Symptomatic orthostatic hypotension in Parkinson's disease patients: Prevalence, associated factors and its impact on balance confidence

Klanbut, Siranan; Phattanarudee, Siripan; Wongwiwatthananukit, Supakit; Suthisisang, Chuthamanee; Bhidayasiri, Roongroj

doi:10.1016/j.jns.2017.12.037

Cited by 12 publications

(8 citation statements)

References 45 publications

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“…It is advised that PwPD exercise at an intensity of 60–80% of HRR or 70–85% of maximum heart rate. Given the prevalence of autonomic dysfunction in this population [ 51 ], 14–17 on a 20 point RPE scale is also appropriate [ 50 ]. To put this into perspective, if one can exercise and hold a conversation, the intensity of the exercise should be increased.…”

Section: Aerobic Exercise Prescriptionmentioning

confidence: 99%

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The Universal Prescription for Parkinson’s Disease: Exercise

Alberts

Rosenfeldt

2020

JPD

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Over the past two decades, aerobic exercise has emerged as a mainstream recommendation to aid in treating Parkinson’s disease (PD). Despite the acknowledgement of the benefits of exercise for people with PD (PwPD), frequently, exercise recommendations lack specificity in terms of frequency, intensity and duration. Additionally, conflating physical activity with exercise has contributed to providing vague exercise recommendations to PwPD. Therefore, the beneficial effects of exercise may not be fully realized in PwPD. Data provided by animal studies and select human trials indicate aerobic exercise may facilitate structural and functional changes in the brain. Recently, several large human clinical trials have been completed and collectively support the use of aerobic exercise, specifically high-intensity aerobic exercise, in improving PD motor symptoms. Data from these and other studies provide the basis to include aerobic exercise as an integral component in treating PD. Based on positive clinical findings and trials, it is advised that PwPD perform aerobic exercise in the following dose: 3x/week, 30–40-minute main exercise set, 60–80% of heart rate reserve or 70–85% of heart rate max. In lieu of heart rate, individuals can achieve an intensity of 14–17 on a 20-point RPE scale. Ongoing clinical trials, SPARX3 and CYCLE-II, have potential to further develop patient-specific exercise recommendations through prognostic modeling.

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Section: Aerobic Exercise Prescriptionmentioning

confidence: 99%

“…Exercise durations of 30–40 minutes for the main exercise set appear to be sufficient [ 11, 12, 41, 42 ]. Importantly, it is recommended that the main exercise set is flanked by a 5–10-minute warm-up and cool-down, particularly important given the prevalence of autonomic dysfunction [ 51 ].…”

Section: Aerobic Exercise Prescriptionmentioning

confidence: 99%

The Universal Prescription for Parkinson’s Disease: Exercise

Alberts

Rosenfeldt

2020

JPD

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“…Large body evidence has documented that the earlier autonomic failure manifests clear OH and/or SH in the PD patients 6,38,39 that is the major cause of cardiovascular events and fractures, even to death in PD patients. To simulate clinical OH and SH in the current model, we tested the changes in BP while changing the position in an unconscious rats with or without vagal application of DOPAL.…”

Section: Resultsmentioning

confidence: 99%

Parkinson‐like early autonomic dysfunction induced by vagal application of DOPAL in rats

Sun

Yan

et al. 2021

CNS Neurosci Ther

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Aim To understand why autonomic failures, a common non‐motor symptom of Parkinson's disease (PD), occur earlier than typical motor disorders. Methods Vagal application of DOPAL (3,4‐dihydroxyphenylacetaldehyde) to simulate PD‐like autonomic dysfunction and understand the connection between PD and cardiovascular dysfunction. Molecular and morphological approaches were employed to test the time‐dependent alternation of α‐synuclein aggregation and the ultrastructure changes in the heart and nodose (NG)/nucleus tractus solitarius (NTS). Results Blood pressure (BP) and baroreflex sensitivity of DOPAL‐treated rats were significantly reduced accompanied with a time‐dependent change in orthostatic BP, consistent with altered echocardiography and cardiomyocyte mitochondrial ultrastructure. Notably, time‐dependent and collaborated changes in Mon‐/Tri‐α‐synuclein were paralleled with morphological alternation in the NG and NTS. Conclusion These all demonstrate that early autonomic dysfunction mediated by vagal application of DOPAL highly suggests the plausible etiology of PD initiated from peripheral, rather than central site. It will provide a scientific basis for the prevention and early diagnosis of PD.

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“…Each item is scored from 0 to 10, with 0 representing no symptoms and 10 representing the worst possible symptoms. The OHQ score is calculated as the average of the OHSA and OHDAS scores (16). We categorized the OH cases as symptomatic and asymptomatic based on the OHQ score and the AST BP measurement.…”

Section: Symptom Assessmentmentioning

confidence: 99%

Impaired Cerebral Autoregulation in Parkinson's Disease: An Orthostatic Hypotension Analysis

Xing

et al. 2022

Front. Neurol.

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Orthostatic hypotension (OH) is an early non-motor manifestation of Parkinson's disease (PD). However, the underlying mechanism of hemodynamic changes in patients with PD and OH remains unclear. This study aimed to investigate the dynamic cerebral autoregulation changes in patients with PD with OH. Ninety patients with PD and 20 age- and sex-matched healthy controls (HCs) were recruited. The patients' non-invasive blood pressure (BP) and cerebral blood flow velocity were simultaneously recorded at supine and orthostatic positions during the active standing test (AST). Transfer function analysis was used to determine autoregulatory parameters including gain [i.e., damping effect of dynamic cerebral autoregulation (dCA) on the magnitude of BP oscillation] and phase difference (i.e., the time delay of the cerebral blood flow response to BP). Sixteen patients (17.8%) in the PD population were diagnosed with OH (PD-OH). The AST results were normal for 74 patients (82.2%) (PD-NOR). In the supine position, the PD-OH group had a lower phase degree than the PD-NOR group (50.3 ± 23.4 vs. 72.6 ± 32.2 vs. 68.9 ± 12.1, p = 0.020); however, no significant difference was found upon comparing with the HC group. In the orthostatic position, the normalized gain was significantly higher for the symptomatic OH group than for the asymptomatic OH group and HC group (1.50 ± 0.58 vs. 0.97 ± 0.29 vs. 1.10 ± 0.31, p = 0.019). A symptomatic OH in the PD population indicates an impaired cerebral autoregulation ability in the orthostatic position. Cerebral autoregulation tends to be impaired in the supine position in the OH population.

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Symptomatic orthostatic hypotension in Parkinson's disease patients: Prevalence, associated factors and its impact on balance confidence

Cited by 12 publications

References 45 publications

The Universal Prescription for Parkinson’s Disease: Exercise

The Universal Prescription for Parkinson’s Disease: Exercise

Parkinson‐like early autonomic dysfunction induced by vagal application of DOPAL in rats

Impaired Cerebral Autoregulation in Parkinson's Disease: An Orthostatic Hypotension Analysis

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