Prevalence of orthostatic hypotension in Parkinson's disease

Senard, Jean‐Michel; Rai, Saurabh; Lapeyre‐Mestre, Maryse; Brefel, Christine; Rascol, O.; Rascol, A; Montastruc, Jean‐Louis

doi:10.1136/jnnp.63.5.584

Cited by 321 publications

(226 citation statements)

References 31 publications

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“…To the best of our knowledge, prior studies have focused on group comparisons ,ofter reaching contradictory results [1,3,16,20,21,25,28,29,32,33,35]. It should be noted that, even if a significant statistical difference associated to a certain feature is consistently revealed across several studies, this is not sufficient to demonstrate its potential application to the clinical necessity of single-subject characterization.…”

Section: Discussionmentioning

confidence: 78%

“…Previous studies have reported a variable prevalence of cardiovascular autonomic dysfunction in PD, ranging from 23% to 80% as determined by studies which included cohorts of between 20 and 91 patients [3, 29,35]. Within these reports, conflicting evidence exists about the extent and characteristics of PD-related aberrations in cardiovascular control.…”

Section: Introductionmentioning

confidence: 89%

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Assessment of spontaneous cardiovascular oscillations in Parkinson's disease

Valenza

Orsolini

Diciotti

et al. 2016

Biomedical Signal Processing and Control

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Parki so 's disease PD has ee reported to i ol e postga glio i s patheti failure and a wide spectrum of autonomic dysfunctions including cadiovascular, sexual, bladder, gastrointestinal and sudo-motor abnormalities. While these symptoms may have a significant impact on daily activities, as well as quality of life, the evaluation of autonomic nervous system (ANS) dysfunctions relies on a large and expensive battery of autonomic tests only accessible in highly specialized laboratories. In this paper we aim to devise a comprehensive computational assessment of disease-related heartbeat dynamics based on instantaneous, time-varying estimates of spontaneous (resting state) cardiovascular oscillations in PD. To this end, we combine standard ANS-related heart rate variability (HRV) metrics with measures of instantaneous complexity (dominant Lyapunov exponent and entropy) and higher-order statistics (bispectra). Such measures are computed over 600-s recordings acquired at rest in 29 healthy subjects and 30 PD patients. The only significant group-wise differences were found in the variability of the dominant Lyapunov exponent. Also, the best PD vs. healthy controls classification performance (balanced accuracy: 73.47%) was achieved only when retaining the time-varying, non-stationary structure of the dynamical features, whereas classification performance dropped significantly (balanced accuracy: 61.91%) when excluding variability-related features. Additionally, both linear and nonlinear model features correlated with both clinical and neuropsychological assessments of the considered patient population.Our results demonstrate the added value and potential of instantaneous measures of heartbeat dynamics and its variability in characterizing PD-related disabilities in motor and cognitive domains.3

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Section: Discussionmentioning

confidence: 78%

Section: Introductionmentioning

confidence: 89%

Assessment of spontaneous cardiovascular oscillations in Parkinson's disease

Valenza

Orsolini

Diciotti

et al. 2016

Biomedical Signal Processing and Control

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“…Familial amyloidotic polyneuropathy constitutes an example of a secondary form. Neurogenic orthostatic hypotension also occurs in pure autonomic failure (formerly called Bradbury-Eggleston syndrome) (8), idiopathic orthostatic hypotension (28,85), or asympathicotonic hypotension (78), autoimmune autonomic failure (22,26), familial dysautonomia (112), diabetic autonomic neuropathy (37), amyloidosis in the setting of multiple myeloma (57,58), Parkinson's disease (PD) (29,68,91,92), and probably several other conditions.…”

Section: History Of L-dops Developmentmentioning

confidence: 99%

L‐Dihydroxyphenylserine (L‐DOPS): A Norepinephrine Prodrug

Goldstein

2006

Cardiovascular Drug Reviews

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L-threo-3,4-dihydroxyphenylserine (L-DOPS, droxydopa) is a synthetic catecholamino acid. When taken orally, L-DOPS is converted to the sympathetic neurotransmitter, norepinephrine (NE), via decarboxylation catalyzed by L-aromatic-amino-acid decarboxylase (LAAAD). Plasma L-DOPS levels peak at about 3 h, followed by a monoexponential decline with a half-time of 2 to 3 h. Plasma levels of NE and of its main neuronal metabolite, dihydroxyphenylglycol (DHPG) peak approximately concurrently but at much lower concentrations. The relatively long half-time for disappearance of L-DOPS from plasma, compared to that of NE, explains their very different attained plasma concentrations. In patients with neurogenic orthostatic hypotension, L-DOPS increases blood pressure and ameliorates orthostatic intolerance. Inhibition of LAAAD, such as by treatment with carbidopa, which does not penetrate the blood-brain barrier, prevents the blood pressure effects of the drug, indicating that L-DOPS increases blood pressure by augmenting NE production outside the brain. Patients with pure autonomic failure (which usually entails loss of sympathetic noradrenergic nerves), and patients with multiple system atrophy (in which noradrenergic innervation remains intact) have similar plasma NE responses to L-DOPS. This suggests mainly non-neuronal production of NE from L-DOPS. L-DOPS is very effective in treatment of deficiency of dopamine-beta-hydroxylase (DBH), the enzyme required for conversion of dopamine to NE in sympathetic nerves. L-DOPS holds promise for treating other much more common conditions involving decreased DBH activity or NE deficiency, such as a variety of syndromes associated with neurogenic orthostatic hypotension.

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“…H ypotension during orthostasis 1-3 is a common finding 4,5 in the advanced phases of Parkinson's disease. It leads to additional disabling symptoms and may worsen movement capability and increase the number of falls, thus further impairing a patient's self-sufficiency.…”

mentioning

confidence: 99%

Early Abnormalities of Vascular and Cardiac Autonomic Control in Parkinson’s Disease Without Orthostatic Hypotension

et al. 2007

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Abstract-Cardiac autonomic abnormalities have been described in Parkinson's disease. Little is known about possible alterations of vascular sympathetic regulatory activity in patients without orthostatic hypotension or symptoms of orthostatic intolerance. Nineteen patients with Parkinson's disease without orthostatic hypotension (PD), 21 with orthostatic hypotension (PDOH), and 20 healthy controls underwent ECG, beat-to-beat arterial pressure, and respiration recordings while recumbent and during a 75°head-up tilt. Spectrum analysis of RR interval and systolic arterial pressure (SAP) variability provided indices of cardiac sympathovagal interaction (low frequency [LF]/high frequency [HF]) to the sinoatrial node and sympathetic vasomotor control (LF SAP ). Arterial baroreceptor mechanisms were assessed by the spontaneous sequences technique and bivariate spectrum analysis (␣ index). Plasma catecholamines provided the neurohormonal profile. At rest, hemodynamics and spectral markers of autonomic function were similar in PD and control subjects. Norepinephrine was lower in PD and PDOH than in control subjects. In PDOH, SAP was higher, whereas LF/HF ratio and LF SAP were lower compared with control subjects. During tilt, SAP was unchanged in PD; however, similar to PDOH, the increase of heart rate, LF/HF ratio, and LF SAP was blunted compared with control subjects. Baroreflex indices were unmodified in PD and PDOH compared with control subjects. Initial alterations in both cardiac and vascular sympathetic modulatory activity were found in PD and revealed by a gravitational stimulus. Prompt recognition of sympathetic abnormalities might result in earlier therapeutic intervention, reduced orthostatic intolerance, and increased quality of life.

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Prevalence of orthostatic hypotension in Parkinson's disease

Cited by 321 publications

References 31 publications

Assessment of spontaneous cardiovascular oscillations in Parkinson's disease

Assessment of spontaneous cardiovascular oscillations in Parkinson's disease

L‐Dihydroxyphenylserine (L‐DOPS): A Norepinephrine Prodrug

Early Abnormalities of Vascular and Cardiac Autonomic Control in Parkinson’s Disease Without Orthostatic Hypotension

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