Sympathetic outflow to skin predicts central autonomic dysfunction in multiple system atrophy

Shindo, Kazumasa; Fukao, Toko; Kurita, Naofumi; Satake, Akane; Tsuchiya, Mai; Ichinose, Yuichi; Hata, Takanori; Koh, Kishin; Nagasaka, Takamura; Takiyama, Yoshihisa

doi:10.1007/s10072-020-04340-6

Cited by 5 publications

(4 citation statements)

References 27 publications

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“…Previous studies have shown that severe dysautonomia, early occurrence of autonomic failure, and OH predicted the poor prognosis of MSA (Coon et al, 2015;Low et al, 2015;Cao et al, 2018), which supports our findings because CHS is caused by disturbed neurovascular thermoregulation of distal extremities and also belongs to autonomic features of MSA. Furthermore, pathophysiological studies have indicated that cutaneous sympathetic vasoconstrictor activity is compromised in patients with MSA, which might be attributable to the skin vasomotor center in the medulla oblongata and hypothalamus (Mano et al, 2006;Shindo et al, 2020). In addition, prolonged vasoconstriction of the cutaneous vessels could cause CHS in patients with MSA and impaired peripheral autonomic function (Shindo et al, 2017).…”

Section: Discussionmentioning

confidence: 99%

“…In addition, prolonged vasoconstriction of the cutaneous vessels could cause CHS in patients with MSA and impaired peripheral autonomic function (Shindo et al, 2017). Therefore, both pre-and postganglionic skin vasomotor dysfunction may contribute to CHS related to the impaired peripheral circulatory pathway (Mano et al, 2006;Shindo et al, 2017Shindo et al, , 2020.…”

Section: Discussionmentioning

confidence: 99%

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The Cold Hand Sign in Multiple System Atrophy: Frequency-Associated Factors and Its Impact on Survival

Cao

Liang

Zhang

et al. 2021

Front. Aging Neurosci.

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Background: Few studies have focused on the cold hand sign (CHS), a red flag symptom, in multiple system atrophy (MSA).Objective: This study aimed to investigate the frequency and correlative factors of CHS in patients with MSA and the impact of its early occurrence on the survival of these patients.Methods: A total of 483 patients with MSA were enrolled in this study, and the motor and non-motor symptoms between patients with MSA with and without CHS were compared. Moreover, patients with disease duration ≤ 3 years at baseline were followed, and the association between CHS and survival of patients with MSA was examined.Results: The frequencies of CHS in patients with MSA were 20, 15.4, and 25.3% in MSA, MSA-parkinsonian subtype (MSA-P), and MSA-cerebellar subtype (MSA-C), respectively. Higher Unified Multiple System Atrophy Rating Scale (UMSARS) scores and higher Non-Motor Symptom Scale (NMSS) scores at baseline were associated with CHS in MSA. CHS was associated with shorter survival after adjusting for baseline diagnosis subtype, age at onset, sex, orthostatic hypotension, disease duration, autonomic onset, UMSARS total score, and NMSS score (p = 0.001; HR = 3.701; 95% CI = 1.765–7.760).Conclusion: CHS is not rare in patients with MSA. Greater disease severity and more severe non-motor symptoms were associated with CHS in patients with MSA. Patients with early occurrence of CHS had a poor prognosis.

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Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

The Cold Hand Sign in Multiple System Atrophy: Frequency-Associated Factors and Its Impact on Survival

Cao

Liang

Zhang

et al. 2021

Front. Aging Neurosci.

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“…ПЭТ с использованием 18 F-ФДГ может быть достаточно информативной при дифференцировании БП и МСА: так, при БП не изменён либо увеличен захват 18 F-ФДГ в скорлупе, когда как при МСА чаще описывают гипометаболические изменения в данной области. Характерным паттерном при МСА-П является симметричный гипометаболизм в об-…”

Section: клиническая картинаunclassified

Multiple system atrophy: diagnostic methods and biomarkers

Andreev

Fedotova

2022

Annals of Clinical and Experimental Neurology

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Multiple system atrophy (MSA) is a neurodegenerative disease belonging to a group of synucleinopathies and characterized by significant autonomic failure, parkinsonian syndrome, and cerebellar signs. Diagnostic criteria used currently were updated in 2022. While the clinical method and neuroimaging are typically diagnostic in MSA, new modalities are currently emerging. Novel candidate biomarkers are being intensively and thoroughly studied. The review analyzes the clinical picture and diagnostic criteria of the disease, describes imaging methods for diagnosing synucleinopathies, as well as known laboratory markers of multiple system atrophy.

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“…and it can represent a measure of the global ability of the ANS to adapt to endogenous and external stimuli, with a particular value in neurological disorders involving the ANS, including PD and MSA ( 15 ). Similarly, Sympathetic Skin Response (SSR) is an easily obtainable index of sympathetic sudomotor function and is defined as the momentary change of the electrical potential of the skin ( 16 ), and has been used as a possible marker of autonomic dysfunction in both PD ( 17 , 18 ) and MSA ( 19 ).…”

Section: Introductionmentioning

confidence: 99%

Cognitive and Autonomic Dysfunction in Multiple System Atrophy Type P and C: A Comparative Study

et al. 2022

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Multiple System Atrophy (MSA) is a rare neurodegenerative disease, clinically defined by a combination of autonomic dysfunction and motor involvement, that may be predominantly extrapyramidal (MSA-P) or cerebellar (MSA-C). Although dementia is generally considered a red flag against the clinical diagnosis of MSA, in the last decade the evidence of cognitive impairment in MSA patients has been growing. Cognitive dysfunction appears to involve mainly, but not exclusively, executive functions, and may have different characteristics and progression in the two subtypes of the disease (i.e., MSA-P and MSA-C). Despite continued efforts, combining in-vivo imaging studies as well as pathological studies, the physiopathological bases of cognitive involvement in MSA are still unclear. In this view, the possible link between cardiovascular autonomic impairment and decreased cognitive performance, extensively investigated in PD, needs to be clarified as well. In the present study, we evaluated a cohort of 20 MSA patients (9 MSA-P, 11 MSA-C) by means of a neuropsychological battery, hemodynamic assessment (heart rate and arterial blood pressure) during rest and active standing and bedside autonomic function tests assessed by heart rate variability (HRV) parameters and sympathetic skin response (SSR) in the same experimental session. Overall, global cognitive functioning, as indicated by the MoCA score, was preserved in most patients. However, short- and long-term memory and attentional and frontal-executive functions were moderately impaired. When comparing MSA-P and MSA-C, the latter obtained lower scores in tests of executive functions and verbal memory. Conversely, no statistically significant difference in cardiovascular autonomic parameters was identified between MSA-P and MSA-C patients. In conclusion, moderate cognitive deficits, involving executive functions and memory, are present in MSA, particularly in MSA-C patients. In addition, our findings do not support the role of dysautonomia as a major driver of cognitive differences between MSA-P and MSA-C.

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Sympathetic outflow to skin predicts central autonomic dysfunction in multiple system atrophy

Cited by 5 publications

References 27 publications

The Cold Hand Sign in Multiple System Atrophy: Frequency-Associated Factors and Its Impact on Survival

The Cold Hand Sign in Multiple System Atrophy: Frequency-Associated Factors and Its Impact on Survival

Multiple system atrophy: diagnostic methods and biomarkers

Cognitive and Autonomic Dysfunction in Multiple System Atrophy Type P and C: A Comparative Study

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