Cardiovascular autonomic dysfunction in PD

[aspergerian13]

I am to have a heart/autonomic ultrasound next week.

Cardiovascular autonomic dysfunction in Parkinson's disease.

Review article.

Ziemssen T, et al. J Neurol Sci. 2010.

ncbi.nlm.nih.gov/m/pubmed/1...

Cardiovascular autonomic neuropathy

Niamh McCarty and Barry Silverman, MD.

Proc (Bayl Univ Med Cent). 2016 Apr; 29(2): 157–159.

Https://ncbi.nlm.nih.gov/pmc/articl...

[parkie13]

Please let us know how you are doing. Best of luck, Mary

[aspergerian13 in reply to parkie13]

Mary,

Thanks for the encouragement. I will post updates.

[aspergerian13 in reply to aspergerian13]

More:

Prevalence of orthostatic hypotension in Parkinson’s disease: A systematic review and meta-analysis.

Daan C. Velseboer, Rob J. de Haan, [...], and Rob M.A. de Bie.

Parkinsonism Relat Disord. 2011 Dec; 17(10): 724–729.

ncbi.nlm.nih.gov/pmc/articl...

In advanced Parkinson’s disease (PD), non-motor symptoms may be the major determinant of disability [1]. Orthostatic hypotension (OH) is one of the non-motor features in PD. It is thought to be the result of degeneration of the peripheral autonomic nervous system as part of the disease progress [2].

These abnormalities lead to an inadequate response to the gravitational force on the effective circulatory volume during standing due to defective vasoconstriction and excess venous pooling of blood [3].

Symptoms of OH mainly result from cerebral and retinal hypoperfusion and include dizziness, faintness, seeing black spots, and may even be accompanied by a transient loss of consciousness [4].

The occurrence of symptoms is directly related to the extent of the blood pressure drop, but autoregulation of the cerebral vasculature and baseline supine blood pressure probably also play a role. This hypothesis is supported by data showing that about one-third of patients with a systolic blood pressure drop of 60 mmHg or more during tilt-table testing are completely asymptomatic during the test [5]...

[aspergerian13 in reply to aspergerian13]

Still more:

Autonomic dysfunction in Parkinson's disease: A prospective cohort study.

Merola A, et al. Mov Disord. 2018.

ncbi.nlm.nih.gov/m/pubmed/2...

BACKGROUND: Dysautonomia is a frequent and disabling complication of PD, with an estimated prevalence of 30-40% and a significant impact on the quality of life.

OBJECTIVES: To evaluate the rate of progression of dysautonomia and, in particular, orthostatic hypotension, in a cohort of unselected PD patients, and assess the extent to which the progression of dysautonomia affects activities of daily living, health-related quality of life, and health care utilization in PD.

METHODS: We recruited 131 consecutive patients into a 12-month, prospective, observational cohort study. Clinical measures included the International Parkinson and Movement Disorder Society/UPDRS, the Scale for Outcomes in Parkinson Disease-Autonomic, the Orthostatic Hypotension Symptoms Assessment, and orthostatic blood pressure measurements. Health care utilization was quantified as the number of hospitalizations, emergency room visits, and outpatient clinic evaluations.

RESULTS: The overall severity of autonomic symptoms, as measured by the the Orthostatic Hypotension Symptoms Assessment total score, worsened by 20% over 12 months (P < 0.001), with an overall increase in orthostatic hypotension prevalence from 31.1% to 46.7% (P < 0.001). Worsening of autonomic symptoms was independently associated with deterioration in daily living activities (P = 0.021) and health-related quality of life (P = 0.025) adjusting for disease duration, cognitive impairment, and motor severity. Regardless of symptomatic status, orthostatic hypotension was associated with greater deterioration in daily living activities, health care utilization, and falls (P ≤ 0.009) compared to patients without orthostatic hypotension.

CONCLUSIONS: The severity of autonomic symptoms progressed by 20% over 1 year and was independently associated with impairments in daily living activities and health-related quality of life. Symptomatic and asymptomatic orthostatic hypotension were both associated with increased prevalence of falls and health care utilization. © 2017 International Parkinson and Movement Disorder Society.

© 2017 International Parkinson and Movement Disorder Society.

PMID 29278286.