Abstract
Autonomic nervous system (ANS) disturbances are common in Parkinson's
disease (PD), but also in other Parkinsonian syndromes, especially in multiple
system atrophy (MSA). The differentiation between various Parkinsonian syndromes
may be difficult, but it is important for prognostic and therapeutic purposes.
The aim of this study was to determine the ability of different analysis methods
to reveal cardiovascular regulation disturbances in PD and to evaluate the
diagnostic capacity of autonomic tests to differentiate between various
Parkinsonian syndromes. Furthermore, this study aimed to evaluate the
relationships between ANS disturbances and the clinical characteristics of PD. In
addition, the cardiac autonomic function was evaluated during various sleep
stages for the first time in untreated PD patients by using spectral heart rate
variability (HRV) measures to determine possible sleep stage specific
cardiovascular regulation disturbances.
Cardiovascular autonomic reflexes were evaluated in 62 untreated and newly
diagnosed PD patients, 34 PD patients under antiparkinsonian medication, 47 MSA
patients and 15 patients with progressive supranuclear palsy (PSP). The
usefulness of different analysis methods was evaluated in a subgroup of 32
untreated PD patients. A further 21 untreated PD patients underwent one-night
polysomnography for nocturnal heart rate variability analysis.
PD patients with hypokinesia/rigidity as their initial onset sign had a
significantly lower max-min ratio in the deep breathing test than those patients
with tremor as the initial sign. MSA patients showed significant reductions in
both HRV and blood pressure responses during orthostatic provocation, whereas PSP
patients had normal results. Absolute spectral measures yielded the clearest
indicators separating the PD patients from the controls, while the cardiovascular
reflexes proved more useful than the normalised spectral HRV measures in
revealing the differences between the two groups. HRV was abnormally decreased
during non-REM sleep in PD patients but not during REM sleep or the S1 sleep
stage. The normalized high frequency power was significantly decreased in PD
patients during sleep stages S2-4, while the standard deviation of the R-R
intervals was increased during the same sleep stages, possibly corresponding to
the increased motility of PD patients during these sleep stages.
The clinical characteristics of PD deserve particular attention in
connection with ANS disturbances, since autonomic failure seems to be more
pronounced in PD patients with hypokinesia/rigidity as their initial sign. The
evaluation of the autonomic function may also be helpful in the differential
diagnosis of Parkinsonian syndromes. Spectral analysis methods should be
implemented in the evaluation of ANS dysfunction to achieve the best possible
efficacy in the differentiation of pathological responses from normal ones.
Nocturnal analysis of cardiovascular regulation revealed new and interesting
features of pathologic HRV in PD patients, thus when HRV is evaluated, the
different sleep stages should be analysed separately.
| Identifer | oai:union.ndltd.org:oulo.fi/oai:oulu.fi:isbn951-42-6448-7 |
| Date | 24 July 2001 |
| Creators | Kallio, M. (Mika) |
| Publisher | University of Oulu |
| Source Sets | University of Oulu |
| Language | English |
| Detected Language | English |
| Type | info:eu-repo/semantics/doctoralThesis, info:eu-repo/semantics/publishedVersion |
| Format | application/pdf |
| Rights | info:eu-repo/semantics/openAccess, © University of Oulu, 2001 |
| Relation | info:eu-repo/semantics/altIdentifier/pissn/0355-3221, info:eu-repo/semantics/altIdentifier/eissn/1796-2234 |
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