Parkinson´s disease cardiovascular symptoms: A new complex functional and structural insight

Characteristics of multimodal physiological signal differences in symptom fluctuations in Parkinson's disease

This study investigates the differences in multimodal physiological signals between patients with Parkinson's disease (PD) and healthy individuals, focusing on how symptom fluctuations affect these signals in PD. A total of 35 PD patients and 30 healthy controls participated. The PD patients were further categorized into two groups: those with symptom fluctuations (SF) and those without (NSF). Multimodal physiological signals, including EEG, ECG, respiration, and pulse, were recorded in resting state. Features were extracted from these signals and analyzed using non-parametric statistical tests. The results showed that the SF group had significantly higher absolute power in the β bands in the frontal, parietal, and central regions, as well as increased δ band power in the parietal regions compared to the NSF group. Additionally, several time-domain characteristics of the ECG signal were significantly greater in the SF group. These findings suggest that symptom fluctuations may influence cortical activity and cardiac autonomic function in PD patients. While levodopa-based treatments can alleviate certain symptoms, they may not fully compensate for the functional alterations in brain activity. Further research is needed to explore the effects on other physiological systems.

Amantadine Reduces Adverse Cardiovascular Outcomes in Patients With Parkinsonism or Parkinson Disease: A Global Propensity Score Matched Analysis

OBJECTIVE

N-methyl-d-aspartate (NMDA) receptor antagonism in the central nervous system has been described. More data are needed regarding its clinical impact on the cardiovascular system. In this study, we assess the cardiovascular impact of NMDA receptor antagonism with amantadine on patients with primary or secondary parkinsonism.

METHODS

To conduct this retrospective cohort analysis, we queried the TriNetX Global database on January 13, 2024 to identify patients 18 years old or older with Parkinsonism between January 2003 and December 2023 and divided them into 2 groups based on amantadine use. We conducted propensity score matched (PSM) analysis for sociodemographics, cardiovascular comorbidities and medications, and antiparkinsonian agents.

RESULTS

After PSM, relative risks (RRs) were used to compare outcomes over a 5-year follow-up period. After PSM, both groups had 28,461 patients each. Amantadine use in patients with parkinsonism was associated with a 13% reduction in 3-point major adverse cardiovascular and cerebrovascular events (RR: 0.867, 95% confidence interval [CI]: 0.836-0.900, P < 0.0001), as well as a significantly lower risk of all-cause mortality (RR: 0.877, 95% CI: 0.844-0.912, P < 0.0001), AMI (RR: 0.790, 95% CI: 0.709-0.881, P < 0.0001), and cerebral infarction (RR: 0.868, 95% CI: 0.791-0.952, P = 0.0026). It was also associated with lower rates of heart failure, atrial arrhythmias, bradycardia, atrioventricular blocks, ventricular tachycardia, syncope and collapse, and peripheral edema. Amantadine use was however associated with a higher risk of orthostatic hypotension.

CONCLUSIONS

NMDA antagonism with amantadine in patients with primary or secondary parkinsonism is associated with a significantly reduced risk of all-cause mortality, AMI, cerebral infarction, heart failure, and arrhythmias.

Molecular remodeling in comorbidities associated with heart failure: a current update

Recent advances in genomics and proteomics have helped in understanding the molecular mechanisms and pathways of comorbidities and heart failure. In this narrative review, we reviewed molecular alterations in common comorbidities associated with heart failure such as obesity, diabetes mellitus, systemic hypertension, pulmonary hypertension, coronary artery disease, hypercholesteremia and lipoprotein abnormalities, chronic kidney disease, and atrial fibrillation. We searched the electronic databases, PubMed, Ovid, EMBASE, Google Scholar, CINAHL, and PhysioNet for articles without time restriction. Although the association between comorbidities and heart failure is already well established, recent studies have explored the molecular pathways in much detail. These molecular pathways demonstrate how novels drugs for heart failure works with respect to the pathways associated with comorbidities. Understanding the altered molecular milieu in heart failure and associated comorbidities could help to develop newer medications and targeted therapies that incorporate these molecular alterations as well as key molecular variations across individuals to improve therapeutic outcomes. The molecular alterations described in this study could be targeted for novel and personalized therapeutic approaches in the future. This knowledge is also critical for developing precision medicine strategies to improve the outcomes for patients living with these conditions.

Impact of Helicobacter pylori and metabolic syndrome on mast cell activation-related pathophysiology and neurodegeneration

Both Helicobacter pylori (H. pylori) infection and metabolic syndrome (MetS) are highly prevalent worldwide. The emergence of relevant research suggesting a pathogenic linkage between H. pylori infection and MetS-related cardio-cerebrovascular diseases and neurodegenerative disorders, particularly through mechanisms involving brain pericyte deficiency, hyperhomocysteinemia, hyperfibrinogenemia, elevated lipoprotein-a, galectin-3 overexpression, atrial fibrillation, and gut dysbiosis, has raised stimulating questions regarding their pathophysiology and its translational implications for clinicians. An additional stimulating aspect refers to H. pylori and MetS-related activation of innate immune cells, mast cells (MC), which is an important, often early, event in systemic inflammatory pathologies and related brain disorders. Synoptically, MC degranulation may play a role in the pathogenesis of H. pylori and MetS-related obesity, adipokine effects, dyslipidemia, diabetes mellitus, insulin resistance, arterial hypertension, vascular dysfunction and arterial stiffness, an early indicator of atherosclerosis associated with cardio-cerebrovascular and neurodegenerative disorders. Meningeal MC can be activated by triggers including stress and toxins resulting in vascular changes and neurodegeneration. Likewise, H.pylori and MetS-related MC activation is linked with: (a) vasculitis and thromboembolic events that increase the risk of cardio-cerebrovascular and neurodegenerative disorders, and (b) gut dysbiosis-associated neurodegeneration, whereas modulation of gut microbiota and MC activation may promote neuroprotection. This narrative review investigates the intricate relationship between H. pylori infection, MetS, MC activation, and their collective impact on pathophysiological processes linked to neurodegeneration. Through a comprehensive search of current literature, we elucidate the mechanisms through which H. pylori and MetS contribute to MC activation, subsequently triggering cascades of inflammatory responses. This highlights the role of MC as key mediators in the pathogenesis of cardio-cerebrovascular and neurodegenerative disorders, emphasizing their involvement in neuroinflammation, vascular dysfunction and, ultimately, neuronal damage. Although further research is warranted, we provide a novel perspective on the pathophysiology and management of brain disorders by exploring potential therapeutic strategies targeting H. pylori eradication, MetS management, and modulation of MC to mitigate neurodegeneration risk while promoting neuroprotection.