinical stage and a prodromal stage, we can better define the risk markers and prodromal markers of PD in the broader context of PD pathogenesis. Here, we review this pathogenetic process, and discuss the evidence behind various heritability factors, exposure to pesticides and farming, high dairy consumption, and traumatic brain injuries that have been known to raise PD risk. Physical activity, early active lifestyle, high serum uric acid, caffeine consumption, exposure to tobacco, nonsteroidal anti-inflammatory drugs, and calcium channel blockers, as well as the Mediterranean and the MIND diets are observed to lower PD risk. This knowledge, when combined with ways to identify at-risk populations and early prodromal PD patients, can help the clinician make practical recommendations. Most importantly, it helps us set the parameters for epidemiological studies and create the paradigms for clinical trials.
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Affiliation(s)
- Suraj Rajan
- Division of Movement Disorders, Department of Neurology, Johns Hopkins University School of Medicine, Baltimore, Maryland
| | - Bonnie Kaas
- Division of Movement Disorders, Department of Neurology, Johns Hopkins University School of Medicine, Baltimore, Maryland
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The cross-sectional area of the vagus nerve is not reduced in Parkinson's disease patients. eNeurologicalSci 2022; 27:100400. [PMID: 35592106 PMCID: PMC9112122 DOI: 10.1016/j.ensci.2022.100400] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/14/2021] [Revised: 03/26/2022] [Accepted: 04/07/2022] [Indexed: 11/23/2022] Open
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Chakravarty K, Ray S. Cardiovascular Autonomic Dysfunction in Parkinson's Disease: Editorial Commentary. Ann Indian Acad Neurol 2022; 25:805-806. [PMID: 36560981 PMCID: PMC9764908 DOI: 10.4103/aian.aian_709_22] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/17/2022] [Accepted: 08/25/2022] [Indexed: 12/24/2022] Open
Affiliation(s)
| | - Sucharita Ray
- Department of Neurology, PGIMER, Chandigarh, India,Address for correspondence: Dr. Sucharita Ray, Department of Neurology, PGIMER, Chandigarh, India. E-mail:
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Cuenca-Bermejo L, Almela P, Navarro-Zaragoza J, Fernández Villalba E, González-Cuello AM, Laorden ML, Herrero MT. Cardiac Changes in Parkinson's Disease: Lessons from Clinical and Experimental Evidence. Int J Mol Sci 2021; 22:13488. [PMID: 34948285 PMCID: PMC8705692 DOI: 10.3390/ijms222413488] [Citation(s) in RCA: 18] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/19/2021] [Revised: 12/10/2021] [Accepted: 12/11/2021] [Indexed: 01/18/2023] Open
Abstract
Dysautonomia is a common non-motor symptom in Parkinson's disease (PD). Most dysautonomic symptoms appear due to alterations in the peripheral nerves of the autonomic nervous system, including both the sympathetic and parasympathetic nervous systems. The degeneration of sympathetic nerve fibers and neurons leads to cardiovascular dysfunction, which is highly prevalent in PD patients. Cardiac alterations such as orthostatic hypotension, heart rate variability, modifications in cardiogram parameters and baroreflex dysfunction can appear in both the early and late stages of PD, worsening as the disease progresses. In PD patients it is generally found that parasympathetic activity is decreased, while sympathetic activity is increased. This situation gives rise to an imbalance of both tonicities which might, in turn, promote a higher risk of cardiac damage through tachycardia and vasoconstriction. Cardiovascular abnormalities can also appear as a side effect of PD treatment: L-DOPA can decrease blood pressure and aggravate orthostatic hypotension as a result of a negative inotropic effect on the heart. This unwanted side effect limits the therapeutic use of L-DOPA in geriatric patients with PD and can contribute to the number of hospital admissions. Therefore, it is essential to define the cardiac features related to PD for the monitorization of the heart condition in parkinsonian individuals. This information can allow the application of intervention strategies to improve the course of the disease and the proposition of new alternatives for its treatment to eliminate or reverse the motor and non-motor symptoms, especially in geriatric patients.
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Affiliation(s)
- Lorena Cuenca-Bermejo
- Clinical and Experimental Neuroscience Group/Biomedical Research Institute of Murcia (NiCE-IMIB)/Institute for Aging Research, School of Medicine, University of Murcia, 30100 Murcia, Spain; (L.C.-B.); (A.-M.G.-C.)
| | - Pilar Almela
- Department of Pharmacology, School of Medicine, Biomedical Research Institute of Murcia (IMIB), University of Murcia, 30100 Murcia, Spain; (P.A.); (J.N.-Z.); (M.-L.L.)
| | - Javier Navarro-Zaragoza
- Department of Pharmacology, School of Medicine, Biomedical Research Institute of Murcia (IMIB), University of Murcia, 30100 Murcia, Spain; (P.A.); (J.N.-Z.); (M.-L.L.)
| | - Emiliano Fernández Villalba
- Clinical and Experimental Neuroscience Group/Biomedical Research Institute of Murcia (NiCE-IMIB)/Institute for Aging Research, School of Medicine, University of Murcia, 30100 Murcia, Spain; (L.C.-B.); (A.-M.G.-C.)
| | - Ana-María González-Cuello
- Clinical and Experimental Neuroscience Group/Biomedical Research Institute of Murcia (NiCE-IMIB)/Institute for Aging Research, School of Medicine, University of Murcia, 30100 Murcia, Spain; (L.C.-B.); (A.-M.G.-C.)
| | - María-Luisa Laorden
- Department of Pharmacology, School of Medicine, Biomedical Research Institute of Murcia (IMIB), University of Murcia, 30100 Murcia, Spain; (P.A.); (J.N.-Z.); (M.-L.L.)
| | - María-Trinidad Herrero
- Clinical and Experimental Neuroscience Group/Biomedical Research Institute of Murcia (NiCE-IMIB)/Institute for Aging Research, School of Medicine, University of Murcia, 30100 Murcia, Spain; (L.C.-B.); (A.-M.G.-C.)
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Yoshida K, Takano K, Tani H, Nobuhara S, Maruyama Y, Marumoto K. ΔHR/ΔWR derived from CPET; A novel predictor of 'off' symptom in Parkinson's disease. Parkinsonism Relat Disord 2021; 92:101-104. [PMID: 34739978 DOI: 10.1016/j.parkreldis.2021.10.022] [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: 06/28/2021] [Revised: 09/28/2021] [Accepted: 10/16/2021] [Indexed: 11/19/2022]
Abstract
INTRODUCTION Chronotropic incompetence (CI) is broadly defined as the inability of the heart to increase its rate commensurate with increased activity. In this study, we tried to clarify the link between CI and UPDRS part II (off-on), which was calculated by subtracting part II (on) from part II (off), in patients with Parkinson's disease (PD). METHODS Thirty-six hospitalized patients were examined by using cardiopulmonary exercise testing (CPET) for exercise tolerance (ΔVO2/ΔWR and peak VO2/W) and the presence of CI (ΔHR/ΔWR), and using electrocardiogram for heart rate variability. RESULTS We originally divided the patients into three groups; Group I (ΔHR/ΔWR x100 <15) (N = 3), Group II (15≥, <60) (N = 28), Group III (>60) (N = 5). Since Group I and III were significantly smaller and older than Group II, we focused and divided into two groups; Group II CI (+), the PD patients with CI (15≤ ΔHR/ΔWR x100 <35), and Group II CI (-), those patients without that (35≤ ΔHR/ΔWR x100 <60). ΔVO2/ΔWR and peak VO2/W in CI (+) patients was lower than CI (-) (P = 0.022 and P = 0.096, respectively). HF power (parasympathetic activity) tends to be decreased, whereas LF/HF ratio (sympathetic activity) was increased in CI (+) patients as compared with CI (-). The UPDRS part II (off-on) of CI (+) patients was significantly higher than CI (-) (P = 0.023). CONCLUSIONS In PD patients, the difference between 'on' and 'off' in activities of daily living might be predicted by using ΔHR/ΔWR x100 obtained from CPET as an index.
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Affiliation(s)
- Kohsuke Yoshida
- Department of Clinical Laboratory, Hyogo Prefectural Rehabilitation Hospital at Nishi-Harima, 1-7-1 Kouto, Shingu-cho, Tatsuno, Hyogo, 679-5165, Japan; Department of Public Health, Kobe University Graduate School of Health Sciences, 7-10-2, Tomogaoka, Suma-ku, Kobe, Hyogo, 654-0142, Japan.
| | - Kazuki Takano
- Department of Clinical Laboratory, Hyogo Prefectural Rehabilitation Hospital at Nishi-Harima, 1-7-1 Kouto, Shingu-cho, Tatsuno, Hyogo, 679-5165, Japan
| | - Hiromi Tani
- Department of Clinical Laboratory, Hyogo Prefectural Rehabilitation Hospital at Nishi-Harima, 1-7-1 Kouto, Shingu-cho, Tatsuno, Hyogo, 679-5165, Japan
| | - Sae Nobuhara
- Department of Clinical Laboratory, Hyogo Prefectural Rehabilitation Hospital at Nishi-Harima, 1-7-1 Kouto, Shingu-cho, Tatsuno, Hyogo, 679-5165, Japan
| | - Yuki Maruyama
- Department of Pharmacy, Hyogo Prefectural Rehabilitation Hospital at Nishi-Harima, 1-7-1 Kouto, Shingu-cho, Tatsuno, Hyogo, 679-5165, Japan
| | - Kohei Marumoto
- Department of Physical Medicine and Rehabilitation, Hyogo Prefectural Rehabilitation Hospital at Nishi-Harima, 1-7-1 Kouto, Shingu-cho, Tatsuno, Hyogo, 679-5165, Japan
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Fernandes B, Barbieri FA, Marҫal IR, do Amaral VT, Simieli L, Penedo T, Ciolac EG. Hemodynamic response to exercise is impaired in individuals with Parkinson's disease. J Sports Med Phys Fitness 2021; 62:389-394. [PMID: 34275259 DOI: 10.23736/s0022-4707.21.12111-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
PURPOSE To assess hemodynamic and cardiac autonomic response to high-intensity interval exercise (HIIE) versus moderate-intensity continuous exercise (MICE) in individuals with Parkinson's disease (PD). METHODS 12 individuals (six men) with PD were randomly assigned to perform HIIE (4 min of warm-up followed by 21 min alternating 1 min at levels 15-17 with 2 min at levels 9-11 of rating of perceived exertion [RPE] in a cycle ergometer), MICE (4 min of warm-up followed by 26 min at levels 11-14 of RPE in a cycle ergometer) and control (CON; 30 min of sitting rest) interventions in separate days. Heart rate (HR), blood pressure (BP), endothelial reactivity and heart rate variability (HRV) were assessed before, immediately after and 45 min after each intervention. HR and exercise workload were measured during each intervention. RESULTS Despite the within (high- vs. low-intensity intervals of HIIE) and between (HIIE vs. MICE) differences in workload during exercise sessions, HR was not different between high- (average HR = 98±18 bpm) and low-intensity (average HR 97±19 bpm) intervals of HIIE, as well as between HIIE (average HR = 97±18 bpm) and MICE (average HR = 93±19 bpm) throughout the exercise. There were significant, but small, increases (P < 0.01) in HR and systolic BP at post HIIE and MICE, which returned to levels similar to pre-intervention during recovery. There were no within- and betweenintervention differences in diastolic BP, endothelial reactivity and HRV. CONCLUSIONS The present results suggest that hemodynamic response to exercise is impaired in individuals with PD.
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Affiliation(s)
- Bianca Fernandes
- Exercise and Chronic Disease Research Laboratory (ECDR), Department of Physical Education, School of Sciences, São Paulo State University (UNESP), Bauru, Brazil
| | | | - Isabela R Marҫal
- Exercise and Chronic Disease Research Laboratory (ECDR), Department of Physical Education, School of Sciences, São Paulo State University (UNESP), Bauru, Brazil
| | - Vanessa T do Amaral
- Exercise and Chronic Disease Research Laboratory (ECDR), Department of Physical Education, School of Sciences, São Paulo State University (UNESP), Bauru, Brazil
| | - Lucas Simieli
- Human Movement Research Laboratory (MOVI-LAB), Bauru, Brazil
| | - Tiago Penedo
- Human Movement Research Laboratory (MOVI-LAB), Bauru, Brazil
| | - Emmanuel G Ciolac
- Exercise and Chronic Disease Research Laboratory (ECDR), Department of Physical Education, School of Sciences, São Paulo State University (UNESP), Bauru, Brazil -
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Yavasoglu NG, Comoglu SS. The effect of subthalamic deep brain stimulation on autonomic dysfunction in Parkinson's disease: clinical and electrophysiological evaluation. Neurol Res 2021; 43:894-899. [PMID: 34134609 DOI: 10.1080/01616412.2021.1942409] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
Abstract
Introduction: Subthalamic nucleus (STN) deep brain stimulation (DBS) is an important option in the treatment of motor symptoms and fluctuations in patients with advanced Parkinson's disease (PD). In addition to the improvement in motor symptoms, many studies have reported changes in some non-motor symptoms (NMS) after STN DBS.Method: 61 patients (42 males) who underwent STN DBS with advanced PD and 24 healthy controls (15 males) were included in the study. Autonomic symptoms (orthostatic hypotension, sweating, salivation) were assessed with a semi-structured questionnaire. Sympathetic skin responses (SSR) were studied by electrophysiological examination within 3-6 months after STN DBS.Results: SSR latency and amplitude were found between the control group and preoperative patients (P ≤ 0.01; p = 0.01, respectively), and between preoperative and postoperative patients (P ≤ 0.01; P ≤ 0.01, respectively). There was a statistically significant difference between the control group and postoperative patients (p = 0.005; p = 0.029, respectively). Orthostatic hypotension (29%) and sweating (48%) improved, but there was no change in the salivation.Discussion: We think that STN DBS applied in PD has not only motor symptoms and fluctuations, but also corrects autonomic dysfunctions such as sweating disorders and orthostatic hypotension; SSR is more sensitive and reliable in detecting autonomic dysfunction, independent of motor symptoms and fluctuations.
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Affiliation(s)
- Nese Gungor Yavasoglu
- Department of Neurology, Dışkapı Yıldırım Beyazıt Training and Research Hospital, Ankara, Turkey
| | - S Selcuk Comoglu
- Department of Neurology, Dışkapı Yıldırım Beyazıt Training and Research Hospital, Ankara, Turkey
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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.
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Sayegh ALC, Janzen A, Strzedulla I, Birklein F, Lautenschläger G, Oertel WH, Krämer HH, Best C. Increased muscle sympathetic nerve activity and impaired baroreflex control in isolated REM-sleep behavior disorder. Clin Neurophysiol 2021; 132:1537-1542. [PMID: 34023631 DOI: 10.1016/j.clinph.2021.04.012] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/23/2021] [Revised: 03/04/2021] [Accepted: 04/01/2021] [Indexed: 10/21/2022]
Abstract
OBJECTIVE Changes in baroreflex sensitivity have been reported in patients with idiopathic Parkinson's disease (PD). We sought to investigate the hypothesis that patients with isolated rapid eye movement (REM)-sleep behavior disorder (iRBD), known to be a prodromal stage for PD, will show abnormalities in baroreflex control. METHODS Ten iRBD patients were compared to 10 sex- and age-matched healthy controls. Their cardiovascular parameters and muscle sympathetic nerve activity (MSNA) were evaluated at rest and during baroreflex stimulation. RESULTS MSNA at rest was higher in iRBD patients (burst frequency [BF]: 44 ± 3 bursts/min; burst incidence [BI]: 60 ± 8 bursts/100 heartbeats) as compared to the controls (BF: 29 ± 3 bursts/min, p < 0.001; BI: 43 ± 9 bursts/100 heartbeats, p < 0.001). During baroreflex stimulation, iRBD patients showed increased absolute values of MSNA (BF: F = 62.728; p < 0.001; BI: F = 16.277; p < 0.001) as compared to the controls. The iRBD patients had decreased diastolic blood pressure at baseline and during lower body negative pressure, but the level of significance was not met. CONCLUSION Our study shows increased MSNA and impaired baroreflex control in iRBD patients. We propose that the inhibitory effect of locus coeruleus on baroreflex function might be impaired, leading to the disinhibition of sympathetic outflow. SIGNIFICANCE These findings might reflect the destruction of brain areas due to the ascending P-α-synuclein deposits in iRBD patients.
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Affiliation(s)
- Ana Luiza C Sayegh
- Department of Neurology, Justus-Liebig-University, Giessen, Germany; Department of Physiology, The University of Auckland, New Zealand
| | - Annette Janzen
- Department of Neurology, Philipps-University, Marburg, Germany
| | | | - Frank Birklein
- Department of Neurology, University Medical Center, Johannes-Gutenberg-University, Mainz, Germany
| | | | | | - Heidrun H Krämer
- Department of Neurology, Justus-Liebig-University, Giessen, Germany.
| | - Christoph Best
- Department of Neurology, Philipps-University, Marburg, Germany
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Lorente-Picón M, Laguna A. New Avenues for Parkinson's Disease Therapeutics: Disease-Modifying Strategies Based on the Gut Microbiota. Biomolecules 2021; 11:433. [PMID: 33804226 PMCID: PMC7998286 DOI: 10.3390/biom11030433] [Citation(s) in RCA: 36] [Impact Index Per Article: 12.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/19/2021] [Revised: 03/09/2021] [Accepted: 03/11/2021] [Indexed: 12/13/2022] Open
Abstract
Parkinson's disease (PD) is a multifactorial neurodegenerative disorder that currently affects 1% of the population over the age of 60 years, and for which no disease-modifying treatments exist. Neurodegeneration and neuropathology in different brain areas are manifested as both motor and non-motor symptoms in patients. Recent interest in the gut-brain axis has led to increasing research into the gut microbiota changes in PD patients and their impact on disease pathophysiology. As evidence is piling up on the effects of gut microbiota in disease development and progression, another front of action has opened up in relation to the potential usage of microbiota-based therapeutic strategies in treating gastrointestinal alterations and possibly also motor symptoms in PD. This review provides status on the different strategies that are in the front line (i.e., antibiotics; probiotics; prebiotics; synbiotics; dietary interventions; fecal microbiota transplantation, live biotherapeutic products), and discusses the opportunities and challenges the field of microbiome research in PD is facing.
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Affiliation(s)
- Marina Lorente-Picón
- Neurodegenerative Diseases Research Group, Vall d'Hebron Research Institute (VHIR)-Center for Networked Biomedical Research on Neurodegenerative Diseases (CIBERNED), Passeig Vall d'Hebron 119-129, 08035 Barcelona, Spain
| | - Ariadna Laguna
- Neurodegenerative Diseases Research Group, Vall d'Hebron Research Institute (VHIR)-Center for Networked Biomedical Research on Neurodegenerative Diseases (CIBERNED), Passeig Vall d'Hebron 119-129, 08035 Barcelona, Spain
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Sympathetic and sensory nerve fiber function in multiple system atrophy and idiopathic Parkinson's disease. J Neurol 2021; 268:3435-3443. [PMID: 33715046 PMCID: PMC8357748 DOI: 10.1007/s00415-021-10514-9] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/12/2021] [Revised: 03/05/2021] [Accepted: 03/08/2021] [Indexed: 12/16/2022]
Abstract
OBJECTIVE To explore small fiber somatosensory and sympathetic function in PD and MSA. METHODS We recruited 20 PD patients (7 women, median age 65.5 years; IQR 54.75-70.0), 10 MSA patients (4 women; median age 68 years; IQR 66.25-74.0), and 10 healthy subjects (HC; 4 women, median age 68; IQR 59.0-71.0 years). Autonomic testing included forehead cooling, intradermal microdialysis of norepinephrine (NE; 10-5; 10-6; 10-7; and 10-8), and orthostatic hypotension (OH); somatosensory testing included quantitative sensory testing (QST) according to the protocol of the German Research Network on Neuropathic Pain (DFNS). RESULTS OH occurred more frequently in PD (p = 0.018) and MSA (p = 0.002) compared to HC. Vasoconstriction responses were stronger in PD compared to MSA during forehead cooling (p = 0.044) and microdialysis of physiologically concentrated NE solutions (10-7; 10-8; p = 0.017). PD and MSA had impaired cold (PD: p < 0.01; MSA: p < 0.05) and warm detection thresholds (PD and MSA, both p < 0.05). The mechanical detection threshold was higher in PD (p < 0.01). Conversely, mechanical pain thresholds were decreased in PD and MSA (both p < 0.001), indicating mechanical hyperalgesia. CONCLUSION In contrast to MSA, we found evidence of peripheral adrenoreceptor hypersensitivity in PD, probably caused by peripheral sympathetic denervation. Sensory testing revealed peripheral neuropathy and central pain sensitization in PD and MSA. Jointly, our data demonstrate autonomic and somatosensory dysfunction in PD and MSA.
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25
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Kaiserova M, Grambalova Z, Kurcova S, Otruba P, Prikrylova Vranova H, Mensikova K, Kanovsky P. Premotor Parkinson's disease: Overview of clinical symptoms and current diagnostic methods. Biomed Pap Med Fac Univ Palacky Olomouc Czech Repub 2021; 165:103-112. [PMID: 33542542 DOI: 10.5507/bp.2021.002] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/27/2020] [Accepted: 01/07/2021] [Indexed: 02/08/2023] Open
Abstract
Parkinson's disease (PD) is characterized by typical motor symptoms. However, recent studies show several non-motor features that may precede the development of the motor symptoms of PD. The best known premotor symptoms include hyposmia, REM sleep behavior disorder (RBD), constipation, and depression; other symptoms are excessive daytime somnolence, orthostatic hypotension and symptomatic hypotension, erectile or urinary dysfunction, musculoskeletal symptoms, pain, and global cognitive deficit. In this review, we summarize currently available diagnostic methods for these symptoms. We also briefly summarize neuroimaging, polyneuropathy, peripheral markers, and cerebrospinal fluid biomarkers that may be used in the early diagnosis of PD.
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Affiliation(s)
- Michaela Kaiserova
- Department of Neurology, Faculty of Medicine and Dentistry, Palacky University and University Hospital, Olomouc, Czech Republic
| | - Zuzana Grambalova
- Department of Neurology, Faculty of Medicine and Dentistry, Palacky University and University Hospital, Olomouc, Czech Republic
| | - Sandra Kurcova
- Department of Neurology, Faculty of Medicine and Dentistry, Palacky University and University Hospital, Olomouc, Czech Republic
| | - Pavel Otruba
- Department of Neurology, Faculty of Medicine and Dentistry, Palacky University and University Hospital, Olomouc, Czech Republic
| | | | - Katerina Mensikova
- Department of Neurology, Faculty of Medicine and Dentistry, Palacky University and University Hospital, Olomouc, Czech Republic
| | - Petr Kanovsky
- Department of Neurology, Faculty of Medicine and Dentistry, Palacky University and University Hospital, Olomouc, Czech Republic
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26
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Coffman CA, Harrison AT, Kay JJM, Holloway JP, LaFountaine MF, Moore RD. The Influence of Family History of Neurodegenerative Disease on Adolescent Concussion Outcomes. J Clin Med 2021; 10:528. [PMID: 33540525 PMCID: PMC7867167 DOI: 10.3390/jcm10030528] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/31/2020] [Revised: 01/21/2021] [Accepted: 01/28/2021] [Indexed: 12/04/2022] Open
Abstract
Evidence suggests that factors associated with a family history of neurodegenerative disease (fhNDD) may influence outcomes following a concussion. However, the relevance of these findings in adolescent populations has not been fully explored. Therefore, the present study sought to evaluate the relationship between fhNDD and neurological outcomes following an adolescent concussion. Data from a local pediatric concussion clinic were used to compare adolescents with (n = 22) and without (n = 44) an fhNDD. Clinical symptom burden, emotional health, cardio-autonomic function, and cognitive performance were assessed at initial (~2 weeks) and follow-up (~5 weeks) post-injury evaluations. Cardio-autonomic function was assessed at rest and during isometric handgrip contraction (IHGC). Results indicated no significant group differences in emotional health or cognitive performance. Across evaluations, those with an fhNDD exhibited greater somatic symptom severity, alterations in HRV at rest, and early blunted cardio-autonomic reactivity during IHGC compared to those without an fhNDD. These findings suggest that positive fhNDD is negatively associated with clinical symptomology and cardio-autonomic functioning following an adolescent concussion. Further, these findings encourage clinicians to utilize a comprehensive neurological evaluation to monitor concussion recovery. Future studies should look into exploring the role of specific neurodegenerative processes and conditions on concussion outcomes in adolescents.
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Affiliation(s)
- Colt A. Coffman
- Concussion Health and Neuroscience Lab, Arnold School of Public Health, University of South Carolina, Columbia, SC 29208, USA; (A.T.H.); (J.J.M.K.)
| | - Adam T. Harrison
- Concussion Health and Neuroscience Lab, Arnold School of Public Health, University of South Carolina, Columbia, SC 29208, USA; (A.T.H.); (J.J.M.K.)
| | - Jacob J. M. Kay
- Concussion Health and Neuroscience Lab, Arnold School of Public Health, University of South Carolina, Columbia, SC 29208, USA; (A.T.H.); (J.J.M.K.)
| | - Jeffrey P. Holloway
- Department of Pediatrics—School of Medicine, University of South Carolina, Columbia, SC 29209, USA;
| | - Michael F. LaFountaine
- Department of Physical Therapy, School of Health and Medical Sciences, Seton Hall University, South Orange, NJ 07110, USA;
- Departments of Medical Sciences and Neurology, Hackensack Meridian School of Medicine, Nutley, NJ 07110, USA
| | - Robert Davis Moore
- Concussion Health and Neuroscience Lab, Arnold School of Public Health, University of South Carolina, Columbia, SC 29208, USA; (A.T.H.); (J.J.M.K.)
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27
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Penko AL, Zimmerman NM, Crawford M, Linder SM, Alberts JL. Effect of Aerobic Exercise on Cardiopulmonary Responses and Predictors of Change in Individuals With Parkinson's Disease. Arch Phys Med Rehabil 2021; 102:925-931. [PMID: 33453190 DOI: 10.1016/j.apmr.2020.12.011] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/26/2020] [Revised: 12/02/2020] [Accepted: 12/05/2020] [Indexed: 10/22/2022]
Abstract
OBJECTIVE To determine the effect of aerobic exercise on maximal and submaximal cardiopulmonary responses and predictors of change in individuals with Parkinson's disease (PD). DESIGN Single-center, parallel-group, rater-blind study. SETTING Research laboratory. PARTICIPANTS Individuals with mild to moderate PD (N=100). INTERVENTION Participants were enrolled in a trial evaluating the effect of cycling on PD and randomized to either voluntary exercise (VE), forced exercise (FE), or a no exercise control group. The exercise groups were time and intensity matched and exercised 3×/wk for 8 weeks on a stationary cycle. MAIN OUTCOME MEASURES Cardiopulmonary responses were collected via gas analysis during a maximal graded exercise test at baseline and post intervention. RESULTS Exercise attendance was 97% and 93% for the FE and VE group, respectively. Average exercise heart rate reserve was 67%±11% for FE and 70%±10% for VE. No significant difference was present for change in peak oxygen consumption (VO2peak) post intervention, even though the FE group had a 5% increase in VO2peak. Both the FE and VE groups had significantly higher percentage oxygen consumption per unit time (V˙o2) at ventilator threshold (VT) than the control group compared with baseline values (P=.04). Mean V˙O2 at VT was 5% (95% CI, 0.1%-11%) higher in the FE group (P=.04) and 7% (2%, 12%) higher in VE group compared with controls. A stepwise linear regression model revealed that lower age, higher exercise cadence, and lower baseline VO2peak were most predictive of improved VO2peak. The overall model was found to be significant (P<.01). CONCLUSIONS Peak and submaximal cardiopulmonary function may improve after aerobic exercise in individuals with PD. Lower age, higher exercise cadence, and lower baseline VO2peak were most predictive of improved VO2peak in this exercise cohort. The improvements observed in aerobic capacity were gained after a relatively short aerobic cycling intervention.
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Affiliation(s)
- Amanda L Penko
- Department of Biomedical Engineering, Cleveland Clinic, Cleveland, Ohio
| | - Nicole M Zimmerman
- Department of Clinical Transformation, Cleveland Clinic, Cleveland, Ohio
| | | | - Susan M Linder
- Department of Biomedical Engineering, Cleveland Clinic, Cleveland, Ohio; Department of Physical Medicine and Rehabilitation, Cleveland Clinic, Cleveland, Ohio
| | - Jay L Alberts
- Department of Biomedical Engineering, Cleveland Clinic, Cleveland, Ohio; Center for Neurological Restoration, Cleveland Clinic, Cleveland, Ohio.
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28
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Han S, Moon I, Choi EK, Han KD, Cho HC, Lee SY, Yang S, Kwon S, Choi YJ, Lee HJ, Lee E, Lee SR, Oh S. Increased atrial fibrillation risk in Parkinson's disease: A nationwide population-based study. Ann Clin Transl Neurol 2021; 8:238-246. [PMID: 33389803 PMCID: PMC7818085 DOI: 10.1002/acn3.51279] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/26/2020] [Revised: 10/29/2020] [Accepted: 11/30/2020] [Indexed: 12/17/2022] Open
Abstract
OBJECTIVE Parkinson's disease (PD) is the second most common neurodegenerative disorder associated with various morbidities. Although the relationship between cardiovascular disease and PD has been studied, a paucity of information on PD and atrial fibrillation (AF) association exists. Thus, we aimed to investigate whether patients with PD have an increased risk of AF. METHODS This study included 57,585 patients with newly diagnosed PD (≥40-year-old, mean age 69.7 years, men 40.2%) and without a history of AF from the Korean National Health Insurance Service (NHIS) database between 2010 and 2015. Furthermore, an equal number of age- and sex-matched subjects without PD were selected for comparison. The primary outcome was new-onset AF. RESULTS During the mean follow-up period of 3.4 ± 1.8 years, AF was newly diagnosed in 3,665 patients. A significantly higher incidence rate of AF was noted among patients with PD than among patients without PD (10.75 and 7.86 per 1000 person-year, respectively). Multivariate Cox-regression analysis revealed that PD was an independent risk factor for AF (hazard ratio [HR]: 1.27, 95% confidence interval [CI]: 1.18-1.36). Furthermore, subgroup analyses revealed that AF risk was higher in the younger age subgroups, and compared with the non-PD group, the youngest PD group (age: 40-49 years) had a threefold increased risk of AF (HR: 3.06, 95% CI: 1.20-7.77). INTERPRETATION Patients with PD, especially the younger age subgroups, have an increased risk of AF. Active surveillance and management of AF should be considered to prevent further complications.
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Affiliation(s)
- Seokmoon Han
- Department of Internal Medicine, Seoul National University Hospital, Seoul, Republic of Korea
| | - Inki Moon
- Department of Internal Medicine, Soonchunhyang University Bucheon Hospital, Gyeonggi-do, Republic of Korea
| | - Eue-Keun Choi
- Department of Internal Medicine, Seoul National University Hospital, Seoul, Republic of Korea
| | - Kyung-Do Han
- Department of Statistics and Actuarial Science, Soongsil University, Seoul, Republic of Korea
| | - Hae-Chan Cho
- Department of Internal Medicine, Seoul National University Hospital, Seoul, Republic of Korea
| | - Seo-Young Lee
- Department of Internal Medicine, Seoul National University Hospital, Seoul, Republic of Korea
| | - Seokhun Yang
- Department of Internal Medicine, Seoul National University Hospital, Seoul, Republic of Korea
| | - Soonil Kwon
- Department of Internal Medicine, Seoul National University Hospital, Seoul, Republic of Korea
| | - You-Jung Choi
- Department of Internal Medicine, Seoul National University Hospital, Seoul, Republic of Korea
| | - Hyun-Jung Lee
- Department of Internal Medicine, Seoul National University Hospital, Seoul, Republic of Korea
| | - Euijae Lee
- Department of Internal Medicine, Seoul National University Hospital, Seoul, Republic of Korea
| | - So-Ryung Lee
- Department of Internal Medicine, Seoul National University Hospital, Seoul, Republic of Korea
| | - Seil Oh
- Department of Internal Medicine, Seoul National University Hospital, Seoul, Republic of Korea
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29
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Yoshino K, Kawaguchi A, Yata S, Iyama A, Sakoda S. Analysis of heart rate response to obstructive apnea/hypopnea events in patients with Parkinson's disease with relatively severe sleep apnea syndrome. INFORMATICS IN MEDICINE UNLOCKED 2021. [DOI: 10.1016/j.imu.2021.100554] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022] Open
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30
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Dayan E, Sklerov M. Autonomic disorders in Parkinson disease: Disrupted hypothalamic connectivity as revealed from resting-state functional magnetic resonance imaging. HANDBOOK OF CLINICAL NEUROLOGY 2021; 182:211-222. [PMID: 34266593 DOI: 10.1016/b978-0-12-819973-2.00014-9] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/24/2023]
Abstract
Converging evidence from diverse methodologies implicate the hypothalamus in the pathophysiology of Parkinson's disease (PD). Pathology in the hypothalamus and in hypothalamic pathways has been linked primarily to autonomic dysfunction, routinely experienced by individuals with PD throughout the course of the disease, sometimes predating onset of motor symptoms. Postmortem and molecular imaging studies have delineated pathologic changes in the hypothalamus and demonstrated alterations in neurotransmitter systems within this structure and associated pathways, which track the progression of the disease. More recently, functional interactions between the hypothalamus, thalamus, and striatum, as assessed using resting-state functional magnetic resonance imaging, were shown to be reduced in PD patients with high in comparison to those with low autonomic symptom burden. These functional changes may relate to micro- and macrostructural alterations which are also observed in PD. An examination of the hypothalamus and hypothalamic pathways can also shed light on atypical parkinsonian disorders and their distinct pathophysiologic characteristics relative to idiopathic PD. Altogether, the current state of knowledge on the involvement of the hypothalamus in PD is profound, yet emerging methodological advances are likely to move our understanding of hypothalamic pathology in PD significantly forward.
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Affiliation(s)
- Eran Dayan
- Department of Radiology and Biomedical Research Imaging Center, University of North Carolina at Chapel Hill, Chapel Hill, NC, United States.
| | - Miriam Sklerov
- Department of Neurology, University of North Carolina at Chapel Hill, Chapel Hill, NC, United States
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31
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Fearon C, Lees AJ, McKinley JJ, McCarthy A, Smyth S, Farrell M, Lynch T. On the Emergence of Tremor in Prodromal Parkinson's Disease. JOURNAL OF PARKINSONS DISEASE 2020; 11:261-269. [PMID: 33325397 DOI: 10.3233/jpd-202322] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
Clinical, neuropathological and neuroimaging research suggests that pathological changes in Parkinson's disease (PD) start many years before the emergence of motor signs. Since disease-modifying treatments are likely to be most effective when initiated early in the disease process, there has been significant interest in characterizing prodromal PD. Some people with PD describe autonomic symptoms at the time of diagnosis suggesting that autonomic dysfunction is a common feature of prodromal PD. Furthermore, subtle motor signs may be present and emerge prior to the time of diagnosis. We present a series of patients who, in the prodromal phase of PD, experienced the emergence of tremor initially only while yawning or straining at stool and discuss how early involvement of autonomic brainstem nuclei could lead to these previously unreported phenomena. The hypothalamic paraventricular nucleus (PVN) plays a central role in autonomic control including bowel/bladder function, cardiovascular homeostasis and yawning and innervates multiple brainstem nuclei involved in autonomic functions (including brainstem reticular formation, locus ceruleus, dorsal raphe nucleus and motor nucleus of the vagus). The PVN is affected in PD and evidence from related phenomena suggest that the PVN could increase tremor either by increasing downstream cholinergic activity on brainstem nuclei such as the reticular formation or by stimulating the locus ceruleus to activate the cerebellothalamocortical network via the ventrolateral nucleus of the thalamus. Aberrant cholinergic/noradrenergic transmission between these brainstem nuclei early in PD couldlead to tremor before the emergence of other parkinsonian signs, representing an early clinical clue to prodromal PD.
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Affiliation(s)
- Conor Fearon
- Centre for Brain Health, Dublin Neurological Institute at the Mater Misericordiae University Hospital, Dublin, Ireland
| | - Andrew J Lees
- Reta Lila Weston Institute of Neurological Studies University College London, London, UK
| | - John J McKinley
- Department of Neurology, Royal Victoria Hospital, Belfast, UK
| | - Allan McCarthy
- Department of Neurology, Tallaght University Hospital, Dublin, Ireland
| | - Shane Smyth
- Centre for Brain Health, Dublin Neurological Institute at the Mater Misericordiae University Hospital, Dublin, Ireland
| | - Michael Farrell
- Department of Neuropathology, Beaumont Hospital, Dublin, Ireland
| | - Timothy Lynch
- Centre for Brain Health, Dublin Neurological Institute at the Mater Misericordiae University Hospital, Dublin, Ireland.,Health Affairs, University College Dublin, Dublin, Ireland
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32
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Kong WL, Huang Y, Qian E, Morris MJ. Constipation and sleep behaviour disorder associate with processing speed and attention in males with Parkinson's disease over five years follow-up. Sci Rep 2020; 10:19014. [PMID: 33149217 PMCID: PMC7643116 DOI: 10.1038/s41598-020-75800-4] [Citation(s) in RCA: 13] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/03/2020] [Accepted: 09/07/2020] [Indexed: 02/06/2023] Open
Abstract
Constipation and REM sleep behaviour disorder (RBD) are the earliest non-motor manifestations of Parkinson's disease (PD). Among non-motor symptoms of PD, it is unclear whether constipation and RBD at early stages of PD are related to cognitive outcomes at later stages. Herein, this study aims to investigate whether the presence of constipation and RBD have an impact on future cognitive outcomes in PD. Access to Parkinson's Progression Markers Initiative (PPMI) database of 360 PD patients with longitudinal observation was requested. Constipation, probable RBD (pRBD) and neuropsychological task scores of PD patients were assessed at baseline and after 5 years. Linear mixed-effects modelling, controlling for gender, age, years of education and LEDD was used to evaluate the association between baseline constipation, pRBD and cognitive performance on follow-up. Gender differences in neuropsychological test performances were found, with men having worse global cognition, speed-attention processing, verbal learning and memory than women at early stages of the disease. We found constipation and pRBD are strongly associated with future decline in some cognitive measures among PD patients, more prominently in men. Our data suggest that early assessment of pRBD and constipation may allow better understanding of the progression of cognitive changes in later phases of PD.
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Affiliation(s)
- Wee Lee Kong
- Department of Pharmacology, School of Medical Sciences, Faculty of Medicine, University of New South Wales, Sydney, NSW 2052 Australia
| | - Yue Huang
- Department of Pharmacology, School of Medical Sciences, Faculty of Medicine, University of New South Wales, Sydney, NSW 2052 Australia
- China National Clinical Research Center for Neurological Diseases, Beijing Tiantan Hospital, Capital Medical University, Beijing, 100071 China
| | - Elizabeth Qian
- Department of Pharmacology, School of Medical Sciences, Faculty of Medicine, University of New South Wales, Sydney, NSW 2052 Australia
| | - Margaret J. Morris
- Department of Pharmacology, School of Medical Sciences, Faculty of Medicine, University of New South Wales, Sydney, NSW 2052 Australia
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33
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Lower Urinary Tract and Gastrointestinal Dysfunction Are Common in Early Parkinson's Disease. PARKINSONS DISEASE 2020; 2020:1694547. [PMID: 33123339 PMCID: PMC7586173 DOI: 10.1155/2020/1694547] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 05/28/2020] [Revised: 10/03/2020] [Accepted: 10/05/2020] [Indexed: 01/08/2023]
Abstract
Purpose Autonomic dysfunction is a common nonmotor feature and early manifestation of Parkinsons disease (PD). Autonomic dysfunction in PD is associated with a worse prognosis. We sought to characterize autonomic dysfunction and identify associated factors in patients with early PD. Methods An observational, cross-sectional, descriptive, and analytical study was conducted to evaluate patients with early PD from the Parkinsons Progression Markers Initiative. We utilized the Scales for Outcomes in Parkinsons Disease-Autonomic dysfunction questionnaire to determine the prevalence and frequencies of autonomic symptomatology. The cohort was grouped into high and low dysautonomic scores. A regression model identified variables that independently explained dysautonomic scores in our early PD cohort. Results 414 PD patients had a mean age of 61.1 (SD 9.7) years at diagnosis and mean disease duration of 6.7 (SD 6.6) months. Among all patients, 43.7% (181/414) had high dysautonomic scores. Urinary and gastrointestinal symptoms were the most prevalent and frequently reported dysautonomic symptoms. Patients with fatigue (beta = 4.28, p < 0.001), probable rapid eye movement sleep behavior disorder (beta = 2.71, p < 0.001), excessive daytime sleepiness (beta = 1.88,p=0.039), impulsivity and compulsivity (beta = 2.42, p < 0.001), and increasing age (beta = 1.05, p < 0.001) were more likely to have high dysautonomic scores. Conclusion Lower urinary tract and gastrointestinal symptoms are prevalent and frequent in early PD patients. Fatigue, sleep disorders, impulsivity and compulsivity, and age are predictors of autonomic dysfunction. Autonomic symptoms predominated in this group of early PD patients in the disease course and were associated with more severe disease.
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34
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Yoo SW, Yun E, Bang M, Yoon U, Yoo JY, Lee KS, Shin NY, Kim JS. Blood pressure lability is associated with subcortical atrophy in early Parkinson's disease. J Hypertens 2020; 38:2043-2049. [PMID: 32890281 DOI: 10.1097/hjh.0000000000002505] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/30/2022]
Abstract
OBJECTIVE Increased cerebral white matter intensities associated with blood pressure (BP) lability were reported in patients with Parkinson's disease. However, this type of cardiovascular dysautonomia has seldom been associated with disruptions in deep gray matter structures in Parkinson's disease. In the present study, the associations between BP lability and subcortical deep gray matter structures in early Parkinson's disease were evaluated. METHODS The present study included 98 early nondemented Parkinson's disease patients. Supine and orthostatic BPs were measured using head-up tilt tests. BP variabilities, measured as standard deviations of 24-h daytime and nighttime BPs, were assessed using 24-h ambulatory BP monitoring. Every patient underwent brain MRI and measurement of deep gray matter volumes. The associations between BP lability and deep gray matter structures were analyzed. RESULTS Parkinson's disease patients with orthostatic hypotension had smaller volumes of striatum, particularly caudate, than patients without OH after adjusting for covariates of age, sex, disease duration, and Mini-Mental Status Examination score. Nocturnal BP variability was inversely associated with thalamus, hippocampus, and globus pallidus volumes. CONCLUSION The results from the present study showed that BP lability was adversely associated with structural changes in early Parkinson's disease. Different forms of BP fluctuations influenced distinct deep gray matter structures.
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Affiliation(s)
- Sang-Won Yoo
- Department of Neurology, College of Medicine, The Catholic University of Korea, Seoul
| | - Eunkyeong Yun
- Department of Biomedical Engineering, College of Health and Medical Science, Catholic University of Daegu, Gyeongbuk
| | - Mirim Bang
- Department of Radiology, College of Medicine, The Catholic University of Korea, Seoul, Republic of Korea
| | - Uicheul Yoon
- Department of Biomedical Engineering, College of Health and Medical Science, Catholic University of Daegu, Gyeongbuk
| | - Ji-Yeon Yoo
- Department of Neurology, College of Medicine, The Catholic University of Korea, Seoul
| | - Kwang-Soo Lee
- Department of Neurology, College of Medicine, The Catholic University of Korea, Seoul
| | - Na-Young Shin
- Department of Radiology, College of Medicine, The Catholic University of Korea, Seoul, Republic of Korea
| | - Joong-Seok Kim
- Department of Neurology, College of Medicine, The Catholic University of Korea, Seoul
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35
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Blumenreich S, Jenkins BJ, Barav OB, Milenkovic I, Futerman AH. The Lysosome and Nonmotor Symptoms: Linking Parkinson's Disease and Lysosomal Storage Disorders. Mov Disord 2020; 35:2150-2155. [PMID: 32986899 DOI: 10.1002/mds.28232] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/05/2020] [Revised: 06/09/2020] [Accepted: 06/29/2020] [Indexed: 11/07/2022] Open
Affiliation(s)
- Shani Blumenreich
- Department of Biomolecular Sciences, Weizmann Institute of Science, Rehovot, Israel
| | - Bethan J Jenkins
- Department of Biomolecular Sciences, Weizmann Institute of Science, Rehovot, Israel
| | - Or B Barav
- Department of Biomolecular Sciences, Weizmann Institute of Science, Rehovot, Israel
| | - Ivan Milenkovic
- Department of Neurology, Medical University of Vienna, Vienna, Austria
| | - Anthony H Futerman
- Department of Biomolecular Sciences, Weizmann Institute of Science, Rehovot, Israel
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36
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Kotagal V, Szpara A, Albin RL, Bohnen NI. Fatigue in Parkinson's Disease Associates with Lower Ambulatory Diastolic Blood Pressure. JOURNAL OF PARKINSONS DISEASE 2020; 9:575-581. [PMID: 31156183 PMCID: PMC6682445 DOI: 10.3233/jpd-191579] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 02/06/2023]
Abstract
BACKGROUND/OBJECTIVE Fatigue is a common debilitating symptom in Parkinson's disease (PD) of unclear etiology. Hypotension and blood pressure variability are common in PD though their relationship to other non-motor symptoms is less well understood. METHODS We conducted a cross-sectional study to explore differences in 24-hour ambulatory blood pressure measurements in PD subjects (n = 35) with and without fatigue. Subjects underwent hourly systolic (SBP) and diastolic (DBP) blood pressure testing in their home environment. The presence of fatigue was assessed using the Movement Disorders Society Unified Parkinson's Disease Rating Scale (MDS-UPDRS) part 1. We compared blood pressure measurements in fatigued vs. non-fatigued PD subjects, assessed over 4 epochs: overnight, morning, midday, and evening. RESULTS PD subjects with symptoms of fatigue demonstrated lower mean DBP, compared to those without fatigue (67.8±4.8 mmHg vs. 75.6±9.4 t = 2.57, p = 0.014). These intergroup differences were most notable in the morning. The two groups did not differ in scoring on the Survey of Autonomic Symptoms or on an office-based blood assessment of SBP or DBP performed on the day of 24-hour monitor initiation. CONCLUSIONS Fatigue in PD may be a clinical manifestation of low-grade systemic hypotension.
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Affiliation(s)
- Vikas Kotagal
- Department of Neurology, University of Michigan, Ann Arbor, MI, USA.,Veterans Affairs Ann Arbor Health System (VAAAHS) and GRECC, Ann Arbor, MI, USA
| | - Ashley Szpara
- Department of Neurology, University of Michigan, Ann Arbor, MI, USA.,Veterans Affairs Ann Arbor Health System (VAAAHS) and GRECC, Ann Arbor, MI, USA
| | - Roger L Albin
- Department of Neurology, University of Michigan, Ann Arbor, MI, USA.,Veterans Affairs Ann Arbor Health System (VAAAHS) and GRECC, Ann Arbor, MI, USA.,University of Michigan Morris K. Udall Center of Excellence for Parkinson's Disease Research, Ann Arbor, MI, USA
| | - Nicolaas I Bohnen
- Department of Neurology, University of Michigan, Ann Arbor, MI, USA.,Veterans Affairs Ann Arbor Health System (VAAAHS) and GRECC, Ann Arbor, MI, USA.,University of Michigan Morris K. Udall Center of Excellence for Parkinson's Disease Research, Ann Arbor, MI, USA.,Department of Radiology, Division of Nuclear Medicine, University of Michigan, Ann Arbor, MI, USA
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Metoprolol prevents neuronal dendrite remodeling in a canine model of chronic obstructive sleep apnea. Acta Pharmacol Sin 2020; 41:620-628. [PMID: 31863057 PMCID: PMC7470867 DOI: 10.1038/s41401-019-0323-8] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/01/2019] [Accepted: 10/26/2019] [Indexed: 12/30/2022] Open
Abstract
Obstructive sleep apnea (OSA) is closely associated with central nervous system diseases and could lead to autonomic nerve dysfunction, which is often seen in neurodegenerative diseases. Previous studies have shown that metoprolol prevents several chronic OSA-induced cardiovascular diseases through inhibiting autonomic nerve hyperactivity. It remains unclear whether chronic OSA can lead to dendritic remodeling in the brain, and whether metoprolol affects the dendritic remodeling. In this study we investigated the effect of metoprolol on dendrite morphology in a canine model of chronic OSA, which was established in beagles through clamping and reopening the endotracheal tube for 4 h every other day for 12 weeks. OSA beagles were administered metoprolol (5 mg· kg−1· d−1). The dendritic number, length, crossings and spine density of neurons in hippocampi and prefrontal cortices were assessed by Golgi staining. And the protein levels of hypoxia-inducible factor-1α (HIF-1α) and brain-derived neurotrophic factor (BDNF) were measured by Western blotting. We showed that chronic OSA successfully induced significant brain hypoxia evidenced by increased HIF-1α levels in CA1 region and dentate gyrus of hippocampi, as well as in prefrontal cortex. Furthermore, OSA led to markedly decreased dendrite number, length and intersections, spine loss as well as reduced BDNF levels. Administration of metoprolol effectively prevented the dendritic remodeling and spine loss induced by chronic OSA. In addition, administration of metoprolol reversed the decreased BDNF, which might be associated with the metoprolol-induced neuronal protection. In conclusion, metoprolol protects against neuronal dendritic remodeling in hippocampi and prefrontal cortices induced by chronic OSA in canine.
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Ashton NJ, Hye A, Rajkumar AP, Leuzy A, Snowden S, Suárez-Calvet M, Karikari TK, Schöll M, La Joie R, Rabinovici GD, Höglund K, Ballard C, Hortobágyi T, Svenningsson P, Blennow K, Zetterberg H, Aarsland D. An update on blood-based biomarkers for non-Alzheimer neurodegenerative disorders. Nat Rev Neurol 2020; 16:265-284. [PMID: 32322100 DOI: 10.1038/s41582-020-0348-0] [Citation(s) in RCA: 108] [Impact Index Per Article: 27.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 03/17/2020] [Indexed: 01/11/2023]
Abstract
Cerebrospinal fluid analyses and neuroimaging can identify the underlying pathophysiology at the earliest stage of some neurodegenerative disorders, but do not have the scalability needed for population screening. Therefore, a blood-based marker for such pathophysiology would have greater utility in a primary care setting and in eligibility screening for clinical trials. Rapid advances in ultra-sensitive assays have enabled the levels of pathological proteins to be measured in blood samples, but research has been predominantly focused on Alzheimer disease (AD). Nonetheless, proteins that were identified as potential blood-based biomarkers for AD, for example, amyloid-β, tau, phosphorylated tau and neurofilament light chain, are likely to be relevant to other neurodegenerative disorders that involve similar pathological processes and could also be useful for the differential diagnosis of clinical symptoms. This Review outlines the neuropathological, clinical, molecular imaging and cerebrospinal fluid features of the most common neurodegenerative disorders outside the AD continuum and gives an overview of the current status of blood-based biomarkers for these disorders.
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Affiliation(s)
- Nicholas J Ashton
- Department of Psychiatry and Neurochemistry, Institute of Neuroscience & Physiology, The Sahlgrenska Academy at the University of Gothenburg, Mölndal, Sweden.,Wallenberg Centre for Molecular and Translational Medicine, University of Gothenburg, Gothenburg, Sweden.,Department of Old Age Psychiatry, Institute of Psychiatry, Psychology & Neuroscience, Maurice Wohl Clinical Neuroscience Institute, King's College London, London, UK.,NIHR Biomedical Research Centre for Mental Health & Biomedical Research Unit for Dementia at South London & Maudsley NHS Foundation, London, UK
| | - Abdul Hye
- Department of Old Age Psychiatry, Institute of Psychiatry, Psychology & Neuroscience, Maurice Wohl Clinical Neuroscience Institute, King's College London, London, UK.,NIHR Biomedical Research Centre for Mental Health & Biomedical Research Unit for Dementia at South London & Maudsley NHS Foundation, London, UK
| | - Anto P Rajkumar
- Department of Old Age Psychiatry, Institute of Psychiatry, Psychology & Neuroscience, Maurice Wohl Clinical Neuroscience Institute, King's College London, London, UK.,NIHR Biomedical Research Centre for Mental Health & Biomedical Research Unit for Dementia at South London & Maudsley NHS Foundation, London, UK.,Institute of Mental Health, University of Nottingham, Nottingham, UK
| | - Antoine Leuzy
- Clinical Memory Research Unit, Lund University, Malmö, Sweden
| | - Stuart Snowden
- Core Metabolomics and Lipidomics Laboratory, Metabolic Research Laboratories, Institute of Metabolic Science, University of Cambridge, Cambridge Biomedical Campus, Cambridge, UK
| | - Marc Suárez-Calvet
- Department of Psychiatry and Neurochemistry, Institute of Neuroscience & Physiology, The Sahlgrenska Academy at the University of Gothenburg, Mölndal, Sweden.,Barcelonaβeta Brain Research Center (BBRC), Pasqual Maragall Foundation, Barcelona, Catalonia, Spain.,Department of Neurology, Hospital del Mar, Barcelona, Catalonia, Spain
| | - Thomas K Karikari
- Department of Psychiatry and Neurochemistry, Institute of Neuroscience & Physiology, The Sahlgrenska Academy at the University of Gothenburg, Mölndal, Sweden
| | - Michael Schöll
- Department of Psychiatry and Neurochemistry, Institute of Neuroscience & Physiology, The Sahlgrenska Academy at the University of Gothenburg, Mölndal, Sweden.,Wallenberg Centre for Molecular and Translational Medicine, University of Gothenburg, Gothenburg, Sweden.,Clinical Memory Research Unit, Lund University, Malmö, Sweden.,Department of Neurodegenerative Disease, UCL Institute of Neurology, London, UK
| | - Renaud La Joie
- Memory and Aging Center, University of California, San Francisco, San Francisco, CA, USA
| | - Gil D Rabinovici
- Memory and Aging Center, University of California, San Francisco, San Francisco, CA, USA
| | - Kina Höglund
- Department of Psychiatry and Neurochemistry, Institute of Neuroscience & Physiology, The Sahlgrenska Academy at the University of Gothenburg, Mölndal, Sweden.,Department of Neurobiology, Care Sciences and Society, Center for Alzheimer Disease Research, Neurogeriatrics Division, Karolinska Institutet, Novum, Huddinge, Stockholm, Sweden
| | | | - Tibor Hortobágyi
- Department of Old Age Psychiatry, Institute of Psychiatry, Psychology & Neuroscience, Maurice Wohl Clinical Neuroscience Institute, King's College London, London, UK.,MTA-DE Cerebrovascular and Neurodegenerative Research Group, Department of Neurology, University of Debrecen, Debrecen, Hungary
| | - Per Svenningsson
- Department of Old Age Psychiatry, Institute of Psychiatry, Psychology & Neuroscience, Maurice Wohl Clinical Neuroscience Institute, King's College London, London, UK.,Clinical Neuroscience, Karolinska Institutet, Stockholm, Sweden
| | - Kaj Blennow
- Department of Psychiatry and Neurochemistry, Institute of Neuroscience & Physiology, The Sahlgrenska Academy at the University of Gothenburg, Mölndal, Sweden.,Clinical Neurochemistry Laboratory, Sahlgrenska University Hospital, Mölndal, Sweden
| | - Henrik Zetterberg
- Department of Psychiatry and Neurochemistry, Institute of Neuroscience & Physiology, The Sahlgrenska Academy at the University of Gothenburg, Mölndal, Sweden.,Clinical Neurochemistry Laboratory, Sahlgrenska University Hospital, Mölndal, Sweden.,Department of Neurodegenerative Disease, UCL Institute of Neurology, Queen Square, London, UK.,UK Dementia Research Institute at UCL, London, UK
| | - Dag Aarsland
- Department of Old Age Psychiatry, Institute of Psychiatry, Psychology & Neuroscience, Maurice Wohl Clinical Neuroscience Institute, King's College London, London, UK. .,NIHR Biomedical Research Centre for Mental Health & Biomedical Research Unit for Dementia at South London & Maudsley NHS Foundation, London, UK. .,Centre for Age-Related Medicine, Stavanger University Hospital, Stavanger, Norway.
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Quarracino C, Otero-Losada M, Capani F, Pérez-Lloret S. State-of-the-art pharmacotherapy for autonomic dysfunction in Parkinson’s disease. Expert Opin Pharmacother 2020; 21:445-457. [DOI: 10.1080/14656566.2020.1713097] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Affiliation(s)
- Cecilia Quarracino
- Institute of Cardiological Research, University of Buenos Aires, National Research Council, ININCA, UBA, CONICET, Buenos Aires, Argentina
| | - Matilde Otero-Losada
- Institute of Cardiological Research, University of Buenos Aires, National Research Council, ININCA, UBA, CONICET, Buenos Aires, Argentina
| | - Francisco Capani
- Institute of Cardiological Research, University of Buenos Aires, National Research Council, ININCA, UBA, CONICET, Buenos Aires, Argentina
| | - Santiago Pérez-Lloret
- Institute of Cardiological Research, University of Buenos Aires, National Research Council, ININCA, UBA, CONICET, Buenos Aires, Argentina
- Department of Physiology, School of Medicine, University of Buenos Aires (UBA), Buenos Aires, Argentina
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40
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Krämer HH, Lautenschläger G, de Azevedo M, Doppler K, Schänzer A, Best C, Oertel WH, Reuter I, Sommer C, Birklein F. Reduced central sympathetic activity in Parkinson's disease. Brain Behav 2019; 9:e01463. [PMID: 31691543 PMCID: PMC6908869 DOI: 10.1002/brb3.1463] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/29/2019] [Accepted: 10/15/2019] [Indexed: 12/11/2022] Open
Abstract
OBJECTIVE With a combination of different sympathetic tests, we aimed to elucidate whether impairment of sympathetic function in Parkinson's disease (PD) is the consequence of a central or peripheral efferent dysfunction. METHODS Thirty-five patients with early-to-intermediate PD (median age: 63 years; IQR: 57-67 years; disease duration 1-9 years, 15 women) and 20 age- and sex-matched healthy controls (median age: 64.5 years; IQR: 58-68 years; 10 women) were recruited. Autonomic testing was performed in two subgroups and included the assessment of resting cardiovascular parameters, postprandial hypotension (PPH), orthostatic hypotension (OH), and vasoconstriction induced by intradermal microdialysis with different concentrations of norepinephrine (NE; 10-5 ; 10-6 ; 10-7 ; 10-8 ) and by cold through forehead cooling. We also used sympathetic multiunit microneurography (muscle sympathetic nerve activity; MSNA; burst frequency (BF): bursts per minute; burst incidence (BI): bursts per 100 heart beats) and evaluated the presence of phosphorylated α-synuclein deposits in skin innervation in biopsies from the thighs by immunohistohemistry. RESULTS Diastolic blood pressure was higher in the PD group at rest (p < .001) and during OH (F = 6.533; p = .022). Vasoconstriction induced by NE microdialysis and cold was unchanged in PD patients. MSNA was lower in PD patients than in controls (BF: p = .001; BI: p = .025). Phosphorylated α-synuclein deposits could be found only in PD patients. CONCLUSION We did not find indications for peripheral sympathetic nerve fiber dysfunction or adrenoreceptor sensitivity changes. The decreased MSNA argues in favor of central sympathetic impairment.
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Affiliation(s)
- Heidrun H Krämer
- Department of Neurology, Justus-Liebig-University, Giessen, Germany
| | | | | | - Kathrin Doppler
- Department of Neurology, University Hospital Würzburg, Würzburg, Germany
| | - Anne Schänzer
- Institute of Neuropathology, Justus-Liebig-University, Giessen, Germany
| | - Christoph Best
- Department of Neurology, Philipps-University, Marburg, Germany
| | | | - Iris Reuter
- Department of Neurology, Justus-Liebig-University, Giessen, Germany
| | - Claudia Sommer
- Department of Neurology, University Hospital Würzburg, Würzburg, Germany
| | - Frank Birklein
- Department of Neurology, University Medical Center, Johannes Gutenberg-University, Mainz, Germany
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41
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Kim YJ, Lee CM, Kim S, Jang JW, Lee SY, Lee SH. Risk of Parkinson’s disease after colectomy: longitudinal follow-up study using a national sample cohort. J Neurol 2019; 267:513-521. [DOI: 10.1007/s00415-019-09617-1] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/26/2019] [Revised: 10/18/2019] [Accepted: 11/02/2019] [Indexed: 12/20/2022]
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42
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Randall EB, Billeschou A, Brinth LS, Mehlsen J, Olufsen MS. A model-based analysis of autonomic nervous function in response to the Valsalva maneuver. J Appl Physiol (1985) 2019; 127:1386-1402. [PMID: 31369335 DOI: 10.1152/japplphysiol.00015.2019] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/20/2022] Open
Abstract
The Valsalva maneuver (VM) is a diagnostic protocol examining sympathetic and parasympathetic activity in patients with autonomic dysfunction (AD) impacting cardiovascular control. Because direct measurement of these signals is costly and invasive, AD is typically assessed indirectly by analyzing heart rate and blood pressure response patterns. This study introduces a mathematical model that can predict sympathetic and parasympathetic dynamics. Our model-based analysis includes two control mechanisms: respiratory sinus arrhythmia (RSA) and the baroreceptor reflex (baroreflex). The RSA submodel integrates an electrocardiogram-derived respiratory signal with intrathoracic pressure, and the baroreflex submodel differentiates aortic and carotid baroreceptor regions. Patient-specific afferent and efferent signals are determined for 34 control subjects and 5 AD patients, estimating parameters fitting the model output to heart rate data. Results show that inclusion of RSA and distinguishing aortic/carotid regions are necessary to model the heart rate response to the VM. Comparing control subjects to patients shows that RSA and baroreflex responses are significantly diminished. This study compares estimated parameter values from the model-based predictions to indices used in clinical practice. Three indices are computed to determine adrenergic function from the slope of the systolic blood pressure in phase II [α (a new index)], the baroreceptor sensitivity (β), and the Valsalva ratio (γ). Results show that these indices can distinguish between normal and abnormal states, but model-based analysis is needed to differentiate pathological signals. In summary, the model simulates various VM responses and, by combining indices and model predictions, we study the pathologies for 5 AD patients.NEW & NOTEWORTHY We introduce a patient-specific model analyzing heart rate and blood pressure during a Valsalva maneuver (VM). The model predicts autonomic function incorporating the baroreflex and respiratory sinus arrhythmia (RSA) control mechanisms. We introduce a novel index (α) characterizing sympathetic activity, which can distinguish control and abnormal patients. However, we assert that modeling and parameter estimation are necessary to explain pathologies. Finally, we show that aortic baroreceptors contribute significantly to the VM and RSA affects early VM.
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Affiliation(s)
- E Benjamin Randall
- Department of Mathematics, North Carolina State University, Raleigh, North Carolina
| | - Anna Billeschou
- Department of Clinical Physiology and Nuclear Medicine, Bispebjerg Frederiksberg Hospital, Frederiksberg, Denmark
| | - Louise S Brinth
- Department of Clinical Physiology and Nuclear Medicine, Bispebjerg Frederiksberg Hospital, Frederiksberg, Denmark
| | - Jesper Mehlsen
- Section of Surgical Pathophysiology, Juliane Marie Centre, Rigshospitalet, Copenhagen University Hospital, Copenhagen, Denmark
| | - Mette S Olufsen
- Department of Mathematics, North Carolina State University, Raleigh, North Carolina
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43
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Cavallo F, Moschetti A, Esposito D, Maremmani C, Rovini E. Upper limb motor pre-clinical assessment in Parkinson's disease using machine learning. Parkinsonism Relat Disord 2019; 63:111-116. [DOI: 10.1016/j.parkreldis.2019.02.028] [Citation(s) in RCA: 19] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/24/2018] [Revised: 02/19/2019] [Accepted: 02/19/2019] [Indexed: 10/27/2022]
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44
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Lafuente JV, Requejo C, Ugedo L. Nanodelivery of therapeutic agents in Parkinson's disease. PROGRESS IN BRAIN RESEARCH 2019; 245:263-279. [PMID: 30961870 DOI: 10.1016/bs.pbr.2019.03.004] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
Abstract
Parkinson's disease (PD) as a motor disorder is pathologically featured by the loss of dopaminergic neurons of the substantia nigra compacta (SNc) and the consequent depletion of dopamine in the striatum. However, motor signs are detectable when the loss of dopaminergic striatal terminals exceeds to the dopaminergic neuronal degeneration in SN. Hence, recent evidences about the topological organization of the nigrostriatal system could provide novel insights about the progression of the neurodegenerative process as well as the correct application of the novel therapeutic strategies. Though dopaminergic drugs and different routes of administration have been proposed to treat PD, most of the effects are symptomatic with temporary effects resorting to invasive procedures to ameliorate the side effects. Since the blood-brain barrier (BBB) is the main obstacle for most of molecules to access to the brain, ongoing research is focused on halting the progression of PD through the use of those technologies that allow the effective delivery and diffusion of therapeutic molecules to the central nervous system for bypassing BBB and avoiding the side effects. In this context, nanotechnology is emerging as a promising tool for drug delivery. In fact, nanodelivery of restorative treatments in PD, such as gene therapy increased the effectiveness of neurotrophic factors for restoring the dopamine deficit and improving motor deficit in rodent models. Therefore, the present review is focused on the description and identification of the available nanotherapies developed in experimental models of PD which could suppose an important advance for controlled delivery of nanobioactive components into the brain and one more step for the clinical projection.
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Affiliation(s)
- José Vicente Lafuente
- LaNCE, Department of Neuroscience, University of the Basque Country (UPV/EHU), Leioa, Spain.
| | - Catalina Requejo
- Department of Neurology, The Friedman Brain Institute, Icahn School of Medicine at Mount Sinai, New York, NY, United States
| | - Luisa Ugedo
- Neuropharmacology Group, University of the Basque Country (UPV-EHU), Leioa, Spain
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45
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Resnikoff H, Metzger JM, Lopez M, Bondarenko V, Mejia A, Simmons HA, Emborg ME. Colonic inflammation affects myenteric alpha-synuclein in nonhuman primates. J Inflamm Res 2019; 12:113-126. [PMID: 31123415 PMCID: PMC6511240 DOI: 10.2147/jir.s196552] [Citation(s) in RCA: 28] [Impact Index Per Article: 5.6] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/01/2018] [Accepted: 03/07/2019] [Indexed: 12/27/2022] Open
Abstract
Background: Parkinson's disease (PD) patients frequently present gastrointestinal (GI) dysfunction that, in many cases, predates the onset of motor symptoms. In PD, the presynaptic protein alpha-synuclein (α-syn) undergoes pathological changes, including phosphorylation and aggregation leading to the formation of Lewy bodies, which can be found in neurons of the enteric nervous system (ENS). Inflammation has been proposed as a possible trigger of α-syn pathology. Interestingly, patients with inflammatory bowel disease and irritable bowel syndrome, conditions associated with GI inflammation, are at higher risk of developing PD. Captive common marmosets (Callithrix jacchus) develop colitis, providing a natural platform to assess the relationship between α-syn pathology and GI inflammation. Materials and Methods: Sections of proximal colon from marmosets with colitis (n=5; 5.3±2.3 years old; 4 male) and normal controls (n=5; 4.1±1.6 years old; 1 male) were immunostained against protein gene product 9.5 (PGP9.5), human leukocyte antigen DR (HLA-DR), cluster of differentiation 3 (CD3), cluster of differentiation 20 (CD20), glial fibrillary acidic protein (GFAP), 8-hydroxy-2'-deoxyguanosine (8-OHdG), α-syn, and serine 129 phosphorylated α-syn (p-α-syn). Immunoreactivity of each staining in the myenteric plexus was quantified using NIH ImageJ software. Results: Marmosets with colitis had significantly increased expression of inflammatory markers (HLA-DR, p<0.02; CD3, p<0.008), oxidative stress (8-OHdG, p<0.05), and p-α-syn (p<0.02) and decreased expression of α-syn (p<0.04) in the colonic myenteric ganglia compared to normal, healthy controls. Conclusion: Colonic inflammation is associated with changes in α-syn expression and phosphorylation in the myenteric plexus of common marmosets. Future evaluation of the vagus nerve and brain of animals with colitis will be key to assess the contribution of colitis-induced ENS α-syn pathology to PD-like pathology in the brain.
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Affiliation(s)
- Henry Resnikoff
- Preclinical Parkinson's Research Program, Wisconsin National Primate Research Center, University of Wisconsin – Madison, Madison, WI, USA
| | - Jeanette M Metzger
- Preclinical Parkinson's Research Program, Wisconsin National Primate Research Center, University of Wisconsin – Madison, Madison, WI, USA
- Cellular and Molecular Pathology Graduate Program, University of Wisconsin – Madison, Madison, WI, USA
| | - Mary Lopez
- Preclinical Parkinson's Research Program, Wisconsin National Primate Research Center, University of Wisconsin – Madison, Madison, WI, USA
| | - Viktoriya Bondarenko
- Preclinical Parkinson's Research Program, Wisconsin National Primate Research Center, University of Wisconsin – Madison, Madison, WI, USA
| | - Andres Mejia
- Preclinical Parkinson's Research Program, Wisconsin National Primate Research Center, University of Wisconsin – Madison, Madison, WI, USA
| | - Heather A Simmons
- Preclinical Parkinson's Research Program, Wisconsin National Primate Research Center, University of Wisconsin – Madison, Madison, WI, USA
| | - Marina E Emborg
- Preclinical Parkinson's Research Program, Wisconsin National Primate Research Center, University of Wisconsin – Madison, Madison, WI, USA
- Cellular and Molecular Pathology Graduate Program, University of Wisconsin – Madison, Madison, WI, USA
- Department of Medical Physics, University of Wisconsin – Madison, Madison, WI, USA
- Correspondence: Marina E EmborgPreclinical Parkinson’s Research Program, Wisconsin National Primate Research Center, University of Wisconsin–Madison, 1220 Capitol Court, Madison, WI53715, USATel +1 608 262 9714Fax +1 608 263 3524Email
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46
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Peripheral blood inflammatory markers in early Parkinson’s disease. J Clin Neurosci 2018; 58:30-33. [DOI: 10.1016/j.jocn.2018.10.079] [Citation(s) in RCA: 46] [Impact Index Per Article: 7.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/10/2018] [Accepted: 10/14/2018] [Indexed: 11/21/2022]
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47
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Guo L, Normando EM, Shah PA, De Groef L, Cordeiro MF. Oculo-visual abnormalities in Parkinson's disease: Possible value as biomarkers. Mov Disord 2018; 33:1390-1406. [DOI: 10.1002/mds.27454] [Citation(s) in RCA: 41] [Impact Index Per Article: 6.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/13/2017] [Revised: 05/16/2018] [Accepted: 05/18/2018] [Indexed: 12/16/2022] Open
Affiliation(s)
- Li Guo
- Glaucoma and Retinal Degenerative Disease Research Group, Institute of Ophthalmology; University College London; London UK
| | - Eduardo M. Normando
- Glaucoma and Retinal Degenerative Disease Research Group, Institute of Ophthalmology; University College London; London UK
- Western Eye Hospital, Imperial College Healthcare National Health Service Trust; London UK
- Imperial College Ophthalmology Research Group, Department of Surgery and Cancer, Imperial College London; London UK
| | - Parth Arvind Shah
- Glaucoma and Retinal Degenerative Disease Research Group, Institute of Ophthalmology; University College London; London UK
| | - Lies De Groef
- Glaucoma and Retinal Degenerative Disease Research Group, Institute of Ophthalmology; University College London; London UK
- Neural Circuit Development and Regeneration Research Group, Department of Biology; University of Leuven; Leuven Belgium
| | - M. Francesca Cordeiro
- Glaucoma and Retinal Degenerative Disease Research Group, Institute of Ophthalmology; University College London; London UK
- Western Eye Hospital, Imperial College Healthcare National Health Service Trust; London UK
- Imperial College Ophthalmology Research Group, Department of Surgery and Cancer, Imperial College London; London UK
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Huang X, Ng SY, Chia NS, Setiawan F, Tay K, Au W, Tan E, Tan LC. Non‐motor symptoms in early Parkinson's disease with different motor subtypes and their associations with quality of life. Eur J Neurol 2018; 26:400-406. [DOI: 10.1111/ene.13803] [Citation(s) in RCA: 44] [Impact Index Per Article: 7.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/13/2018] [Accepted: 08/28/2018] [Indexed: 12/01/2022]
Affiliation(s)
- X. Huang
- Department of Neurology National Neuroscience Institute Singapore
- Duke‐NUS Graduate Medical School Singapore
| | - S. Y.‐E. Ng
- Department of Neurology National Neuroscience Institute Singapore
- Parkinson's Disease and Movement Disorders Centre Parkinson Foundation International Center of Excellence National Neuroscience Institute Singapore Singapore
| | - N. S.‐Y. Chia
- Department of Neurology National Neuroscience Institute Singapore
- Parkinson's Disease and Movement Disorders Centre Parkinson Foundation International Center of Excellence National Neuroscience Institute Singapore Singapore
| | - F. Setiawan
- Department of Neurology National Neuroscience Institute Singapore
- Parkinson's Disease and Movement Disorders Centre Parkinson Foundation International Center of Excellence National Neuroscience Institute Singapore Singapore
| | - K.‐Y. Tay
- Department of Neurology National Neuroscience Institute Singapore
- Duke‐NUS Graduate Medical School Singapore
- Parkinson's Disease and Movement Disorders Centre Parkinson Foundation International Center of Excellence National Neuroscience Institute Singapore Singapore
| | - W.‐L. Au
- Department of Neurology National Neuroscience Institute Singapore
- Duke‐NUS Graduate Medical School Singapore
- Parkinson's Disease and Movement Disorders Centre Parkinson Foundation International Center of Excellence National Neuroscience Institute Singapore Singapore
| | - E.‐K. Tan
- Department of Neurology National Neuroscience Institute Singapore
- Duke‐NUS Graduate Medical School Singapore
- Parkinson's Disease and Movement Disorders Centre Parkinson Foundation International Center of Excellence National Neuroscience Institute Singapore Singapore
| | - L. C.‐S. Tan
- Department of Neurology National Neuroscience Institute Singapore
- Duke‐NUS Graduate Medical School Singapore
- Parkinson's Disease and Movement Disorders Centre Parkinson Foundation International Center of Excellence National Neuroscience Institute Singapore Singapore
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49
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Li Y, Jiao Q, Du X, Bi M, Han S, Jiao L, Jiang H. Investigation of Behavioral Dysfunctions Induced by Monoamine Depletions in a Mouse Model of Parkinson's Disease. Front Cell Neurosci 2018; 12:241. [PMID: 30135645 PMCID: PMC6092512 DOI: 10.3389/fncel.2018.00241] [Citation(s) in RCA: 23] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/24/2018] [Accepted: 07/17/2018] [Indexed: 01/10/2023] Open
Abstract
Parkinson's disease (PD) is characterized not only by typical motor symptoms, but also by nonmotor symptoms in the early stages. In addition to the loss of dopaminergic (DAergic) neurons, progressive degenerations of noradrenergic (NA) and serotonergic (5-HT) neurons were also observed. However, the respective effects and interactions of these monoamine depletions on certain nonmotor symptoms are still largely unknown. In the present study, we performed selective depletions of NA, 5-HT and DA in mice by intraperitioneal injection of N-(2-chloroethyl)-N-ethyl-2-bromobenzylamine hydrochloride (DSP-4), 4-chloro-L-phenylalanine (pCPA) and 1-methyl-4-phenyl-1,2,3,6-tetrahydropyridine (MPTP), respectively. DSP-4 led to a 34% decrease in the number of NAergic neurons in the locus coeruleus, and MPTP led to a 30% decrease in the number of DAergic neurons in the substantia nigra. Although there was no obvious change in the number of 5-HTergic neurons in the dorsal raphe nucleus after pCPA treatment, the levels of 5-HT and its metabolite in the frontal cortex and hippocampus were reduced, respectively. Locomotor activity deficit was induced by DA depletion and a decrease in traveled distance was potentiated by additional NA depletion. Despair-associated depressive-like behavior could be observed in every group. Anxiety states emerged only from the combined depletion of two or three monoamines. However, combined depletion of the three monoamines dramatically induced anhedonia, and it could also aggravate the depressive-like and anxiety behavior. Furthermore, NA depletion significantly reduced spatial learning and memory ability, which was not enhanced by additional 5-HT or DA depletion. Our data highlighted the interactive role of NA, 5-HT and DA in the motor, emotional and cognitive deficits, providing new insight into the complex orchestration of impaired monoaminergic systems that related to the pathology of PD.
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Affiliation(s)
- Yong Li
- Department of Physiology, Shandong Provincial Key Laboratory of Pathogenesis and Prevention of Neurological Disorders and State Key Disciplines, Physiology, Qingdao University Medical College, Qingdao University, Qingdao, China
| | - Qian Jiao
- Department of Physiology, Shandong Provincial Key Laboratory of Pathogenesis and Prevention of Neurological Disorders and State Key Disciplines, Physiology, Qingdao University Medical College, Qingdao University, Qingdao, China
| | - Xixun Du
- Department of Physiology, Shandong Provincial Key Laboratory of Pathogenesis and Prevention of Neurological Disorders and State Key Disciplines, Physiology, Qingdao University Medical College, Qingdao University, Qingdao, China
| | - Mingxia Bi
- Department of Physiology, Shandong Provincial Key Laboratory of Pathogenesis and Prevention of Neurological Disorders and State Key Disciplines, Physiology, Qingdao University Medical College, Qingdao University, Qingdao, China
| | - Shuaishuai Han
- Department of Physiology, Shandong Provincial Key Laboratory of Pathogenesis and Prevention of Neurological Disorders and State Key Disciplines, Physiology, Qingdao University Medical College, Qingdao University, Qingdao, China
| | - Lingling Jiao
- Department of Physiology, Shandong Provincial Key Laboratory of Pathogenesis and Prevention of Neurological Disorders and State Key Disciplines, Physiology, Qingdao University Medical College, Qingdao University, Qingdao, China
| | - Hong Jiang
- Department of Physiology, Shandong Provincial Key Laboratory of Pathogenesis and Prevention of Neurological Disorders and State Key Disciplines, Physiology, Qingdao University Medical College, Qingdao University, Qingdao, China
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Features of autonomic dysfunction in the patients with Parkinson’s disease on the background of autoimmune pathology. Fam Med 2018. [DOI: 10.30841/2307-5112.3.2018.146693] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
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