1
|
Lv S, Wang Z, Sun X, Jin H, Liu J, Deng F, Lv Y, Jia M, Guo ZN, Yang Y. Compromised Dynamic Cerebral Autoregulation in Patients With Idiopathic Rapid Eye Movement Behavior Disorder: A Case-Control Study Using Transcranial Doppler. Front Psychiatry 2020; 11:51. [PMID: 32140114 PMCID: PMC7042385 DOI: 10.3389/fpsyt.2020.00051] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/25/2019] [Accepted: 01/21/2020] [Indexed: 11/13/2022] Open
Abstract
BACKGROUND Patients with idiopathic rapid eye movement behavior disorder (IRBD) have been suggested to exhibit altered cerebral perfusion and abnormal cerebral blood flow, which imply a possibility of cerebral autoregulation (CA) impairment. We aimed to investigate the dynamic CA (dCA) in patients with IRBD during wakefulness and to explore the correlations between dCA parameters and clinical measurements. METHODS We assessed the dCA capability of 30 patients with IRBD and 36 sex- and age-matched healthy controls by using transcranial Doppler and finger plethysmography. CA function was evaluated by transfer function analysis based on spontaneous oscillation of cerebral blood flow and arterial blood pressure. Transfer function parameters (phase difference and gain) were used to quantify the CA. RESULTS No significant differences were observed between the right and left middle cerebral artery dCA parameters (phase difference and gain) of both groups. Patients with IRBD had significantly lower phase difference than the healthy controls, indicating their impaired CA capability. Besides, the value of gain in patients with IRBD was higher than the healthy controls, but the difference did not reach statistical level. CONCLUSIONS CA function is compromised in patients with IRBD during wakefulness, which might be an intermediate link between IRBD and neurological symptoms.
Collapse
Affiliation(s)
- Shan Lv
- Department of Neurology, The First Hospital of Jilin University, Changchun, China
| | - Zan Wang
- Department of Neurology, The First Hospital of Jilin University, Changchun, China
| | - Xin Sun
- Department of Neurology, The First Hospital of Jilin University, Changchun, China
| | - Hang Jin
- Department of Neurology, The First Hospital of Jilin University, Changchun, China
| | - Jia Liu
- Shenzhen Institutes of Advanced Technology, Chinese Academy of Sciences, Shenzhen, China
| | - Fang Deng
- Department of Neurology, The First Hospital of Jilin University, Changchun, China
| | - Yudan Lv
- Department of Neurology, The First Hospital of Jilin University, Changchun, China
| | - Meiyan Jia
- Department of Neurology, The First Hospital of Jilin University, Changchun, China
| | - Zhen-Ni Guo
- Clinical Trial and Research Center for Stroke, Department of Neurology, The First Hospital of Jilin University, Changchun, China
| | - Yi Yang
- Department of Neurology, The First Hospital of Jilin University, Changchun, China.,Clinical Trial and Research Center for Stroke, Department of Neurology, The First Hospital of Jilin University, Changchun, China
| |
Collapse
|
2
|
Indelicato E, Fanciulli A, Poewe W, Antonini A, Pontieri FE, Wenning GK. Cerebral autoregulation and white matter lesions in Parkinson's disease and multiple system atrophy. Parkinsonism Relat Disord 2015; 21:1393-7. [PMID: 26578037 DOI: 10.1016/j.parkreldis.2015.10.018] [Citation(s) in RCA: 24] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/14/2015] [Revised: 09/23/2015] [Accepted: 10/29/2015] [Indexed: 11/28/2022]
Abstract
Cerebral autoregulation is a complex homeostatic process which ensures constant brain blood supply, despite continuous blood pressure fluctuations. Recent evidence suggests that in Parkinson's disease (PD) and multiple system atrophy (MSA) this process is maintained in a broadened range of blood pressure values, consistent with an adaptive mechanism to increase tolerance to orthostatic hypotension. In PD and MSA orthostatic hypotension may be accompanied by supine hypertension which has been recently linked with cerebral white matter lesions in these conditions. We hypothesize that cerebral autoregulation adaptation to chronic orthostatic hypotension may be directly related with an increase susceptibility to hypertensive peaks. Evaluation of cerebral autoregulatory behavior may thus represent a novel approach to simultaneously target orthostatic symptoms and silent end-organ damage in alpha-synucleinopathies, with a beneficial impact on cerebrovascular and cognitive outcome.
Collapse
Affiliation(s)
- Elisabetta Indelicato
- Department of Neuroscience, Mental Health and Sensory Organs, "Sapienza" University of Rome, Via di Grottarossa 1035, 00189 Rome, Italy; IRCCS Santa Lucia Foundation, Via Ardeatina 306, 00179 Rome, Italy.
| | - Alessandra Fanciulli
- Department of Neuroscience, Mental Health and Sensory Organs, "Sapienza" University of Rome, Via di Grottarossa 1035, 00189 Rome, Italy; Department of Neurology, Innsbruck Medical University, Anichstraße 35, 6020 Innsbruck, Austria
| | - Werner Poewe
- Department of Neurology, Innsbruck Medical University, Anichstraße 35, 6020 Innsbruck, Austria
| | - Angelo Antonini
- IRCCS Ospedale San Camillo, Via Alberoni 70, 30126 Venice, Italy
| | - Francesco E Pontieri
- Department of Neuroscience, Mental Health and Sensory Organs, "Sapienza" University of Rome, Via di Grottarossa 1035, 00189 Rome, Italy; IRCCS Santa Lucia Foundation, Via Ardeatina 306, 00179 Rome, Italy
| | - Gregor K Wenning
- Department of Neurology, Innsbruck Medical University, Anichstraße 35, 6020 Innsbruck, Austria
| |
Collapse
|
3
|
Kobayashi S. Angiotensin II receptor antagonist has beneficial effect on hypertensive stroke patients? J Hum Hypertens 2004; 18:685-6. [PMID: 15129231 DOI: 10.1038/sj.jhh.1001736] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Affiliation(s)
- S Kobayashi
- Department of Neurology, Hematology and Rheumatology, School of Medicine, Shimane University, Izumo, Japan.
| |
Collapse
|
4
|
Serrador JM, Sorond FA, Vyas M, Gagnon M, Iloputaife ID, Lipsitz LA. Cerebral pressure-flow relations in hypertensive elderly humans: transfer gain in different frequency domains. J Appl Physiol (1985) 2004; 98:151-9. [PMID: 15361517 DOI: 10.1152/japplphysiol.00471.2004] [Citation(s) in RCA: 98] [Impact Index Per Article: 4.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
The dynamics of the cerebral vascular response to blood pressure changes in hypertensive humans is poorly understood. Because cerebral blood flow is dependent on adequate perfusion pressure, it is important to understand the effect of hypertension on the transfer of pressure to flow in the cerebrovascular system of elderly people. Therefore, we examined the effect of spontaneous and induced blood pressure changes on beat-to-beat and within-beat cerebral blood flow in three groups of elderly people: normotensive, controlled hypertensive, and uncontrolled hypertensive subjects. Cerebral blood flow velocity (transcranial Doppler), blood pressure (Finapres), heart rate, and end-tidal CO(2) were measured during the transition from a sit to stand position. Transfer function gains relating blood pressure to cerebral blood flow velocity were assessed during steady-state sitting and standing. Cerebral blood flow regulation was preserved in all three groups by using changes in cerebrovascular resistance, transfer function gains, and the autoregulatory index as indexes of cerebral autoregulation. Hypertensive subjects demonstrated better attenuation of cerebral blood flow fluctuations in response to blood pressure changes both within the beat (i.e., lower gain at the cardiac frequency) and in the low-frequency range (autoregulatory, 0.03-0.07 Hz). Despite a better pressure autoregulatory response, hypertensive subjects demonstrated reduced reactivity to CO(2). Thus otherwise healthy hypertensive elderly subjects, whether controlled or uncontrolled with antihypertensive medication, retain the ability to maintain cerebral blood flow in the face of acute changes in perfusion pressure. Pressure regulation of cerebral blood flow is unrelated to cerebrovascular reactivity to CO(2).
Collapse
Affiliation(s)
- Jorge M Serrador
- Hebrew Rehabilitation Center for Aged, Beth Israel Deaconess Medical Center Gerontology-Palmer 117, One Deaconess Road, Boston, MA 02215, USA.
| | | | | | | | | | | |
Collapse
|
5
|
Niehaus L, Böckeler GC, Kupsch A, Meyer BU. Normal cerebral hemodynamic response to orthostasis in Parkinson's disease. Parkinsonism Relat Disord 2002; 8:255-9. [PMID: 12039420 DOI: 10.1016/s1353-8020(01)00014-1] [Citation(s) in RCA: 17] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
In patients with Idiopathic Parkinson's Disease (IPD) without a history of syncope the cardiovascular and cerebrovascular response to orthostatic stress was studied to search for subclinical impairment of autoregulatory mechanisms. Fifteen patients with IPD and 15 healthy age-matched controls were studied at rest and during head-up tilt (HUT). Heart rate, mean arterial blood pressure (MAP) and mean blood flow velocity (MBFV) in the middle cerebral artery were measured simultaneously. Changes of MAP and MBFV and the relationship between both were assessed. During HUT, heart rate increased less in patients than in healthy subjects (16.3% versus 24.2%, p=0.03). In the first minute of orthostasis MAP decreased more in patients than in healthy subjects (-4.0% versus -0.6%, p=0.04). MAP reached the pre-tilt values within 2 min in healthy subjects and 5 min in patients. Cerebral blood flow velocities fell to a similar degree and with similar time characteristics in patients and controls (-15.4% versus -16.7%, p=0.3). In both groups, patients and controls, changes of MAP did not correlate with changes of MBFV. It can be concluded that in IPD patients without symptoms of orthostatic dysregulation the autonomic circulatory control is impaired while the cerebral hemodynamic regulation during orthostasis is unaffected.
Collapse
Affiliation(s)
- L Niehaus
- Department of Neurology, Charité, Campus Virchow Klinikum, Humboldt-University, Berlin, Germany.
| | | | | | | |
Collapse
|
6
|
Ogawa M, Fukuyama H, Harada K, Kimura J. Cerebral blood flow and metabolism in multiple system atrophy of the Shy-Drager syndrome type: a PET study. J Neurol Sci 1998; 158:173-9. [PMID: 9702688 DOI: 10.1016/s0022-510x(98)00117-8] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
To investigate the role of the autonomic nervous system in cerebral blood flow (CBF) and metabolism, CBF and oxygen metabolism in patients with multiple system atrophy of the Shy-Drager syndrome type were examined. Seven patients with Shy-Drager syndrome were imaged using positron emission tomography and 15O-labeled gases. There was excellent local coupling between CBF and the cerebral metabolic rate of oxygen in the resting state. Elevation of blood pressure induced by leg raising increased CBF. The inhalation of CO2 also increased CBF in the Shy-Drager patients. These results showed that autoregulation is impaired in Shy-Drager syndrome, but local metabolic-flow coupling in the resting state and the CBF response to CO2 inhalation are spared. We conclude that the autonomic nervous system plays an important role in autoregulation, but not in local metabolic-flow coupling in the resting state. We suggest that metabolic mechanisms may mediate resting metabolic-flow coupling.
Collapse
Affiliation(s)
- M Ogawa
- Department of Neurology, Faculty of Medicine, Kyoto University, Japan
| | | | | | | |
Collapse
|
7
|
Morita Y, Hardebo JE, Bouskela E. Influence of cerebrovascular sympathetic, parasympathetic, and sensory nerves on autoregulation and spontaneous vasomotion. ACTA PHYSIOLOGICA SCANDINAVICA 1995; 154:121-30. [PMID: 7572208 DOI: 10.1111/j.1748-1716.1995.tb09894.x] [Citation(s) in RCA: 47] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/26/2023]
Abstract
The effect of removal of cerebrovascular sympathetic, parasympathetic or sensory nerve on brain cortical blood flow and spontaneous vasomotion during changes in systemic blood pressure was studied by laser-Doppler flowmetry in anaesthetized rats. Selective section of sympathetic fibres along the internal carotid artery markedly affected the ability to autoregulate, as measured in microvessels of the middle cerebral arterial territory. Removal of the parasympathetic nerves tended to reduce the ability to autoregulate, whereas no significant influence was found after sensory denervation. Following the denervations, spontaneous vasomotion was not significantly affected in frequency or amplitude.
Collapse
Affiliation(s)
- Y Morita
- Department of Medical Cell Research, University of Lund, Sweden
| | | | | |
Collapse
|
8
|
Shinohara Y. Management of blood pressure in acute and chronic cerebrovascular disease from the viewpoint of cerebral blood flow. J Stroke Cerebrovasc Dis 1994; 4 Suppl 1:S80-3. [DOI: 10.1016/s1052-3057(10)80265-4] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
|
9
|
Yamamoto M, Meyer JS, Sakai F, Jakoby R. Effect of differential spinal cord transection on human cerebral blood flow. J Neurol Sci 1980; 47:395-406. [PMID: 6775053 DOI: 10.1016/0022-510x(80)90092-1] [Citation(s) in RCA: 13] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/21/2023]
Abstract
Regional cerebral blood flow (rCBF) was measured by 133Xe inhalation in 17 patients with chronic spinal cord transection. This was done to investigate any effects such spinal cord deafferentation might have on resting rCBF and to test whether resulting chronic preganglionic sympathectomy influenced cerebral vasomotor CO2 responsiveness and autoregulation. Thirteen patients had complete cervical cord transection (CCT) at levels C4--C6 (age 37 +/- 15 years, time interval, 2 months--20 years). Four patients had complete thoracic cord transection at levels T3--4, T8 and T12 (TCT; age 49 +/- 22 years; time interval 2--5 months). CO2 responsiveness was tested by induced hypercapnia in 11 patients with CCT and 2 patients with TCT. Autoregulation was tested in 10 patients with CCT and 4 patients with TCT by decreasing cerebral perfusion pressure during postural tilting. Mean resting hemispheric Fg values (MHFg) were significantly reduced only in patients with CCT (MHFg = 69 +/- 12 ml/100 g brain/min), while brain stem-cerebellar Fg values (BSC Fg) were reduced significantly both in patients with CCT (BSC Fg = 85 +/- 10) and with TCT (BSC Fg = 88 +/- 12) compared to values measured in healthy normals (N = 21, MHFg = 81 +/- 10, BSC Fg = 98 +/- 10). Hemispheric CO2 responsiveness showed a trend toward reduction in patients with CCT but this was not statistically significant. Hemispheric autoregulation was significantly impaired in CCT compared to healthy normals but improved with time and rehabilitation.
Collapse
|