Non-motor symptoms are now commonly recognized in Parkinson’s disease (PD) and can include dysautonomia. Impairment of cardiovascular autonomic function can occur at any stage of PD but is typically prevalent in advanced stages or related to (anti-Parkinsonian) drugs and can result in atypical blood pressure (BP) readings and related symptoms such as orthostatic hypotension (OH) and supine hypertension. OH is usually diagnosed with a head-up-tilt test (HUT) or an (active) standing test (also known as Schellong test) in the laboratory, but 24 h ambulatory blood pressure monitoring (ABPM) in a home setting may have several advantages, such as providing an overview of symptoms in daily life alongside pathophysiology as well as assessment of treatment interventions. This, however, is only possible if ABPM is administrated correctly and an autonomic protocol (including a diary) is followed which will be discussed in this review. A 24-h ABPM does not only allow the detection of OH, if it is present, but also the assessment of cardiovascular autonomic dysfunction during and after various daily stimuli, such as postprandial and alcohol dependent hypotension, as well as exercise and drug induced hypotension. Furthermore, information about the circadian rhythm of BP and heart rate (HR) can be obtained and establish whether or not a patient has a fall of BP at night (i.e., “dipper” vs. non-“dipper”). The information about nocturnal BP may also allow the investigation or detection of disorders such as sleep dysfunction, nocturnal movement disorders, and obstructive sleep apnea, which are common in PD. Additionally, a 24-h ABPM should be conducted to examine the effectiveness of OH therapy. This review will outline the methodology of 24 h ABPM in PD, summarize findings of such studies in PD, and briefly consider common daily stimuli that might affect 24 h ABPM.
Parkinson's disease with autonomic failure and MSA patients had similar circadian BP patterns suggesting that autonomic dysfunction influences abnormal BP circadian patterns similarly in these disorders. The higher sensitivity and specificity in detecting OH using a systolic BP fall of >20 mmHg compared to a diastolic BP fall of >10 mmHg during the standing test supports its usefulness to assess autonomic function in MSA and PD.
Financial disclosure:The authors declare that the research was conducted in the absence of any commercial or financial relationships that could be construed as a potential conflict of interest.Funding sources for study: None
2Background: Non-motor symptoms are increasingly recognized in Parkinson's Disease (PD) and include physical as well as psychological symptoms. A psychological condition that has been well studied in PD is psychosis.Cardiovascular autonomic dysfunction in PD can include a reversed or lack of blood pressure (BP) circadian rhythm, referred to as nocturnal non-dipping. The aim of this study was to determine the relationship between 24 hr ambulatory blood pressure measurements (ABPM), e.g., absence or presence of nocturnal dipping, and psychosis scores in PD.Methods: 21 patients with Parkinson's disease underwent 24 hr ABPM using an autonomic protocol. A decrease in nocturnal mean arterial blood pressure (MAP) of less than 10% was defined as non-dipping. Patients were interviewed (including the Brief Psychiatric Rating Scale; BPRS) for the assessment of psychosis.Results: 11 patients were dippers and 10 were non-dippers. BPRS scores were higher in non-dippers who on average met the criteria for psychosis (mean non-dipper BPRS: 34.3± 7,3 vs mean dipper BPRS: 27.5 ±5,3; cut off for "mildly ill" 31). There was a correlation between BPRS scores and non-dipping, indicating that those patients who had a blunted nocturnal fall in BP were more prone to psychotic symptoms.(Pearson's Correlation = .554, p =.009).
Conclusion:These results suggest that a blunted BP rhythm in Parkinson's disease patients may possibly be associated with psychosis symptoms compared to patients whose BP decreases physiologically at night. This association warrants further investigation.3
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