1
|
Kleinz T, Scholz L, Huckemann S, Rohmann R, Kühn E, Averdunk P, Kools S, Hilker L, Bieber A, Müller K, Motte J, Fisse AL, Schneider-Gold C, Gold R, Kwon EH, Tönges L, Pitarokoili K. The association of vagal atrophy with parameters of autonomic function in multiple system atrophy and progressive supranuclear palsy. Ther Adv Neurol Disord 2024; 17:17562864241267300. [PMID: 39175851 PMCID: PMC11339749 DOI: 10.1177/17562864241267300] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/21/2023] [Accepted: 06/18/2024] [Indexed: 08/24/2024] Open
Abstract
Background Vagal atrophy is a hallmark of Parkinson's disease (PD) and has been found to be associated with autonomic dysfunction, while analyses of the vagus nerve (VN) in atypical Parkinsonian syndromes (APS) have not yet been performed. We here investigate the characteristics of the VN in multiple system atrophy (MSA) and progressive supranuclear palsy (PSP) and, in a second step, its potential as a possible biomarker for orthostatic dysregulation. Objectives The aim was to compare the VN pathology in MSA and PSP with healthy individuals and patients with PD as a differentiating factor and to further analyse the correlation of the VN with clinical parameters and cardiovascular response. Design We conducted a monocentric, cross-sectional cohort study in 41 APS patients and compared nerve ultrasound (NUS) parameters with 90 PD patients and 39 healthy controls. Methods In addition to a detailed neurological history and examination, several clinical severity and motor scores were obtained. Autonomic symptoms were reported in the Scales for Outcomes in Parkinson's Disease - Autonomic questionnaire. Further scores were used to detect other non-motor symptoms, quality of life and cognition. Additionally, we performed a head up tilt test (HUTT) and NUS of the VN. We conducted correlation analyses of the VN cross-sectional area (CSA) with clinical scores and the heart rate and blood pressure variability parameters of the HUTT. Results The examination demonstrated a high prevalence of abnormal autonomic response in both MSA (90%) and PSP (80%). The VN CSA correlated with spectral parameters of the HUTT, which are associated with sympatho-vagal imbalance. In addition, the CSA of the VN in patients with PD and PSP were significantly smaller than in healthy controls. In MSA, however, there was no marked vagal atrophy in comparison. Conclusion The occurrence of autonomic dysfunction was high in MSA and PSP, which underlines its impact on these syndromes. Our findings indicate a connection between vagal pathology and autonomic dysfunction and might contribute to a better comprehension of APS. To further evaluate the clinical relevance and the VN as a possible marker of autonomic dysfunction in APS, prospective longitudinal observations are necessary.
Collapse
Affiliation(s)
- Teresa Kleinz
- Department of Neurology, St. Josef Hospital, Ruhr-University Bochum, Gudrunstr. 56, 1267300 Bochum, Germany
| | - Leonard Scholz
- Department of Neurology, St. Josef Hospital, Ruhr-University Bochum, Gudrunstr. 56, 44791 Bochum, Germany
| | - Sophie Huckemann
- Department of Neurology, St. Josef Hospital, Ruhr-University Bochum, Bochum, Germany
| | - Rachel Rohmann
- Department of Neurology, St. Josef Hospital, Ruhr-University Bochum, Bochum, Germany
| | - Eva Kühn
- Department of Neurology, St. Josef Hospital, Ruhr-University Bochum, Bochum, Germany
| | - Paulina Averdunk
- Department of Neurology, St. Josef Hospital, Ruhr-University Bochum, Bochum, Germany
| | - Saskia Kools
- Department of Neurology, St. Josef Hospital, Ruhr-University Bochum, Bochum, Germany
| | - Lovis Hilker
- Department of Neurology, St. Josef Hospital, Ruhr-University Bochum, Bochum, Germany
| | - Antonia Bieber
- Department of Neurology, St. Josef Hospital, Ruhr-University Bochum, Bochum, Germany
| | - Katharina Müller
- Department of Neurology, St. Josef Hospital, Ruhr-University Bochum, Bochum, Germany
| | - Jeremias Motte
- Department of Neurology, St. Josef Hospital, Ruhr-University Bochum, Bochum, Germany
| | - Anna-Lena Fisse
- Department of Neurology, St. Josef Hospital, Ruhr-University Bochum, Bochum, Germany
| | | | - Ralf Gold
- Department of Neurology, St. Josef Hospital, Ruhr-University Bochum, Bochum, Germany
- Neurodegeneration Research, Centre for Protein Diagnostics (ProDi), Ruhr University, Bochum, Germany
| | - Eun Hae Kwon
- Department of Neurology, St. Josef Hospital, Ruhr-University Bochum, Bochum, Germany
| | - Lars Tönges
- Department of Neurology, St. Josef Hospital, Ruhr-University Bochum, Bochum, Germany
- Neurodegeneration Research, Centre for Protein Diagnostics (ProDi), Ruhr University, Bochum, Germany
| | - Kalliopi Pitarokoili
- Department of Neurology, St. Josef Hospital, Ruhr-University Bochum, Bochum, Germany
| |
Collapse
|
2
|
Wang H, Gao X, Shi Y, Wu D, Li C, Wang W. Effects of trunk posture on cardiovascular and autonomic nervous systems: A pilot study. Front Physiol 2022; 13:1009806. [PMID: 36330208 PMCID: PMC9623330 DOI: 10.3389/fphys.2022.1009806] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/02/2022] [Accepted: 09/28/2022] [Indexed: 01/28/2024] Open
Abstract
Objective: Although regular and moderate physical activity has been shown to improve the cardiovascular and autonomic nervous systems, little has been done to study the effects of postural changes in the movement on the heart and autonomic nervous system. To uncover changes in cardiac function and autonomic nerves induced by different underlying posture transitions and explore which trunk postures lead to chronic sympathetic activation. Therefore, this study investigated the effects of trunk posture on the cardiovascular and autonomic nervous systems. Methods: Twelve male subjects (age 24.7 ± 1.3) underwent this study. The non-invasive cardiac output NICOM monitoring equipment and the FIRSTBEAT system are used to dynamically monitor seven trunk postures in the sitting position simultaneously (neutral position, posterior extension, forward flexion, left lateral flexion, right lateral flexion, left rotation, right rotation). Each posture was maintained for 3 min, and the interval between each movement was 3 min to ensure that each index returned to the baseline level. Repeated analysis of variance test was used to compare and analyze the differences in human cardiac function, heart rate variability index, and respiratory rate under different postures. Results: Compared with the related indicators of cardiac output in a neutral trunk position: the cardiac index (CI) was significantly reduced in forwarding flexion and left rotation (3.48 ± 0.34 vs. 3.21 ± 0.50; 3.48 ± 0.34 vs. 3.21 ± 0.46, Δ L/(min/m2)) (p = 0.016, p = 0.013), cardiac output decreased significantly (6.49 ± 0.78 vs. 5.93 ± 0.90; 6.49 ± 0.78 vs. 6.00 ± 0.96, Δ L/min) (p = 0.006, p = 0.014), the stroke volume (stroke volume)decreased significantly (87.90 ± 15.10 vs. 81.04 ± 16.35; 87.90 ± 15.10 vs. 79.24 ± 16.83, Δ ml/beat) (p = 0.017, p = 0.0003); heart rate increased significantly in posterior extension (75.08 ± 10.43 vs. 78.42 ± 10.18, Δ beat/min) (p = 0.001); left rotation stroke volume index (SVI) decreased significantly (47.28 ± 7.97 vs. 46.14 ± 8.06, Δ ml/m2) (p = 0.0003); in the analysis of HRV-related indicators, compared with the neutral trunk position, the LF/HF of the posterior extension was significantly increased (1.90 ± 1.38 vs. 3.00 ± 1.17, p = 0.037), and the LF/HF of the forward flexion was significantly increased (1.90 ± 1.38 vs. 2.85 ± 1.41, p = 0.041), and the frequency-domain index LF/HF of right rotation was significantly increased (1.90 ± 1.38 vs. 4.06 ± 2.19, p = 0.008). There was no significant difference in respiratory rate (p > 0.05). Conclusion: A neutral trunk is the best resting position, and deviations from a neutral trunk position can affect the cardiovascular and autonomic nervous systems, resulting in decreased stroke volume, increased heart rate, and relative activation of sympathetic tone.
Collapse
Affiliation(s)
- Hao Wang
- Sports Rehabilitation Research Center, China Institute of Sport Science, Beijing, China
| | - Xiaolin Gao
- Sports Rehabilitation Research Center, China Institute of Sport Science, Beijing, China
| | - Yongjin Shi
- Department of Sports and Arts, China Agricultural University, Beijing, China
| | - Dongzhe Wu
- Sports Rehabilitation Research Center, China Institute of Sport Science, Beijing, China
| | - Chuangtao Li
- Sports Rehabilitation Research Center, China Institute of Sport Science, Beijing, China
| | - Wendi Wang
- Sports Rehabilitation Research Center, China Institute of Sport Science, Beijing, China
| |
Collapse
|
3
|
Upadhyayula A, Preetham BS, Mudunuru AK, Fatima F, Reddy B, Sri PSS, Srinivas M. Objective Assessment of Cardiopostural Control and its Improvement after Yoga Training using Wii Balance Board and Heart Rate Variability in Young Girls with Flat Foot. INDIAN JOURNAL OF CARDIOVASCULAR DISEASE IN WOMEN 2022. [DOI: 10.25259/mm_ijcdw_436] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/23/2022]
Abstract
Objective:
Bipedalism in humans demanded robust postural control systems to maintain balance and equilibrium during variety of volitional activities. Adaptive learning is a key characteristic of these control systems. Postural control and balance are associated with autonomic changes trying to maintain cardiovascular homeostasis during postural imbalances, which are specifically important in conditions like flat foot. Yoga training could help such cases to achieve better postural balance and autonomic state. Young adolescent girls with flat foot were studied in comparison to normal girls and flat foot boys.
Materials and Methods:
Sixteen girls and 11 boys with flat foot were subjected to posturography on Wii Balance Board connected wirelessly to PowerLab 15T. Wireless heart rate belt was used to acquire RR intervals. Vrikshasana was chosen as the suitable asana for 4-week training. Displacement of center of pressure (COP) and heart rate variability was analyzed using LabChart pro software before and after yoga training.
Results:
COP displacement in flat foot subjects is away from the center during erect stance and sway toward sides. Flat foot girls showed significant greater displacements and lesser correction after yoga compared to flat foot boys (P < 0.05). Flat foot girls also showed lesser recovery in LF% and RMSSD after 4-week yoga training.
Conclusion:
Studying the autonomic changes during voluntary postural imbalance on balance board provide real-time picture of internal state in flat foot individuals. The sympathetic dominance would account for preparedness and adaptation in postural control systems. This state improved with yoga training toward better cardiac vagal tone.
Collapse
Affiliation(s)
- Aditya Upadhyayula
- Department of Physiology, ESIC Medical College, Hyderabad, Telangana, India,
| | - B. Shashi Preetham
- Department of Physiology, ESIC Medical College, Hyderabad, Telangana, India,
| | | | - Farheen Fatima
- Department of Physiology, ESIC Medical College, Hyderabad, Telangana, India,
| | - Bhavya Reddy
- Department of Physiology, ESIC Medical College, Hyderabad, Telangana, India,
| | - P. Sushma Sai Sri
- Department of Physiology, ESIC Medical College, Hyderabad, Telangana, India,
| | - M. Srinivas
- Department of Paediatric Surgery, ESIC Super Specialty Hospital, Hyderabad, Telangana, India,
| |
Collapse
|