Cardiovascular autonomic function and MCI in Parkinson's disease

Cicero, Calogero Edoardo; Raciti, Loredana; Monastero, Roberto; Mostile, Giovanni; Donzuso, Giulia; Sciacca, Giorgia; Luca, Antonina; Terravecchia, Claudio; Giuliano, Loretta; Baschi, Roberta; Davi, Maria; Zappia, Mario

doi:10.1016/j.parkreldis.2019.10.023

Cited by 12 publications

(11 citation statements)

References 17 publications

(21 reference statements)

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“…The symptoms of OH are mainly caused by insufficient perfusion of target organs [ 12 , 13 ]. For example, patients with cerebral hypoperfusion may show light-headedness, dizziness, vision loss, pre-syncope, or even syncope [ 14 - 16 ], whereas, patients with hypoperfusion within lung area may result in “coat hanger” pain or orthostatic dyspnea [ 17 , 18 ]. Notably, sometimes OH is asymptomatic and is often ignored by clinical doctors.…”

Section: Orthostatic Hypotensionmentioning

confidence: 99%

The Pathogenesis and Treatment of Cardiovascular Autonomic Dysfunction in Parkinson’s Disease: What We Know and Where to Go

Zhu

et al. 2021

Aging and disease

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Cardiovascular autonomic dysfunctions (CAD) are prevalent in Parkinson’s disease (PD). It contributes to the development of cognitive dysfunction, falls and even mortality. Significant progress has been achieved in the last decade. However, the underlying mechanisms and effective treatments for CAD have not been established yet. This review aims to help clinicians to better understand the pathogenesis and therapeutic strategies. The literatures about CAD in patients with PD were reviewed. References for this review were identified by searches of PubMed between 1972 and March 2021, with the search term “cardiovascular autonomic dysfunctions, postural hypotension, orthostatic hypotension (OH), supine hypertension (SH), postprandial hypotension, and nondipping”. The pathogenesis, including the neurogenic and non-neurogenic mechanisms, and the current pharmaceutical and non-pharmaceutical treatment for CAD, were analyzed. CAD mainly includes four aspects, which are OH, SH, postprandial hypotension and nondipping, among them, OH is the main component. Both non-neurogenic and neurogenic mechanisms are involved in CAD. Failure of the baroreflex circulate, which includes the lesions at the afferent, efferent or central components, is an important pathogenesis of CAD. Both non-pharmacological and pharmacological treatment alleviate CAD-related symptoms by acting on the baroreflex reflex circulate. However, pharmacological strategy has the limitation of failing to enhance baroreflex sensitivity and life quality. Novel OH treatment drugs, such as pyridostigmine and atomoxetine, can effectively improve OH-related symptoms via enhancing residual sympathetic tone, without adverse reactions of supine hypertension. Baroreflex impairment is a crucial pathological mechanism associated with CAD in PD. Currently, non-pharmacological strategy was the preferred option for its advantage of enhancing baroreflex sensitivity. Pharmacological treatment is a second-line option. Therefore, to find drugs that can enhance baroreflex sensitivity, especially via acting on its central components, is urgently needed in the scientific research and clinical practice.

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Section: Orthostatic Hypotensionmentioning

confidence: 99%

The Pathogenesis and Treatment of Cardiovascular Autonomic Dysfunction in Parkinson’s Disease: What We Know and Where to Go

Zhu

et al. 2021

Aging and disease

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“…Cicero et al [4] examined the correlation between cardiovascular autonomic function and MCI among 185 PD patients from two Movement Disorders centres. Orthostatic hypotension was recorded in 52 of them, significantly more frequently in patients with long disease duration, and was associated with amnestic MCI.…”

Section: Orthostatic Hypotensionmentioning

confidence: 99%

“…It is neurogenic, regarding the pathophysiology of PD and both peripheral and central denervation, but also influenced by treatment, as almost all dopaminergic medications (levodopa, dopamine agonists) can decrease BP [3]. Dysautonomia and Parkinson's Disease-related dementia (PDD) are the most disabling non-motor symptoms resulting in short life expectancy and nursing home placement [4].…”

Section: Introductionmentioning

confidence: 99%

Cardiovascular dysautonomia and cognition in Parkinson’s Disease — a possible relationship

Kwaśniak-Butowska

Dulski

Pierzchlińska

et al. 2021

Neurol Neurochir Pol.

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Dementia in advanced Parkinson's Disease (PD) is a fatal milestone resulting in reduced life expectancy and nursing home placement. Cognitive impairment and cardiovascular dysautonomia are common and debilitating non-motor symptoms that frequently coexist in PD since the early stages and progress in subsequent years.In particular, blood pressure (BP) abnormalities, including orthostatic hypotension (OH), supine hypertension (SH) and the loss of nocturnal BP fall (non-dipping) in PD have been associated with cognitive deterioration. They usually have multifactorial aetiology, including neuronal (central and peripheral) mechanisms and concomitant intake of medications. BP abnormalities can influence cognition in many ways, including repeated cerebral hypoperfusion leading to cerebral ischaemic lesions, higher burden of white matter hyperintensities, and possible impact on neurodegenerative process in PD. They are often asymptomatic and remain unrecognised, hence 24-hour ambulatory BP monitoring is recommended in patients with clinical symptoms of dysautonomia. Management is challenging and should address the multifactorial nature of BP disturbances. The aim of this review was to present the state of current knowledge regarding the possible relationship between cardiovascular dysautonomia and cognition in PD, its diagnosis and treatment.

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“…However, over the time, these structural changes predispose to different pathologies, including microatheroma, microinfarcts, microbleeds, lacunae, atherosclerosis, resulting in WMLs [33]. Moreover, it has been reported that patients suffering from hypertension, frequently experience orthostatic hypotension, the latter in turn associated with both cognitive decline [34,35] and cerebral hypoperfusion [36].…”

Section: Vrfs and Wmls And The Risk Of Pddmentioning

confidence: 99%

Vascular risk factors, white matter lesions and cognitive impairment in Parkinson’s disease: the PACOS longitudinal study

et al. 2020

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Background Vascular risk factors (VRFs) may be associated with cognitive decline in early Parkinson's disease (PD) but results are inconclusive. The identification of modifiable risk factors is relevant for prevention and treatment. Methods Parkinson's disease (PD) patients of the PACOS cohort who underwent a baseline and follow-up neuropsychological evaluation were enrolled in the study. PD with Mild Cognitive Impairment (MCI) and dementia (PDD) were diagnosed according to the MDS criteria. A Baseline 1.5 T brain MRI was used to calculate the white matter lesions (WMLs) burden using the Wahlund visual scale. Laboratory data, presence of hypertension, diabetes and use of anti-hypertensive drugs were collected and the Framingham Risk (FR) score was calculated. VRFs predicting PD-MCI and PDD were evaluated using Cox proportional hazard regression model. Results Out of 139 enrolled patients, 84 (60.4%) were classified as normal cognition (NC) and 55 (39.6%) as MCI at baseline. At follow-up 28 (33.3%) PD-NC developed MCI and 4 (4.8%) PDD (follow-up time 23.5 ± 10.3 months). Out of 55 PD-MCI patients at baseline, 14 (25.4%) converted to PDD. At multivariate analysis among PD-NC a systolic blood pressure (SBP) > 140 mmHg was the stronger predictor of MCI (adjHR 4.04; 95% CI 1.41-11.3) while the presence of MCI at baseline (adj HR 7.55; 95% CI 1.76-32.3) and a severe WMLs burden (adj HR 2.80; 95% CI 0.86-9.04) were the strongest predictors of PDD, even if this latter association has a trend towards significance. Conclusion Hypertension represents the most important modifiable risk factor for PD-MCI in the PACOS cohort, increasing the risk of about four times.

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Cardiovascular autonomic function and MCI in Parkinson's disease

Cited by 12 publications

References 17 publications

The Pathogenesis and Treatment of Cardiovascular Autonomic Dysfunction in Parkinson’s Disease: What We Know and Where to Go

The Pathogenesis and Treatment of Cardiovascular Autonomic Dysfunction in Parkinson’s Disease: What We Know and Where to Go

Cardiovascular dysautonomia and cognition in Parkinson’s Disease — a possible relationship

Vascular risk factors, white matter lesions and cognitive impairment in Parkinson’s disease: the PACOS longitudinal study

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