Non-dipping nocturnal blood pressure and psychosis parameters in Parkinson disease

Abstract

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

Circadian Variation of Blood Pressure in Patients with Chronic Musculoskeletal Pain: A Cross-Sectional Study

“…BP disturbances are associated with cardiovascular and renal conditions, including high risk of terminal-organ injury, particularly to the heart (left ventricular hypertrophy, CHF, and myocardial infarct), brain (stroke), and kidney (albuminuria and progression to end-stage renal failure) [ 18 ]. The majority of previous studies which analyzed BPI in the aforementioned pathologies showed participants to have non-dipper BPI values [ 41 , 42 ]; however, our results showed the BPI values of the group (presenting with different chronic conditions) to be even inverse-dippers (see Figure 1 ). These even higher blood pressure values at night, significantly more present in women than in men, did not show any hypoalgesia effect in both men and women, which means that our patient group suffering from chronic pain does not react with any pain killing mechanism caused by higher blood pressure in other populations.…”

Blood Pressure Patterns in Patients with Parkinson’s Disease: A Systematic Review

“…The pathological nocturnal profiles are reverse dipping, reduced dipping, and extreme dipping, described in 477 (40.46% of the patients evaluated for this), 310 (35.67%) and 23 (5.1%) subjects, respectively. In one study, PD patients with reduced dipping were more prone to psychotic symptoms [35], but not to depression [34]. Those with reverse dipping had more severe non-motor manifestations such as cognitive decline [16][17][18]24], anxiety [16,17] and autonomic symptoms [16,17,23,39].…”

Altered sleep and neurovascular dysfunction in alpha-synucleinopathies: the perfect storm for glymphatic failure

“…The abnormalities in the circadian rhythm of BP in PD have been described decades ago ( Senard et al, 1992 ) and, more recently, Tanaka et al (2018) found that the nocturnal riser profile was cross-sectionally associated with the presence of dementia (odds ratio 11.6), while the physiological dipper pattern (a reduction in nighttime BP greater than 10% with respect to daytime BP) was almost inexistent in the demented group (<4%). Similarly, non-dipper PD patients also show higher degree of psychotic symptoms ( Stuebner et al, 2015 ). Non-dipping and riser profiles seem independent of age, gender, disease duration, age at onset, the severity of the disease, the use of anti-PD drugs and vitamin D level ( Arici Duz and Helvaci Yilmaz, 2020 ).…”