Loss of nocturnal blood pressure fall in various extrapyramidal syndromes

Objective: Cognitive impairment and neurocirculatory abnormalities such as orthostatic hypotension (OH), supine hypertension (SH), and failure to decrease blood pressure at night (nondipping) occur relatively commonly in Parkinson disease (PD); however, whether cognitive dysfunction in early PD is related to neurocirculatory abnormalities has not been established. Cognitive dysfunction in PD is associated with white matter hyperintensities on MRI. We report results of an analysis of neuropsychological and hemodynamic parameters in patients with early PD.Methods: Among 87 patients, 25 had normal cognition, 48 had mild cognitive impairment, and 14 had dementia, based on comprehensive neuropsychological tests. Orthostatic vital signs and ambulatory 24-hour blood pressure monitoring were recorded, and brain magnetic resonance scans were obtained for all patients. Results:Cognitive impairment was associated with OH, SH, and white matter hyperintensities but not with nondipping. Dementia and white matter hyperintensities were common in SH. Of 13 patients with OH ϩ SH, every one had mild cognitive impairment or dementia. Conclusions:Cognitive dysfunction is related to neurocirculatory abnormalities, especially OH ϩ SH, in early PD, raising the possibility that early detection and effective treatment of those abnormalities might slow the rate of cognitive decline. Neurology It is increasingly being recognized that Parkinson disease (PD) involves prominent nonmotor manifestations such as dementia and autonomic failure.A variety of neurocirculatory abnormalities have been noted in PD, including orthostatic hypotension (OH), 1-4 supine hypertension (SH), 5-7 labile blood pressure, and the absence of a decrease in pressure during the night, a phenomenon called nondipping. 8 These abnormalities are related to each other. SH is found in a substantial proportion of patients with PD with OH.

show abstract

“…8 These abnormalities are related to each other. SH is found in a substantial proportion of patients with PD with OH.…”

mentioning

confidence: 97%

Association of cognitive dysfunction with neurocirculatory abnormalities in early Parkinson disease

et al. 2012

View full text Add to dashboard Cite

show abstract

“…6-8 Many patients with autonomic failure have both OH and a nondipping BP pattern. 10 Circadian patterns of BP have not been well studied among individuals with OH. Moreover, there is little data relating postural BP changes to nocturnal BP changes.…”

mentioning

confidence: 99%

Orthostatic Hypotension Is Associated With Nocturnal Change in Systolic Blood Pressure

Voichanski

Grossman

Leibowitz

et al. 2012

American Journal of Hypertension

View full text Add to dashboard Cite

159original contributions nature publishing group Ambulatory blood pressure monitoring (ABPM) in normotensive and hypertensive subjects demonstrates a dipping blood pressure (BP) circadian pattern with a 10% decrease in BP readings at night. Some patients demonstrate a decrease of less than 10% (nondipping) or even an increase in BP at night (reverse-dipping). 1 A nondipping pattern is observed in elderly, diabetics, patients with sleep apnea syndrome, patients with metabolic syndrome, in patients with several forms of secondary hypertension and is associated with increased cardiovascular (CV) morbidity and mortality. 2-4 Orthostatic hypotension (OH) is defined as a decline of at least 20 mm Hg in systolic BP, and/or 10 mm Hg in diastolic BP, when changing from the recumbent to an upright position. 5 The incidence of OH increases with age and is common in individuals with peripheral neuropathy and autonomic failure.The association between OH and CV morbidity and mortality is controversial. 6-9 Weiss et al. failed to show increased mortality in elderly patients with OH, 9 whereas several other studies have shown that OH is associated with CV morbidity and mortality. 6-8 Many patients with autonomic failure have both OH and a nondipping BP pattern. 10 Circadian patterns of BP have not been well studied among individuals with OH. Moreover, there is little data relating postural BP changes to nocturnal BP changes. We hypothesized that the changes in BP during upright posture may contribute to the circadian pattern of BP. Therefore, we designed this prospective study to evaluate whether OH is associated with an abnormal dipping BP pattern, and whether nocturnal changes in BP levels are related to postural BP changes. MethodsThis was a prospective study that included 185 consecutive hypertensive patients, who were referred for 24-h ABPM at the Chaim Sheba Medical Center's hypertension unit either to confirm the diagnosis of hypertension before treatment, or to assess BP control. Participants were included in the study if they were able to lie down for 5 min and stand up for 3 min without any external support. Patients with sleep apnea di agnosed in a sleep laboratory, and patients with documentedThe first two authors contributed equally to this study and are co-first authors of this manuscript.

show abstract

“…They also found that all of the PD patients had postprandial hypotension and nocturnal hypertension. Schmidt et al observed a similar pathological nocturnal blood pressure regulation [55]. Usually, the mean arterial pressure decreases by 10%-20% during sleep, compared to the waking time.…”

Section: Autonomic System Dysfunctionsmentioning

confidence: 81%

A New Perspective for Parkinson’s Disease: Circadian Rhythm

Wang

et al. 2016

Neurosci. Bull.

View full text Add to dashboard Cite

Circadian rhythm is manifested by the behavioral and physiological changes from day to night, which is controlled by the pacemaker and its regulator. The former is located at the suprachiasmatic nuclei (SCN) in the anterior hypothalamus, while the latter is composed of clock genes present in all tissues. Circadian desynchronization influences normal patterns of day-night rhythms such as sleep and alertness cycles, rest and activity cycles. Parkinson's disease (PD) exhibits diurnal fluctuations. Circadian dysfunction has been observed in PD patients and animal models, which may result in negative consequences to the homeostasis and even exacerbate the disease progression. Therefore, circadian therapies, including light stimulation, physical activity, dietary and social schedules, may be helpful for PD patients. However, the cellular and molecular mechanisms that underlie the circadian dysfunction in PD remain elusive. Further research on circadian patterns is needed. This article summarizes the existing research on the circadian rhythms in PD, focusing on the clinical symptom variations, molecular changes, as well as the available treatment options.

show abstract

Loss of nocturnal blood pressure fall in various extrapyramidal syndromes

Cited by 100 publications

References 26 publications

Association of cognitive dysfunction with neurocirculatory abnormalities in early Parkinson disease

Association of cognitive dysfunction with neurocirculatory abnormalities in early Parkinson disease

Orthostatic Hypotension Is Associated With Nocturnal Change in Systolic Blood Pressure

A New Perspective for Parkinson’s Disease: Circadian Rhythm

Contact Info

Product

Resources

About