1
|
Kincl V, Panovský R, Bočková M, Rektor I, Mojica‐Pisciotti ML, Máchal J. Parkinson´s disease cardiovascular symptoms: A new complex functional and structural insight. Eur J Neurol 2024; 31:e16110. [PMID: 37889890 PMCID: PMC11235594 DOI: 10.1111/ene.16110] [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: 07/11/2023] [Revised: 09/27/2023] [Accepted: 10/06/2023] [Indexed: 10/29/2023]
Abstract
BACKGROUND The known impairments of the cardiovascular system in Parkinson´s disease (PD) are caused by autonomic dysfunction and manifested mainly in postural hypotension, chronotropic insufficiency, and reduced heart rate variability. Other dysfunctions, mainly stress response, arrhythmia occurrence, and heart morphology changes, are still the subject of research. OBJECTIVES To assess the heart rate and blood pressure reaction during exercise, advanced measurements of heart volumes and mass using cardiac magnetic resonance (CMR), and occurrence of arrhythmias in PD patients. METHODS Thirty PD patients (19 men, mean age 57.5 years) without known cardiac comorbidities underwent bicycle ergometry, electrocardiogram Holter monitoring and CMR. Exercise and CMR parameters were compared with controls (24 subjects for ergometry, 20 for CMR). RESULTS PD patients had lower baseline systolic blood pressure (SBP) (117.8 vs. 128.3 mmHg, p < 0.01), peak SBP (155.8 vs. 170.8 mmHg, p < 0.05), and lower heart rate increase (49.7 vs. 64.3 beats per minute, p < 0.01). PD patients had higher indexed left and right ventricular end-diastolic volumes (68.5 vs. 57.3, p = 0.003 and 73.5 vs. 61.0 mL/m2 , respectively) and also indexed left and right ventricular end-systolic volumes (44.1 vs. 39.0, p = 0.013 and 29.0 vs. 22.0 mL/m2 , p = 0.013, respectively). A high prevalence of atrial fibrillation (8 subjects, 26.7%) was found. CONCLUSIONS This novel study combining functional and structural approaches showed that PD is linked with weaker blood pressure and heart rate reaction during exercise, increased myocardial mass and heart volumes compared to controls, and a high prevalence of atrial fibrillation.
Collapse
Affiliation(s)
- Vladimír Kincl
- International Clinical Research Center, St. Anne 's University Hospital, Faculty of MedicineMasaryk UniversityBrnoCzech Republic
- Department of Internal Medicine/Cardiology, St. Anne 's University Hospital, Faculty of MedicineMasaryk UniversityBrnoCzech Republic
| | - Roman Panovský
- International Clinical Research Center, St. Anne 's University Hospital, Faculty of MedicineMasaryk UniversityBrnoCzech Republic
- Department of Internal Medicine/Cardiology, St. Anne 's University Hospital, Faculty of MedicineMasaryk UniversityBrnoCzech Republic
| | - Martina Bočková
- Department of NeurologySt. Anne 's University Hospital, Masaryk UniversityBrnoCzech Republic
- Central European Institute of TechnologyBrnoCzech Republic
| | - Ivan Rektor
- Department of NeurologySt. Anne 's University Hospital, Masaryk UniversityBrnoCzech Republic
- Central European Institute of TechnologyBrnoCzech Republic
| | - Mary Luz Mojica‐Pisciotti
- International Clinical Research Center, St. Anne 's University Hospital, Faculty of MedicineMasaryk UniversityBrnoCzech Republic
| | - Jan Máchal
- International Clinical Research Center, St. Anne 's University Hospital, Faculty of MedicineMasaryk UniversityBrnoCzech Republic
- Department of Pathological Physiology, Faculty of MedicineMasaryk UniversityBrnoCzech Republic
| |
Collapse
|
2
|
Fadil R, Huether AXA, Sadeghian F, Verma AK, Blaber AP, Lou JS, Tavakolian K. The Effect of Skeletal Muscle-Pump on Blood Pressure and Postural Control in Parkinson's Disease. Cardiovasc Eng Technol 2023; 14:755-773. [PMID: 37749359 DOI: 10.1007/s13239-023-00685-z] [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: 11/07/2022] [Accepted: 09/06/2023] [Indexed: 09/27/2023]
Abstract
PURPOSE Activation of the calf (gastrocnemius and soleus) and tibialis anterior muscles play an important role in blood pressure regulation (via muscle-pump mechanism) and postural control. Parkinson's disease is associated with calf (and tibialis anterior muscles weakness and stiffness, which contribute to postural instability and associated falls. In this work, we studied the role of the medial and lateral gastrocnemius, tibialis anterior, and soleus muscle contractions in maintaining blood pressure and postural stability in Parkinson's patients and healthy controls during standing. In addition, we investigated whether the activation of the calf and tibialis anterior muscles is baroreflex dependent or postural-mediated. METHODS We recorded electrocardiogram, blood pressure, center of pressure as a measure of postural sway, and muscle activity from the medial and lateral gastrocnemius, tibialis anterior, and soleus muscles from twenty-six Parkinson's patients and eighteen sex and age-matched healthy controls during standing and with eyes open. The interaction and bidirectional causalities between the cardiovascular, musculoskeletal, and postural variables were studied using wavelet transform coherence and convergent cross-mapping techniques, respectively. RESULTS Parkinson's patients experienced a higher postural sway and demonstrated mechanical muscle-pump dysfunction of all individual leg muscles, all of which contribute to postural instability. Moreover, our results showed that coupling between the cardiovascular, musculoskeletal, and postural variables is affected by Parkinson's disease while the contribution of the calf and tibialis anterior muscles is greater for blood pressure regulation than postural sway. CONCLUSION The outcomes of this study could assist in the development of appropriate physical exercise programs that target lower limb muscles to improve the muscle-pump function and reduce postural instability in Parkinson's disease.
Collapse
Affiliation(s)
- Rabie Fadil
- Biomedical Engineering Program, University of North Dakota, Grand Forks, ND, USA
| | - Asenath X A Huether
- Parkinson Disease Research Laboratory, Department of Neurology, Sanford Health, Fargo, ND, USA
| | - Farshid Sadeghian
- Department of Biomedical Physiology and Kinesiology, Simon Fraser University, Burnaby, BC, Canada
| | - Ajay K Verma
- Biomedical Engineering Program, University of North Dakota, Grand Forks, ND, USA
| | - Andrew P Blaber
- Department of Biomedical Physiology and Kinesiology, Simon Fraser University, Burnaby, BC, Canada
| | - Jau-Shin Lou
- Parkinson Disease Research Laboratory, Department of Neurology, Sanford Health, Fargo, ND, USA
- Department of Neurology, University of North Dakota, School of Medicine, and Health Sciences, Grand Forks, USA
| | - Kouhyar Tavakolian
- Biomedical Engineering Program, University of North Dakota, Grand Forks, ND, USA.
- Department of Biomedical Physiology and Kinesiology, Simon Fraser University, Burnaby, BC, Canada.
- Biomedical Engineering Program, University of North Dakota, 243 Centennial Drive, Upson Hall II, Room 11, Grand Forks, ND, 58202, USA.
| |
Collapse
|
3
|
Pitton Rissardo J, Fornari Caprara AL. Cardiac 123I-Metaiodobenzylguanidine (MIBG) Scintigraphy in Parkinson's Disease: A Comprehensive Review. Brain Sci 2023; 13:1471. [PMID: 37891838 PMCID: PMC10605004 DOI: 10.3390/brainsci13101471] [Citation(s) in RCA: 6] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/29/2023] [Revised: 09/23/2023] [Accepted: 10/13/2023] [Indexed: 10/29/2023] Open
Abstract
Cardiac sympathetic denervation, as documented on 123I-metaiodobenzylguanidine (MIBG) myocardial scintigraphy, is relatively sensitive and specific for distinguishing Parkinson's disease (PD) from other neurodegenerative causes of parkinsonism. The present study aims to comprehensively review the literature regarding the use of cardiac MIBG in PD. MIBG is an analog to norepinephrine. They share the same uptake, storage, and release mechanisms. An abnormal result in the cardiac MIBG uptake in individuals with parkinsonism can be an additional criterion for diagnosing PD. However, a normal result of cardiac MIBG in individuals with suspicious parkinsonian syndrome does not exclude the diagnosis of PD. The findings of cardiac MIBG studies contributed to elucidating the pathophysiology of PD. We investigated the sensitivity and specificity of cardiac MIBG scintigraphy in PD. A total of 54 studies with 3114 individuals diagnosed with PD were included. The data were described as means with a Hoehn and Yahr stage of 2.5 and early and delayed registration H/M ratios of 1.70 and 1.51, respectively. The mean cutoff for the early and delayed phases were 1.89 and 1.86. The sensitivity for the early and delayed phases was 0.81 and 0.83, respectively. The specificity for the early and delayed phases were 0.86 and 0.80, respectively.
Collapse
|
4
|
Chun IK. Optimal Protocol and Clinical Usefulness of 123I-MIBG Cardiac Scintigraphy for Differentiation of Parkinson's Disease and Dementia with Lewy Body from Non-Parkinson's Diseases. Nucl Med Mol Imaging 2023; 57:145-154. [PMID: 37187951 PMCID: PMC10172433 DOI: 10.1007/s13139-023-00790-w] [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: 10/31/2022] [Revised: 02/02/2023] [Accepted: 02/07/2023] [Indexed: 03/09/2023] Open
Abstract
Purpose 123I-metaiodobenzylguanidine (MIBG) cardiac scintigraphy was a useful imaging modality for the diagnosis of Parkinson's disease, but its diagnostic performances were variably reported. This retrospective study compared the diagnostic performances and investigated the optimal imaging protocol of 123I-MIBG cardiac scintigraphy at various imaging time points in patients suspected of Parkinson's disease in clinical practice. Methods In patients suspected of Parkinson's disease, clinical records, autonomic function tests, and 123I-MIBG cardiac scintigraphy were retrospectively reviewed. Semi-quantitative parameters such as heart-to-mediastinum ratio (HMR) and washout rate (WR) were calculated and compared at 15 min, 1 h, 2 h, 3 h, and 4 h post-injection (p.i.). of 123I-MIBG cardiac scintigraphy. Group A consisted of Parkinson's disease (PD), Parkinson's disease dementia (PDD), and dementia with Lewy body (DLB), and group B consisted of non-Parkinson's diseases such as multiple system atrophy (MSA), progressive supranuclear palsy (PSP), drug-induced parkinsonism (DIP), essential tremor (ET), Parkinson-plus syndrome (PPS), and unspecified secondary parkinsonism (NA). The diagnostic performances of HMR and WR were compared for differentiation of group A from group B, and their clinical usefulness and optimal imaging time points were explored. Results Seventy-eight patients were included in group A (67 PD, 7 PDD, 4 DLB), and 18 patients were included in group B (5 MSA, 3 PSP, 2 DIP, 2 ET, 1 PPS, and 1 NA). Sensitivity, specificity, accuracy, positive predictive value (PPV), and negative predictive value of HMR and WR were maximized at 4 h p.i., (82.1%, 85.7%, 82.6%, 97.0%, and 46.2%; cutoff threshold < 1.717; area under curve 0.8086) and at the time interval between 1 and 4 h p.i. (65.4%, 85.7%, 68.5%, 96.2%, and 30.8%; cutoff threshold > 24.1%; area under curve 0.8246), respectively, and PPVs of both HMR and WR persistently showed greater than 92.7% at earlier time points and shorter time intervals. Conclusion This study reassured that 4-h-delayed imaging is recommended for the best diagnostic performances in 123I-MIBG cardiac scintigraphy. Although it showed suboptimal diagnostic performances to differentiate PD, PDD, and DLB from non-Parkinson's diseases, it can be useful as an auxiliary measure for the differential diagnosis in usual clinical practice. Supplementary Information The online version contains supplementary material available at 10.1007/s13139-023-00790-w.
Collapse
Affiliation(s)
- In Kook Chun
- Department of Nuclear Medicine, Kangwon National University Hospital, Kangwon National University College of Medicine and School of Medicine, 1 Kangwondaehak-gil, Chuncheon, Gangwon-do 24341 Republic of Korea
| |
Collapse
|
5
|
Bardutz H, Singh J, Rehman Z, Bernat P. Parkinson's Disease and the Cardiac Cycle: A Rapid Literature Review and Case Series. Life (Basel) 2023; 13:life13041003. [PMID: 37109530 PMCID: PMC10143446 DOI: 10.3390/life13041003] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/26/2023] [Revised: 03/17/2023] [Accepted: 04/11/2023] [Indexed: 04/29/2023] Open
Abstract
BACKGROUND AND OBJECTIVES Cardiac function in patients with Parkinson's Disease (PD) is not well understood. We conducted a review of the literature to summarize all available data on the cardiac cycle in patients with PD and followed up the review with a case series to describe the cardiac cycle timing intervals in this patient population. METHODS Using the search terms ("Cardiac cycle" OR "echocardiography" OR "LVET" OR "IVCT" OR "IVRT" OR "LVEF" OR "Systolic Dysfunction" OR "Diastolic Dysfunction") AND ("Parkinson's Disease"), 514 studies were found with 19 included in the review. RESULTS Studies focused on the impact of medication, the presence of autonomic dysfunction, and resting-state, descriptive observational studies which considered the cardiac cycle. While inconsistent, the evidence suggests that patients with PD have some systolic dysfunction, with recent research implying the presence of subclinical systolic dysfunction. From the case series, 13 participants with PD were included and collected cardiac data daily for 6 weeks. Heart rate was consistent on a weekly basis at 67-71 bpm. Mean week-by-week cardiac parameters were also consistent with the systolic time interval at 332-348 ms, isovolumic relaxation time at 92-96 ms, and isovolumic contraction time at 34-36 ms. CONCLUSION These timing intervals add valuable normative values for this patient population and the review of the literature suggests that more research is required to better understand cardiac cycle timing intervals in patients with Parkinson's Disease.
Collapse
Affiliation(s)
- Holly Bardutz
- Faculty of Kinesiology & Health Studies, University of Regina, Regina, SK S4S 0A2, Canada
| | - Jyotpal Singh
- Faculty of Kinesiology & Health Studies, University of Regina, Regina, SK S4S 0A2, Canada
| | - Ziaur Rehman
- Department of Medicine, University of Saskatchewan, Regina, SK S4P 0W5, Canada
| | - Patrick Bernat
- Faculty of Kinesiology & Health Studies, University of Regina, Regina, SK S4S 0A2, Canada
| |
Collapse
|
6
|
Sagastibeltza N, Salazar-Ramirez A, Martinez R, Jodra JL, Muguerza J. Automatic detection of the mental state in responses towards relaxation. Neural Comput Appl 2023; 35:5679-5696. [PMID: 35698721 PMCID: PMC9178946 DOI: 10.1007/s00521-022-07435-7] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/15/2021] [Accepted: 05/11/2022] [Indexed: 11/03/2022]
Abstract
Nowadays, considering society's highly demanding lifestyles, it is important to consider the usefulness of relaxation from the perspective of both psychology and clinical practice. The response towards relaxation (RResp) is a mind-body interaction that relaxes the organism or compensates for the physiological effects caused by stress. This work aims to automatically detect the different mental states (relaxation, rest and stress) in which RResps may occur so that complete feedback about the quality of the relaxation can be given to the subject itself, the psychologist or the doctor. To this end, an experiment was conducted to induce both states of stress and relaxation in a sample of 20 university students (average age of 25.76 ± 3.7 years old). The electrocardiographic and electrodermal activity signals collected from the participants produced a dataset with 1641 episodes or instances in which the previously mentioned mental states take place. This data was used to extract up to 50 features and train several supervised learning algorithms (rule-based, trees, probabilistic, ensemble classifiers, etc.) using and not using feature selection techniques. Besides, the authors synthesised the cardiac activity information into a single new feature and discretised it down to three levels. The experimentation revealed which features were most discriminating, reaching a classification average accuracy of up to 94.01 ± 1.73 % with the 6 most relevant features for the own-collected dataset. Finally, being restrictive, the same solution/subspace was tested with a dataset referenced in the bibliography (WESAD) and scored an average accuracy of 90.36 ± 1.62 %.
Collapse
Affiliation(s)
- Nagore Sagastibeltza
- grid.11480.3c0000000121671098Department of Computer Architecture and Technology, University of the Basque Country (UPV-EHU), Donostia, Spain
| | - Asier Salazar-Ramirez
- grid.11480.3c0000000121671098Department of Systems Engineering and Automation, University of the Basque Country (UPV-EHU), Bilbao, Spain
| | - Raquel Martinez
- grid.11480.3c0000000121671098Department of Systems Engineering and Automation, University of the Basque Country (UPV-EHU), Bilbao, Spain
| | - Jose Luis Jodra
- grid.11480.3c0000000121671098Department of Electronic Technology, University of the Basque Country (UPV-EHU), Donostia, Spain
| | - Javier Muguerza
- grid.11480.3c0000000121671098Department of Computer Architecture and Technology, University of the Basque Country (UPV-EHU), Donostia, Spain
| |
Collapse
|
7
|
Fadil R, Huether AXA, Verma AK, Brunnemer R, Blaber AP, Lou JS, Tavakolian K. Effect of Parkinson’s Disease on Cardio-postural Coupling During Orthostatic Challenge. Front Physiol 2022; 13:863877. [PMID: 35755448 PMCID: PMC9214860 DOI: 10.3389/fphys.2022.863877] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/27/2022] [Accepted: 05/06/2022] [Indexed: 11/13/2022] Open
Abstract
Cardiac baroreflex and leg muscles activation are two important mechanisms for blood pressure regulation, failure of which could result in syncope and falls. Parkinson’s disease is known to be associated with cardiac baroreflex impairment and skeletal muscle dysfunction contributing to falls. However, the mechanical effect of leg muscles contractions on blood pressure (muscle-pump) and the baroreflex-like responses of leg muscles to blood pressure changes is yet to be comprehensively investigated. In this study, we examined the involvement of the cardiac baroreflex and this hypothesized reflex muscle-pump function (cardio-postural coupling) to maintain blood pressure in Parkinson’s patients and healthy controls during an orthostatic challenge induced via a head-up tilt test. We also studied the mechanical effect of the heart and leg muscles contractions on blood pressure. We recorded electrocardiogram blood pressure and electromyogram from 21 patients with Parkinson’s disease and 18 age-matched healthy controls during supine, head-up tilt at 70°, and standing positions with eyes open. The interaction and bidirectional causalities between the cardiovascular and musculoskeletal signals were studied using wavelet transform coherence and convergent cross mapping techniques, respectively. Parkinson’s patients displayed an impaired cardiac baroreflex and a reduced mechanical effect of the heart on blood pressure during supine, tilt and standing positions. However, the effectiveness of the cardiac baroreflex decreased in both Parkinson’s patients and healthy controls during standing as compared to supine. In addition, Parkinson’s patients demonstrated cardio-postural coupling impairment along with a mechanical muscle pump dysfunction which both could lead to dizziness and falls. Moreover, the cardiac baroreflex had a limited effect on blood pressure during standing while lower limb muscles continued to contract and maintain blood pressure via the muscle-pump mechanism. The study findings highlighted altered bidirectional coupling between heart rate and blood pressure, as well as between muscle activity and blood pressure in Parkinson’s disease. The outcomes of this study could assist in the development of appropriate physical exercise programs to reduce falls in Parkinson’s disease by monitoring the cardiac baroreflex and cardio-postural coupling effect on maintaining blood pressure.
Collapse
Affiliation(s)
- Rabie Fadil
- Biomedical Engineering Program, University of North Dakota, Grand Forks, ND, United States
| | - Asenath X. A. Huether
- Parkinson Disease Research Laboratory, Department of Neurology, Sanford Health, Fargo, ND, United States
| | - Ajay K. Verma
- Biomedical Engineering Program, University of North Dakota, Grand Forks, ND, United States
| | - Robert Brunnemer
- Biomedical Engineering Program, University of North Dakota, Grand Forks, ND, United States
| | - Andrew P. Blaber
- Department of Biomedical Physiology and Kinesiology, Simon Fraser University, Burnaby, BC, Canada
| | - Jau-Shin Lou
- Parkinson Disease Research Laboratory, Department of Neurology, Sanford Health, Fargo, ND, United States
- School of Medicine and Health Sciences, Department of Neurology, University of North Dakota, Grand Forks, ND, United States
| | - Kouhyar Tavakolian
- Biomedical Engineering Program, University of North Dakota, Grand Forks, ND, United States
- Department of Biomedical Physiology and Kinesiology, Simon Fraser University, Burnaby, BC, Canada
- *Correspondence: Kouhyar Tavakolian,
| |
Collapse
|
8
|
Heart-brain synchronization breakdown in Parkinson's disease. NPJ Parkinsons Dis 2022; 8:64. [PMID: 35637221 PMCID: PMC9151654 DOI: 10.1038/s41531-022-00323-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/04/2021] [Accepted: 04/27/2022] [Indexed: 11/08/2022] Open
Abstract
Heart rate variability (HRV) abnormalities are potential early biomarkers in Parkinson’s disease (PD) but their relationship with central autonomic network (CAN) activity is not fully understood. We analyzed the synchronization between HRV and brain activity in 31 PD patients and 21 age-matched healthy controls using blood-oxygen-level-dependent (BOLD) signals from resting-state functional brain MRI and HRV metrics from finger plethysmography recorded for 7.40 min. We additionally quantified autonomic symptoms (SCOPA-AUT) and objective autonomic cardiovascular parameters (blood pressure and heart rate) during deep breathing, Valsalva, and head-up tilt, which were used to classify the clinical severity of dysautonomia. We evaluated HRV and BOLD signals synchronization (HRV-BOLD-sync) with Pearson lagged cross-correlations and Fisher’s statistics for combining window-length-dependent HRV-BOLD-Sync Maps and assessed their association with clinical dysautonomia. HRV-BOLD-sync was lower significantly in PD than in controls in various brain regions within CAN or in networks involved in autonomic modulation. Moreover, heart-brain synchronization index (HBSI), which quantifies heart-brain synchronization at a single-subject level, showed an inverse exposure–response relationship with dysautonomia severity, finding the lowest HBSI in patients with severe dysautonomia, followed by moderate, mild, and, lastly, controls. Importantly, HBSI was associated in PD, but not in controls, with Valsalva pressure recovery time (sympathetic), deep breathing E/I ratio (cardiovagal), and SCOPA-AUT. Our findings support the existence of heart-brain de-synchronization in PD with an impact on clinically relevant autonomic outcomes.
Collapse
|
9
|
Del Pino R, Murueta-Goyena A, Acera M, Carmona-Abellan M, Tijero B, Lucas-Jiménez O, Ojeda N, Ibarretxe-Bilbao N, Peña J, Gabilondo I, Gómez-Esteban JC. Autonomic dysfunction is associated with neuropsychological impairment in Lewy body disease. J Neurol 2020; 267:1941-1951. [PMID: 32170444 DOI: 10.1007/s00415-020-09783-7] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/13/2020] [Revised: 03/02/2020] [Accepted: 03/04/2020] [Indexed: 02/07/2023]
Abstract
OBJECTIVE This study aimed to analyze the association of autonomic dysfunction with cognition, depression, apathy, and fatigue in Lewy body disease (LBD). METHODS We included 61 patients [49 with idiopathic Parkinson's disease, 7 with dementia with Lewy bodies, and 5 E46K-SNCA mutation carriers] and 22 healthy controls. All participants underwent a comprehensive battery of neuropsychological and clinical measures, autonomic symptom assessment with the SCOPA-AUT, analysis of non-invasive hemodynamic parameters during deep breathing, the Valsalva maneuver, and a 20-min tilt test, and electrochemical skin conductance measurement at rest (Sudoscan). Student's t tests were used to assess group differences, and bivariate correlations and stepwise linear regressions to explore associations between autonomic function, cognition, depression, apathy, and fatigue. RESULTS Compared to controls, patients who had significant impairment (p < 0.05) in cognition, higher depression, apathy, and fatigue, more autonomic symptoms and objective autonomic dysfunction, reduced deep breathing heart rate variability [expiratory-to-inspiratory (E/I) ratio], prolonged pressure recovery time, and lower blood pressure in Valsalva late phase II and phase IV, while 24.1% had orthostatic hypotension in the tilt test. Autonomic parameters significantly correlated with cognitive and neuropsychiatric outcomes, systolic blood pressure during the Valsalva maneuver predicting apathy and depression. The E/I ratio was the main predictor of cognitive performance (17.6% for verbal fluency to 32.8% for visual memory). CONCLUSION Cardiovascular autonomic dysfunction is associated with cognitive and neuropsychiatric impairment in LBD, heart rate variability during deep breathing and systolic blood pressure changes during the Valsalva procedure are the main predictors of neuropsychological performance and depression/apathy symptoms, respectively.
Collapse
Affiliation(s)
- Rocío Del Pino
- Neurodegenerative Diseases Group, Biocruces Bizkaia Health Research Institute, Plaza de Cruces 12, CP, 48903, Barakaldo, Bizkaia, Spain. .,International University of La Rioja, La Rioja, Spain.
| | - Ane Murueta-Goyena
- Neurodegenerative Diseases Group, Biocruces Bizkaia Health Research Institute, Plaza de Cruces 12, CP, 48903, Barakaldo, Bizkaia, Spain
| | - Marian Acera
- Neurodegenerative Diseases Group, Biocruces Bizkaia Health Research Institute, Plaza de Cruces 12, CP, 48903, Barakaldo, Bizkaia, Spain
| | - Mar Carmona-Abellan
- Neurodegenerative Diseases Group, Biocruces Bizkaia Health Research Institute, Plaza de Cruces 12, CP, 48903, Barakaldo, Bizkaia, Spain
| | - Beatriz Tijero
- Neurodegenerative Diseases Group, Biocruces Bizkaia Health Research Institute, Plaza de Cruces 12, CP, 48903, Barakaldo, Bizkaia, Spain.,Neurology Department, Cruces University Hospital, Barakaldo, Bizkaia, Spain
| | - Olaia Lucas-Jiménez
- Department of Methods and Experimental Psychology, Faculty of Psychology and Education, University of Deusto, Bilbao, Spain
| | - Natalia Ojeda
- Department of Methods and Experimental Psychology, Faculty of Psychology and Education, University of Deusto, Bilbao, Spain
| | - Naroa Ibarretxe-Bilbao
- Department of Methods and Experimental Psychology, Faculty of Psychology and Education, University of Deusto, Bilbao, Spain
| | - Javier Peña
- Department of Methods and Experimental Psychology, Faculty of Psychology and Education, University of Deusto, Bilbao, Spain
| | - Iñigo Gabilondo
- Neurodegenerative Diseases Group, Biocruces Bizkaia Health Research Institute, Plaza de Cruces 12, CP, 48903, Barakaldo, Bizkaia, Spain.,Neurology Department, Cruces University Hospital, Barakaldo, Bizkaia, Spain.,Ikerbasque: The Basque Foundation for Science, Bilbao, Spain
| | - Juan Carlos Gómez-Esteban
- Neurodegenerative Diseases Group, Biocruces Bizkaia Health Research Institute, Plaza de Cruces 12, CP, 48903, Barakaldo, Bizkaia, Spain.,Neurology Department, Cruces University Hospital, Barakaldo, Bizkaia, Spain.,Department of Neurosciences, University of the Basque Country (UPV/EHU), Leioa, Spain
| |
Collapse
|
10
|
Roberson KB, Signorile JF, Singer C, Jacobs KA, Eltoukhy M, Ruta N, Mazzei N, Buskard ANL. Hemodynamic responses to an exercise stress test in Parkinson's disease patients without orthostatic hypotension. Appl Physiol Nutr Metab 2018; 44:751-758. [PMID: 30521353 DOI: 10.1139/apnm-2018-0638] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022]
Abstract
The presence of postganglionic sympathetic denervation is well established in Parkinson's disease (PD). Denervation at cardiac and blood vessel sites may lead to abnormal cardiovascular and hemodynamic responses to exercise. The aim of the present investigation was to examine how heart rate (HR) and hemodynamics are affected by an exercise test in PD patients without orthostatic hypotension. Thirty individuals without orthostatic hypotension, 14 individuals with PD, and 16 age-matched healthy controls performed an exercise test on a cycle ergometer. Heart rate, blood pressure, and other hemodynamic variables were measured in a fasted state during supine rest, active standing, exercise, and supine recovery. Peak HR and percent of age-predicted maximum HR (HRmax) achieved were significantly blunted in PD (p < 0.05, p < 0.01). HR remained significantly elevated in PD during recovery compared with controls (p = 0.03, p < 0.05). Systolic, diastolic, and mean arterial pressures were significantly lower at multiple time-points during active standing in PD compared with controls. Systemic vascular resistance index (SVRI) decreased significantly at the onset of exercise in PD, and remained significantly lower during exercise and the first minute of supine recovery. End diastolic volume index (EDVI) was significantly lower in PD during supine rest and recovery. Our results indicate for the first time that normal hemodynamics are disrupted during orthostatic stress and exercise in PD. Despite significant differences in EDVI at rest and during recovery, and SVRI during exercise, cardiac index was unaffected. Our finding of significantly blunted HRmax and HR recovery in PD patients has substantial implications for exercise prescription and recovery guidelines.
Collapse
Affiliation(s)
- Kirk B Roberson
- a Laboratory of Neuromuscular Research & Active Aging, Department of Kinesiology and Sport Sciences, University of Miami, Coral Gables, FL 33146, USA
| | - Joseph F Signorile
- a Laboratory of Neuromuscular Research & Active Aging, Department of Kinesiology and Sport Sciences, University of Miami, Coral Gables, FL 33146, USA.,b Center on Aging, Miller School of Medicine, University of Miami, Miami, FL 33136, USA
| | - Carlos Singer
- c Department of Neurology, Miller School of Medicine, University of Miami, Miami, FL, USA.,d Director, Division of Parkinson's Disease and Movement Disorders, Miami, FL 33136, USA
| | - Kevin A Jacobs
- e Laboratory of Clinical and Applied Physiology, Department of Kinesiology and Sport Sciences, University of Miami, Coral Gables, FL 33146, USA
| | - Moataz Eltoukhy
- f Sports Medicine and Motion Analysis Laboratory, Department of Kinesiology and Sport Sciences, University of Miami, Coral Gables, FL 33146, USA
| | - Nicolette Ruta
- a Laboratory of Neuromuscular Research & Active Aging, Department of Kinesiology and Sport Sciences, University of Miami, Coral Gables, FL 33146, USA
| | - Nicolle Mazzei
- a Laboratory of Neuromuscular Research & Active Aging, Department of Kinesiology and Sport Sciences, University of Miami, Coral Gables, FL 33146, USA
| | - Andrew N L Buskard
- a Laboratory of Neuromuscular Research & Active Aging, Department of Kinesiology and Sport Sciences, University of Miami, Coral Gables, FL 33146, USA
| |
Collapse
|
11
|
Akbar U, Kurkchubasche AG, Friedman JH. Perioperative management of Parkinson’s disease. Expert Rev Neurother 2016; 17:301-308. [DOI: 10.1080/14737175.2017.1241143] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
Affiliation(s)
- Umer Akbar
- Department of Neurology, Brown University, Rhode Island Hospital, Providence, RI, USA
| | - Arlet G. Kurkchubasche
- Department of Surgery and Pediatrics, Brown University, Hasbro Children’s Hospital, Providence, RI, USA
| | - Joseph H. Friedman
- Department of Neurology, Brown University, Butler Hospital, Providence, RI, USA
| |
Collapse
|