Sudomotor and Cardiovascular Dysfunction in Patients with Early Untreated Parkinson's Disease

Abstract

BACKGROUND: According to Braak staging of Parkinson's disease (PD), detection of autonomic dysfunction would help with early diagnosis of PD. OBJECTIVE: To determine whether the autonomic nervous system is involved in the early stage of PD, we evaluated cardiovascular and sudomotor function in early untreated PD patients. METHODS: Orthostatic blood pressure regulation, heart rate variability, skin vasomotor function, and palmar sympathetic sweat responses were examined in 50 early untreated PD patients and 20 healthy control subjects. RESULTS: The mean decrease in systolic blood pressure during head-up tilt in PD patients was mildly but significantly larger than in controls (p = 0.0001). There were no differences between the 2 groups in heart rate variability, with analysis of low frequency (LF; mediated by baroreflex feedback), and high frequency (HF; mainly reflecting parasympathetic vagal) modulation. However, LF/HF, an index of sympatho-parasympathetic balance, was lower in the PD group than in controls (p = 0.02). Amplitudes of palmar sweat responses to deep inspiration (p = 0.004), mental arithmetic (p = 0.01), and exercise (p = 0.01) in PD patients were lower than in controls, with negative correlations with motor severity. Amplitudes of palmar skin vasomotor reflexes in PD patients did not differ from controls. CONCLUSIONS: Our study indicates impairment of sympathetic cardiovascular and sudomotor function with orthostatic dysregulation of blood pressure control, reduced LF/HF and reduction in palm sweat responses even in early untreated PD patients.

Heart rate variability in leucine‐rich repeat kinase 2‐associated Parkinson's disease

“…The proposed early involvement of postganglionic cardiac autonomic nerves in PD, and the simplicity of assessing HRV, suggests potential value as a screening tool for prodromal PD. Several studies have demonstrated reduced HRV in early PD . Furthermore, we and others have described significantly reduced HRV in idiopathic rapid eye movement (REM) sleep behavior disorder .…”

“…Several studies have demonstrated reduced HRV in early PD. 14,15 Furthermore, we and others have described significantly reduced HRV in idiopathic rapid eye movement (REM) sleep behavior disorder. 16,17 Finally, a large prospective cohort study found decreased time domain HRV measures were associated with an increased risk of PD.…”

Heart Rate Variability Analyses in Parkinson’s Disease: A Systematic Review and Meta-Analysis

“…HFms 2 . HFms 2 was reported in 24 studies [18,[20][21][22][23][24][26][27][28][29][30]35,36,39,40,45,47,48,[54][55][56]59,63,64]. The mean HFms 2 was 145.2 ± 41.1 ms 2 in PD patients and 219.4 ± 48.8 ms 2 in the healthy control group.…”

Lower Urinary Tract and Gastrointestinal Dysfunction Are Common in Early Parkinson’s Disease

“…However, studies in patients with early PD are scarce, and the majority of studies that have investigated dysautonomias have focused on gastrointestinal and cardiovascular symptoms. Most studies report gastrointestinal symptoms as the most common dysautonomia, and it is well known that constipation typically presents before the onset of motor symptoms [ 14 , 15 ]. Urinary symptoms were more prevalent and frequent in our cohort.…”