Impairment of cerebral hemodynamic response to the cold pressor test in patients with Parkinson's disease

Tsai, Shih Jei; Chen, Shiuan Chih; Leu, T.-M.; Chen, Chiu Mei; Chou, H.; Peng, Hsien Yu; Liao, Jiuan Miaw; Lin, Tzu‐Hao

doi:10.1016/j.parkreldis.2008.03.007

Cited by 17 publications

(15 citation statements)

References 52 publications

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“…Our findings of altered CVR and lower cBFV agree with more recent studies that used TCD to analyze cerebral hemodynamics in PD patients [ 23 , 24 ]. Vokatch et al [ 11 ] used TCD and thigh cuffs to assess CA and found striking differences in mBFV between controls and PD patients, especially after a reduction in blood pressure, providing strong evidence of impaired CA in patients with this disorder.…”

Section: Discussionsupporting

confidence: 92%

Abnormal Cerebrovascular Reactivity in Patients with Parkinson’s Disease

Camargo

Martins

Lange

et al. 2015

Parkinson's Disease

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Background. Orthostatic hypotension (OH) is an important nonmotor manifestation of Parkinson's disease (PD). Changes in cerebrovascular reactivity may contribute to this manifestation and can be monitored using transcranial Doppler. Objective. To identify possible changes in cerebrovascular reactivity in patients with OH. Methods. Twenty-two individuals were selected and divided into three groups: with and without OH and controls. Transcranial Doppler was used to assess basal mean blood flow velocity, postapnea mean blood flow velocity, percentage increase in mean blood flow velocity, and cerebrovascular reactivity as measured by the breath-holding index. Results. PD patients had lower values of basal velocity (p = 0.019), postapnea velocity (p = 0.0015), percentage increase in velocity (p = 0.039), and breath-holding index (p = 0.04) than the controls. Patients with OH had higher values of basal velocity (p = 0.09) and postapnea velocity (p = 0.19) but lower values of percentage increase in velocity (p = 0.22) and breath-holding index (p = 0.32) than patients without OH. Conclusions. PD patients present with abnormalities in a compensatory mechanism that regulates cerebral blood flow. OH could be an indicator of these abnormalities.

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Section: Discussionsupporting

confidence: 92%

Abnormal Cerebrovascular Reactivity in Patients with Parkinson’s Disease

Camargo

Martins

Lange

et al. 2015

Parkinson's Disease

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“…To evaluate dysautonomia, vasomotor reactivity, and cerebral haemodynamics in parkinsonian patients, TCD is usually used in combination with one of the standardised methods applied to activate the sympathetic adrenergic innervation system. These methods include the tilt-table test [37], head-up tilt test [38], thigh cuff release test [39], carbon dioxide test [8], Diamox injection [40], or the cold pressure test (CPT) [41, 42]. These techniques make it possible to identify even asymptomatic OH patients.…”

Section: Resultsmentioning

confidence: 99%

Orthostatic Hypotension in Patients with Parkinson’s Disease and Atypical Parkinsonism

Fereshtehnejad

Lökk

2014

Parkinson's Disease

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Orthostatic hypotension (OH) is one of the commonly occurring nonmotor symptoms in patients with idiopathic Parkinson's disease (IPD) and atypical parkinsonism (AP). We aimed to review current evidences on epidemiology, diagnosis, treatment, and prognosis of OH in patients with IPD and AP. Major electronic medical databases were assessed including PubMed/MEDLINE and Embase up to February 2013. English-written original or review articles with keywords such as “Parkinson's disease,” “atypical parkinsonism,” and “orthostatic hypotension” were searched for relevant evidences. We addressed different issues such as OH definition, epidemiologic characteristics, pathophysiology, testing and diagnosis, risk factors for symptomatic OH, OH as an early sign of IPD, prognosis, and treatment options of OH in parkinsonian syndromes. Symptomatic OH is present in up to 30% of IPD, 80% of multiple system atrophy (MSA), and 27% of other AP patients. OH may herald the onset of PD before cardinal motor symptoms and our review emphasises the importance of its timely diagnosis (even as one preclinical marker) and multifactorial treatment, starting with patient education and lifestyle approach. Advancing age, male sex, disease severity, and duration and subtype of motor symptoms are predisposing factors. OH increases the risk of falls, which affects the quality of life in PD patients.

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“…pain receptors), which can potentially increase ventilation (Duranti et al 1991), leading to a reduction in P ET,CO 2 , and thus CBF (Kety & Schmidt, 1948). Although some studies using the CPT demonstrated either no changes in ventilation and/or P ET,CO 2 (Thomsen et al 1995;Zvan et al 1998;Oblak et al 2002;Tsai et al 2009;Hartwich et al 2010;Vianna et al 2012;Perry et al 2016), other investigations reported increases in ventilation and/or reductions in P ET,CO 2 during CPT (Oblak et al 2002;Wirch et al 2006;Solaiman et al 2014;Perry et al 2016). The disparity between these investigations could be attributable to differences in methodology, as there is little agreement concerning both the length and the severity (i.e.…”

Section: Effect Of Cold Pressor Test On Cardiovascular and Respiratormentioning

confidence: 99%

“…temperature) of the CPT. For example, most of the CPT investigations that report no change in ventilation and/or P ET,CO 2 used a CPT stimulus in between 1 and 2 min and reported use of a wide temperature range of 0-4°C (Thomsen et al 1995;Tsai et al 2009;Hartwich et al 2010;Vianna et al 2012).…”

Section: Effect Of Cold Pressor Test On Cardiovascular and Respiratormentioning

confidence: 99%

Cerebrovascular response to the cold pressor test – the critical role of carbon dioxide

Tymko

Kerstens

Wildfong

et al. 2017

Experimental Physiology

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What is the central question of this study? What is the role of carbon dioxide in the cerebral blood flow (CBF) response to the cold pressor test (CPT)? What is the main finding and its importance? The CBF response was elevated during the isocapnic (controlled CO ) CPT in the middle cerebral artery and the internal carotid artery compared with the poikilocapnic (uncontrolled CO ) CPT, owing to ventilation-associated reductions in end-tidal CO . Furthermore, the common carotid artery vasodilated to a greater extent during the isocapnic compared with the poikilocapnic CPT, whereas the internal carotid artery vasoconstricted during both CPTs. Our data highlight the importance of CO control when investigating the CBF response to the CPT. In addition to increasing sympathetic nervous activity, blood pressure and cerebral blood flow (CBF), the cold pressor test (CPT) stimulates pain receptors, which may increase ventilation above metabolic demand; this response is likely to reduce the partial pressure of end-tidal carbon dioxide (P ET ,CO2) and will attenuate elevations in CBF. Our hypotheses were as follows: (i) the CPT will elicit hyperventilation, effectively lowering P ET ,CO2; (ii) the CBF response will be elevated during an isocapnic (controlled P ET ,CO2) compared with a poikilocapnic CPT (uncontrolled P ET ,CO2); and (iii) in response to the CPT, the common carotid artery (CCA) will vasodilate, while the internal carotid artery (ICA) will remain unchanged to help regulate CBF. Using a new, randomized experimental design, we measured the cerebrovascular response in the middle cerebral artery (MCA), CCA and internal carotid artery (ICA), during an isocapnic and poikilocapnic CPT in 15 participants. Blood pressure and cardiac output (finger photoplethysmography), heart rate (ECG), MCA mean velocity (transcranial Doppler ultrasound) and CCA and ICA CBF (Duplex ultrasound) were recorded during both CPT trials. Our findings were as follows: (i) ventilation increased, which reduced P ET ,CO2 (-5.3 ± 6.4 mmHg) during the poikilocapnic compared with the isocapnic CPT; (ii) the CBF response was elevated during the isocapnic compared with the poikilocapnic CPT in the MCA and ICA, but not in the CCA; and (iii) the CCA dilated to a greater extent during the isocapnic compared with the poikilocapnic CPT, and the ICA vasoconstricted during both trials. Our data emphasize the importance of P ET ,CO2 control in the CBF response to the CPT and in the differential vasomotor regulation between the CCA and ICA.

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Impairment of cerebral hemodynamic response to the cold pressor test in patients with Parkinson's disease

Cited by 17 publications

References 52 publications

Abnormal Cerebrovascular Reactivity in Patients with Parkinson’s Disease

Abnormal Cerebrovascular Reactivity in Patients with Parkinson’s Disease

Orthostatic Hypotension in Patients with Parkinson’s Disease and Atypical Parkinsonism

Cerebrovascular response to the cold pressor test – the critical role of carbon dioxide

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