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Park JW, Okamoto LE, Kim SH, Lee CN, Park KW, Baek SH, Sung JH, Jeon N, Koh SB, Gamboa A, Shibao CA, Diedrich A, Kim BJ, Biaggioni I. Sympathetic dysfunction as an early indicator of autonomic involvement in Parkinson's disease. Clin Auton Res 2024; 34:269-279. [PMID: 38652421 DOI: 10.1007/s10286-024-01031-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/11/2023] [Accepted: 04/09/2024] [Indexed: 04/25/2024]
Abstract
PURPOSE The specific characteristics of autonomic involvement in patients with early Parkinson's disease (PD) are unclear. This study aimed to evaluate the characteristics of autonomic dysfunction in drug-naïve patients with early-stage PD without orthostatic hypotension (OH) by analyzing Valsalva maneuver (VM) parameters. METHODS We retrospectively analyzed drug-naïve patients without orthostatic hypotension (n = 61) and controls (n = 20). The patients were subcategorized into early PD (n = 35) and mid-PD (n = 26) groups on the basis of the Hoehn and Yahr staging. VM parameters, including changes in systolic blood pressure at late phase 2 (∆SBPVM2), ∆HRVM3, Valsalva ratio (VR), pressure recovery time, adrenergic baroreflex sensitivity, and vagal baroreflex sensitivity, were assessed. RESULTS In the early PD group, ∆SBPVM2, a marker of sympathetic function, was significantly lower compared with that in controls (risk ratio = 0.95, P = 0.027). Receiver operating characteristic (ROC) curve analysis showed an optimal cut-off value of -10 mmHg for ∆SBPVM2 [P = 0.002, area under the curve (AUC): 0.737]. VR exhibited an inverse relationship with Unified Parkinson's Disease Rating Scale Part 3 scores in the multivariable regression analysis (VR: P = 0.038, β = -28.61), whereas age showed a positive relationship (age: P = 0.027, β = 0.35). CONCLUSION The ∆BPVM2 parameter of the VM may help detect autonomic nervous system involvement in early-PD without OH. Our results suggest that sympathetic dysfunction is an early manifestation of autonomic dysfunction in patients with PD.
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Affiliation(s)
- Jin-Woo Park
- Department of Neurology, Korea University Anam Hospital, Korea University Medicine, #73, Goryeodae-Ro, Seongbuk-gu, Seoul, 02841, Korea
- Division of Clinical Pharmacology, Department of Medicine, Vanderbilt University Medical Center, Nashville, TN, USA
| | - Luis E Okamoto
- Division of Clinical Pharmacology, Department of Medicine, Vanderbilt University Medical Center, Nashville, TN, USA
| | - Sung-Hwan Kim
- Department of Neurology, Korea University Anam Hospital, Korea University Medicine, #73, Goryeodae-Ro, Seongbuk-gu, Seoul, 02841, Korea
| | - Chan-Nyoung Lee
- Department of Neurology, Korea University Anam Hospital, Korea University Medicine, #73, Goryeodae-Ro, Seongbuk-gu, Seoul, 02841, Korea
| | - Kun Woo Park
- Department of Neurology, Korea University Anam Hospital, Korea University Medicine, #73, Goryeodae-Ro, Seongbuk-gu, Seoul, 02841, Korea
| | - Seol-Hee Baek
- Department of Neurology, Korea University Anam Hospital, Korea University Medicine, #73, Goryeodae-Ro, Seongbuk-gu, Seoul, 02841, Korea
| | - Joo Hye Sung
- Department of Neurology, Korea University Anam Hospital, Korea University Medicine, #73, Goryeodae-Ro, Seongbuk-gu, Seoul, 02841, Korea
| | - Namjoon Jeon
- Department of Neurology, Korea University Anam Hospital, Korea University Medicine, #73, Goryeodae-Ro, Seongbuk-gu, Seoul, 02841, Korea
| | - Seong-Beom Koh
- Department of Neurology, Korea University Anam Hospital, Korea University Medicine, #73, Goryeodae-Ro, Seongbuk-gu, Seoul, 02841, Korea
| | - Alfredo Gamboa
- Division of Clinical Pharmacology, Department of Medicine, Vanderbilt University Medical Center, Nashville, TN, USA
| | - Cyndya A Shibao
- Division of Clinical Pharmacology, Department of Medicine, Vanderbilt University Medical Center, Nashville, TN, USA
| | - André Diedrich
- Division of Clinical Pharmacology, Department of Medicine, Vanderbilt University Medical Center, Nashville, TN, USA
- Department of Biomedical Engineering, Vanderbilt University, Nashville, TN, USA
| | - Byung-Jo Kim
- Department of Neurology, Korea University Anam Hospital, Korea University Medicine, #73, Goryeodae-Ro, Seongbuk-gu, Seoul, 02841, Korea.
- BK21 FOUR R&E Center for Learning Health Systems, Graduate School, Korea University, Seoul, Republic of Korea, Seoul, Korea.
| | - Italo Biaggioni
- Division of Clinical Pharmacology, Department of Medicine, Vanderbilt University Medical Center, Nashville, TN, USA
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Power spectral analysis of heart rate variability is useful as a screening tool for detecting sympathetic and parasympathetic nervous dysfunctions in Parkinson’s disease. BMC Neurol 2022; 22:339. [PMID: 36088296 PMCID: PMC9463782 DOI: 10.1186/s12883-022-02872-2] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/27/2022] [Accepted: 09/02/2022] [Indexed: 11/12/2022] Open
Abstract
Background Parkinson’s disease (PD) is a progressive neurodegenerative disorder that causes motor symptoms and autonomic dysfunction. However, autonomic function tests commonly performed in PD can only evaluate either the sympathetic or parasympathetic nervous system. Therefore, the purpose of this pilot study is to investigate whether power spectral analysis of heart rate variability could detect both sympathetic and parasympathetic nervous dysfunctions in patients with PD. Methods Seventeen patients with PD and 11 healthy control subjects underwent electrocardiogram recording for the spectral analysis of heart rate variability to obtain values of low-frequency (LF) (0.04–0.15 Hz) and high-frequency (HF) (0.15–0.4 Hz) powers. Moreover, we examined the coefficient of variation of R–R intervals (CVRR) as a parameter of parasympathetic function in all participants and performed 123I-metaiodobenzylguanidine scintigraphy to measure the heart-to-mediastinum ratio as a parameter of cardiac sympathetic innervation in patients with PD. Results The median age of control subjects and PD patients was 63 and 66 years old, respectively. The median Hoehn and Yahr scale of PD patients was stage 2. The values of resting LF and HF powers widely varied. The median values of resting LF powers of control subjects and PD patients and those of HF powers were 169 and 70 ms2, 279 and 65 ms2, respectively, the difference was statistically insignificant. Approximately 41% of patients with PD had values below the first quartile of resting LF powers (< 58 ms2) or HF powers (< 50 ms2); however, no control subject had such low values. Positive correlations were found between resting LF powers and heart-to-mediastinum ratios of 123I-metaiodobenzylguanidine uptake (r = 0.6) and between resting HF powers and CVRRs (r = 0.7). The resting LF power was also associated with CVRRs and constipation. Furthermore, a positive correlation was observed between resting LF powers and resting HF powers in patients with PD (r = 0.8). Conclusions The power spectral analysis of heart rate variability may be useful as a screening tool for detecting autonomic dysfunctions by detecting low resting LF and HF powers in patients with PD. Sympathetic and parasympathetic nerves may be concurrently damaged in patients with PD. Supplementary Information The online version contains supplementary material available at 10.1186/s12883-022-02872-2.
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Heart-brain synchronization breakdown in Parkinson's disease. NPJ Parkinsons Dis 2022; 8:64. [PMID: 35637221 PMCID: PMC9151654 DOI: 10.1038/s41531-022-00323-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/04/2021] [Accepted: 04/27/2022] [Indexed: 11/08/2022] Open
Abstract
Heart rate variability (HRV) abnormalities are potential early biomarkers in Parkinson’s disease (PD) but their relationship with central autonomic network (CAN) activity is not fully understood. We analyzed the synchronization between HRV and brain activity in 31 PD patients and 21 age-matched healthy controls using blood-oxygen-level-dependent (BOLD) signals from resting-state functional brain MRI and HRV metrics from finger plethysmography recorded for 7.40 min. We additionally quantified autonomic symptoms (SCOPA-AUT) and objective autonomic cardiovascular parameters (blood pressure and heart rate) during deep breathing, Valsalva, and head-up tilt, which were used to classify the clinical severity of dysautonomia. We evaluated HRV and BOLD signals synchronization (HRV-BOLD-sync) with Pearson lagged cross-correlations and Fisher’s statistics for combining window-length-dependent HRV-BOLD-Sync Maps and assessed their association with clinical dysautonomia. HRV-BOLD-sync was lower significantly in PD than in controls in various brain regions within CAN or in networks involved in autonomic modulation. Moreover, heart-brain synchronization index (HBSI), which quantifies heart-brain synchronization at a single-subject level, showed an inverse exposure–response relationship with dysautonomia severity, finding the lowest HBSI in patients with severe dysautonomia, followed by moderate, mild, and, lastly, controls. Importantly, HBSI was associated in PD, but not in controls, with Valsalva pressure recovery time (sympathetic), deep breathing E/I ratio (cardiovagal), and SCOPA-AUT. Our findings support the existence of heart-brain de-synchronization in PD with an impact on clinically relevant autonomic outcomes.
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Carandina A, Lazzeri G, Rodrigues GD, Franco G, Monfrini E, Arienti F, Frattini E, Trezzi I, da Silva Soares PP, Bellocchi C, Furlan L, Montano N, Di Fonzo A, Tobaldini E. Dysautonomia in Parkinson’s Disease: Impact of Glucocerebrosidase Gene Mutations on Cardiovascular Autonomic Control. Front Neurosci 2022; 16:842498. [PMID: 35368256 PMCID: PMC8964968 DOI: 10.3389/fnins.2022.842498] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/23/2021] [Accepted: 02/21/2022] [Indexed: 12/20/2022] Open
Abstract
Evidence from clinical practice suggests that PD patients with the Glucocerebrosidase gene mutations (GBA-PD) are characterized by more severe dysautonomic symptoms than patients with idiopathic PD (iPD). Therefore, an accurate assessment of cardiovascular autonomic control (CAC) is necessary to clarify the role of GBA mutations in the pathophysiology of PD. We evaluated the CAC at rest and during orthostatic challenge of 15 iPD, 15 GBA-PD and 15 healthy controls (CTR). ECG and respiration were recorded in supine position and during active standing. The analysis of Heart Rate Variability (HRV) was performed on ECG recordings using two different approaches, linear spectral analysis and non-linear symbolic analysis. GBA-PD patients presented more frequently an akinetic-rigid phenotype and cognitive dysfunction than iPD patients. Both iPD and GBA-PD group were characterized by a lower spectral HRV than CTR group. At rest, the GBA-PD group was characterized by a lower parasympathetic modulation and a shift of the sympathovagal balance toward a sympathetic predominance compared to the CTR group. Moreover, the GBA-PD patients presented a lower HR increment and a lower or absent reduction of the vagal modulation in response to the active standing than iPD patients. Lastly, the cardiovascular autonomic dysfunction in PD patients was associated with longer disease duration, and with the occurrence of REM sleep behavior disorder and constipation. Our findings suggest a more severe impairment of the CAC in PD patients with GBA mutations. These results and further studies on the role of GBA mutations could allow a stratification based on cardiovascular risk in PD patients and the implementation of specific prevention programs.
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Affiliation(s)
- Angelica Carandina
- Department of Internal Medicine, Fondazione IRCCS Ca’ Granda, Ospedale Maggiore Policlinico, Milan, Italy
| | - Giulia Lazzeri
- Neurology Unit, Fondazione IRCCS Ca’ Granda, Ospedale Maggiore Policlinico, Milan, Italy
- Centro Dino Ferrari, Neuroscience Section, Department of Pathophysiology and Transplantation, University of Milan, Milan, Italy
| | - Gabriel Dias Rodrigues
- Department of Clinical Sciences and Community Health, University of Milan, Milan, Italy
- Laboratory of Experimental and Applied Exercise Physiology, Department of Physiology and Pharmacology, Fluminense Federal University, Niterói, Brazil
| | - Giulia Franco
- Neurology Unit, Fondazione IRCCS Ca’ Granda, Ospedale Maggiore Policlinico, Milan, Italy
| | - Edoardo Monfrini
- Neurology Unit, Fondazione IRCCS Ca’ Granda, Ospedale Maggiore Policlinico, Milan, Italy
- Centro Dino Ferrari, Neuroscience Section, Department of Pathophysiology and Transplantation, University of Milan, Milan, Italy
| | - Federica Arienti
- Neurology Unit, Fondazione IRCCS Ca’ Granda, Ospedale Maggiore Policlinico, Milan, Italy
- Centro Dino Ferrari, Neuroscience Section, Department of Pathophysiology and Transplantation, University of Milan, Milan, Italy
| | - Emanuele Frattini
- Neurology Unit, Fondazione IRCCS Ca’ Granda, Ospedale Maggiore Policlinico, Milan, Italy
- Centro Dino Ferrari, Neuroscience Section, Department of Pathophysiology and Transplantation, University of Milan, Milan, Italy
| | - Ilaria Trezzi
- Neurology Unit, Fondazione IRCCS Ca’ Granda, Ospedale Maggiore Policlinico, Milan, Italy
- Centro Dino Ferrari, Neuroscience Section, Department of Pathophysiology and Transplantation, University of Milan, Milan, Italy
| | - Pedro Paulo da Silva Soares
- Laboratory of Experimental and Applied Exercise Physiology, Department of Physiology and Pharmacology, Fluminense Federal University, Niterói, Brazil
| | - Chiara Bellocchi
- Department of Internal Medicine, Fondazione IRCCS Ca’ Granda, Ospedale Maggiore Policlinico, Milan, Italy
- Department of Clinical Sciences and Community Health, University of Milan, Milan, Italy
| | - Ludovico Furlan
- Department of Internal Medicine, Fondazione IRCCS Ca’ Granda, Ospedale Maggiore Policlinico, Milan, Italy
- Department of Clinical Sciences and Community Health, University of Milan, Milan, Italy
| | - Nicola Montano
- Department of Internal Medicine, Fondazione IRCCS Ca’ Granda, Ospedale Maggiore Policlinico, Milan, Italy
- Department of Clinical Sciences and Community Health, University of Milan, Milan, Italy
| | - Alessio Di Fonzo
- Neurology Unit, Fondazione IRCCS Ca’ Granda, Ospedale Maggiore Policlinico, Milan, Italy
- Centro Dino Ferrari, Neuroscience Section, Department of Pathophysiology and Transplantation, University of Milan, Milan, Italy
| | - Eleonora Tobaldini
- Department of Internal Medicine, Fondazione IRCCS Ca’ Granda, Ospedale Maggiore Policlinico, Milan, Italy
- Department of Clinical Sciences and Community Health, University of Milan, Milan, Italy
- *Correspondence: Eleonora Tobaldini,
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Yalçin M, Malhan D, Basti A, Peralta AR, Ferreira JJ, Relógio A. A Computational Analysis in a Cohort of Parkinson's Disease Patients and Clock-Modified Colorectal Cancer Cells Reveals Common Expression Alterations in Clock-Regulated Genes. Cancers (Basel) 2021; 13:cancers13235978. [PMID: 34885088 PMCID: PMC8657387 DOI: 10.3390/cancers13235978] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/31/2021] [Revised: 11/18/2021] [Accepted: 11/21/2021] [Indexed: 12/13/2022] Open
Abstract
Simple Summary Cancer and neurodegenerative diseases are two aging-related pathologies with differential developmental characteristics, but they share altered cellular pathways. Interestingly, dysregulations in the biological clock are reported in both diseases, though the extent and potential consequences of such disruption have not been fully elucidated. In this study, we aimed at characterizing global changes on common cellular pathways associated with Parkinson’s disease (PD) and colorectal cancer (CRC). We used gene expression data retrieved from an idiopathic PD (IPD) patient cohort and from CRC cells with unmodified versus genetically altered clocks. Our results highlight common differentially expressed genes between IPD patients and cells with disrupted clocks, suggesting a role for the circadian clock in the regulation of pathways altered in both pathologies. Interestingly, several of these genes are related to cancer hallmarks and may have an impact on the overall survival of colon cancer patients, as suggested by our analysis. Abstract Increasing evidence suggests a role for circadian dysregulation in prompting disease-related phenotypes in mammals. Cancer and neurodegenerative disorders are two aging related diseases reported to be associated with circadian disruption. In this study, we investigated a possible effect of circadian disruption in Parkinson’s disease (PD) and colorectal cancer (CRC). We used high-throughput data sets retrieved from whole blood of idiopathic PD (IPD) patients and time course data sets derived from an in vitro model of CRC including the wildtype and three core-clock knockout (KO) cell lines. Several gene expression alterations in IPD patients resembled the expression profiles in the core-clock KO cells. These include expression changes in DBP, GBA, TEF, SNCA, SERPINA1 and TGFB1. Notably, our results pointed to alterations in the core-clock network in IPD patients when compared to healthy controls and revealed variations in the expression profile of PD-associated genes (e.g., HRAS and GBA) upon disruption of the core-clock genes. Our study characterizes changes at the transcriptomic level following circadian clock disruption on common cellular pathways associated with cancer and neurodegeneration (e.g., immune system, energy metabolism and RNA processing), and it points to a significant influence on the overall survival of colon cancer patients for several genes resulting from our analysis (e.g., TUBB6, PAK6, SLC11A1).
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Affiliation(s)
- Müge Yalçin
- Institute for Theoretical Biology (ITB), Charité—Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin, Humboldt-Universität zu Berlin, 10117 Berlin, Germany; (M.Y.); (D.M.); (A.B.)
- Molecular Cancer Research Center (MKFZ), Medical Department of Hematology, Oncology, and Tumour Immunology, Charité—Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin, Humboldt-Universität zu Berlin, 10117 Berlin, Germany
| | - Deeksha Malhan
- Institute for Theoretical Biology (ITB), Charité—Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin, Humboldt-Universität zu Berlin, 10117 Berlin, Germany; (M.Y.); (D.M.); (A.B.)
- Molecular Cancer Research Center (MKFZ), Medical Department of Hematology, Oncology, and Tumour Immunology, Charité—Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin, Humboldt-Universität zu Berlin, 10117 Berlin, Germany
- Institute for Systems Medicine and Faculty of Human Medicine, MSH Medical School Hamburg, 20457 Hamburg, Germany
| | - Alireza Basti
- Institute for Theoretical Biology (ITB), Charité—Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin, Humboldt-Universität zu Berlin, 10117 Berlin, Germany; (M.Y.); (D.M.); (A.B.)
- Molecular Cancer Research Center (MKFZ), Medical Department of Hematology, Oncology, and Tumour Immunology, Charité—Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin, Humboldt-Universität zu Berlin, 10117 Berlin, Germany
- Institute for Systems Medicine and Faculty of Human Medicine, MSH Medical School Hamburg, 20457 Hamburg, Germany
| | - Ana Rita Peralta
- EEG/Sleep Laboratory, Department Neurosciences and Mental Health, Hospital de Santa Maria—CHULN, 1649-035 Lisbon, Portugal;
- Department of Neurology, Faculdade de Medicina, Universidade de Lisboa, 1649-028 Lisbon, Portugal
- Instituto de Fisiologia, Faculdade de Medicina, Universidade de Lisboa, 1649-028 Lisbon, Portugal
- CNS-Campus Neurológico Senior, 2560-280 Torres Vedras, Portugal;
| | - Joaquim J. Ferreira
- CNS-Campus Neurológico Senior, 2560-280 Torres Vedras, Portugal;
- Instituto de Medicina Molecular, Faculdade de Medicina, Universidade de Lisboa, 1649-028 Lisbon, Portugal
- Laboratory of Clinical Pharmacology and Therapeutics, Faculdade de Medicina, Universidade de Lisboa, 1649-028 Lisbon, Portugal
| | - Angela Relógio
- Institute for Theoretical Biology (ITB), Charité—Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin, Humboldt-Universität zu Berlin, 10117 Berlin, Germany; (M.Y.); (D.M.); (A.B.)
- Molecular Cancer Research Center (MKFZ), Medical Department of Hematology, Oncology, and Tumour Immunology, Charité—Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin, Humboldt-Universität zu Berlin, 10117 Berlin, Germany
- Institute for Systems Medicine and Faculty of Human Medicine, MSH Medical School Hamburg, 20457 Hamburg, Germany
- Correspondence: or
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Heart Rate Variability Analyses in Parkinson's Disease: A Systematic Review and Meta-Analysis. Brain Sci 2021; 11:brainsci11080959. [PMID: 34439578 PMCID: PMC8394422 DOI: 10.3390/brainsci11080959] [Citation(s) in RCA: 19] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/25/2021] [Revised: 07/11/2021] [Accepted: 07/16/2021] [Indexed: 12/16/2022] Open
Abstract
Recent evidence suggests that the vagus nerve and autonomic dysfunction play an important role in the pathogenesis of Parkinson's disease. Using heart rate variability analysis, the autonomic modulation of cardiac activity can be investigated. This meta-analysis aims to assess if analysis of heart rate variability may indicate decreased parasympathetic tone in patients with Parkinson's disease. The MEDLINE, EMBASE and Cochrane Central databases were searched on 31 December 2020. Studies were included if they: (1) were published in English, (2) analyzed idiopathic Parkinson's disease and healthy adult controls, and (3) reported at least one frequency- or time-domain heart rate variability analysis parameter, which represents parasympathetic regulation. We included 47 studies with 2772 subjects. Random-effects meta-analyses revealed significantly decreased effect sizes in Parkinson patients for the high-frequency spectral component (HFms2) and the short-term measurement of the root mean square of successive normal-to-normal interval differences (RMSSD). However, heterogeneity was high, and there was evidence for publication bias regarding HFms2. There is some evidence that a more advanced disease leads to an impaired parasympathetic regulation. In conclusion, short-term measurement of RMSSD is a reliable parameter to assess parasympathetically impaired cardiac modulation in Parkinson patients. The measurement should be performed with a predefined respiratory rate.
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Short-term deceleration capacity of heart rate: a sensitive marker of cardiac autonomic dysfunction in idiopathic Parkinson's disease. Clin Auton Res 2021; 31:729-736. [PMID: 34251546 DOI: 10.1007/s10286-021-00815-4] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/05/2021] [Accepted: 06/22/2021] [Indexed: 10/20/2022]
Abstract
PURPOSE Cardiac autonomic dysfunction in idiopathic Parkinson's disease (PD) manifests as reduced heart rate variability (HRV). In the present study, we explored the deceleration capacity of heart rate (DC) in patients with idiopathic PD, an advanced HRV marker that has proven clinical utility. METHODS Standard and advanced HRV measures derived from 7-min electrocardiograms in 20 idiopathic PD patients and 27 healthy controls were analyzed. HRV measures were compared using regression analysis, controlling for age, sex, and mean heart rate. RESULTS Significantly reduced HRV was found only in the subcohort of PD patients older than 60 years. Low- frequency power and global HRV measures were lower in patients than in controls, but standard beat-to-beat HRV markers (i.e., rMSSD and high-frequency power) were not significantly different between groups. DC was significantly reduced in the subcohort of PD patients older than 60 years compared to controls. CONCLUSIONS Deceleration-related oscillations of HRV were significantly reduced in the older PD patients compared to healthy controls, suggesting that short-term DC may be a sensitive marker of cardiac autonomic dysfunction in PD. DC may be complementary to traditional markers of short-term HRV for the evaluation of autonomic modulation in PD. Further study to examine the association between DC and cardiac adverse events in PD is needed to clarify the clinical relevance of DC in this population.
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Liu Y, Niu L, Liu X, Cheng C, Le W. Recent Progress in Non-motor Features of Parkinson's Disease with a Focus on Circadian Rhythm Dysregulation. Neurosci Bull 2021; 37:1010-1024. [PMID: 34128188 DOI: 10.1007/s12264-021-00711-x] [Citation(s) in RCA: 21] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/25/2020] [Accepted: 03/31/2021] [Indexed: 12/14/2022] Open
Abstract
Parkinson's disease (PD) is the second most common neurodegenerative disease, which manifests with both motor and non-motor symptoms. Circadian rhythm dysregulation, as one of the most challenging non-motor features of PD, usually appears long before obvious motor symptoms. Moreover, the dysregulated circadian rhythm has recently been reported to play pivotal roles in PD pathogenesis, and it has emerged as a hot topic in PD research. In this review, we briefly introduce the circadian rhythm and circadian rhythm-related genes, and then summarize recent research progress on the altered circadian rhythm in PD, ranging from clinical features to the possible causes of PD-related circadian disorders. We believe that future comprehensive studies on the topic may not only help us to explore the mechanisms of PD, but also shed light on the better management of PD.
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Affiliation(s)
- Yufei Liu
- Liaoning Provincial Key Laboratory for Research on the Pathogenic Mechanisms of Neurological Diseases, the First Affiliated Hospital, Dalian Medical University, Dalian, 116021, China
- Liaoning Provincial Center for Clinical Research on Neurological Diseases, the First Affiliated Hospital, Dalian Medical University, Dalian, 116021, China
| | - Long Niu
- Liaoning Provincial Key Laboratory for Research on the Pathogenic Mechanisms of Neurological Diseases, the First Affiliated Hospital, Dalian Medical University, Dalian, 116021, China
- Liaoning Provincial Center for Clinical Research on Neurological Diseases, the First Affiliated Hospital, Dalian Medical University, Dalian, 116021, China
| | - Xinyao Liu
- Liaoning Provincial Key Laboratory for Research on the Pathogenic Mechanisms of Neurological Diseases, the First Affiliated Hospital, Dalian Medical University, Dalian, 116021, China
- Liaoning Provincial Center for Clinical Research on Neurological Diseases, the First Affiliated Hospital, Dalian Medical University, Dalian, 116021, China
| | - Cheng Cheng
- Liaoning Provincial Key Laboratory for Research on the Pathogenic Mechanisms of Neurological Diseases, the First Affiliated Hospital, Dalian Medical University, Dalian, 116021, China
- Liaoning Provincial Center for Clinical Research on Neurological Diseases, the First Affiliated Hospital, Dalian Medical University, Dalian, 116021, China
| | - Weidong Le
- Liaoning Provincial Key Laboratory for Research on the Pathogenic Mechanisms of Neurological Diseases, the First Affiliated Hospital, Dalian Medical University, Dalian, 116021, China.
- Liaoning Provincial Center for Clinical Research on Neurological Diseases, the First Affiliated Hospital, Dalian Medical University, Dalian, 116021, China.
- Institute of Neurology, Sichuan Academy of Medical Science-Sichuan Provincial Hospital, University of Electronic Science and Technology of China, Chengdu, 610072, China.
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Sabino-Carvalho JL, Fisher JP, Vianna LC. Autonomic Function in Patients With Parkinson's Disease: From Rest to Exercise. Front Physiol 2021; 12:626640. [PMID: 33815139 PMCID: PMC8017184 DOI: 10.3389/fphys.2021.626640] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/06/2020] [Accepted: 02/24/2021] [Indexed: 12/16/2022] Open
Abstract
Parkinson’s disease (PD) is a common neurodegenerative disorder classically characterized by symptoms of motor impairment (e.g., tremor and rigidity), but also presenting with important non-motor impairments. There is evidence for the reduced activity of both the parasympathetic and sympathetic limbs of the autonomic nervous system at rest in PD. Moreover, inappropriate autonomic adjustments accompany exercise, which can lead to inadequate hemodynamic responses, the failure to match the metabolic demands of working skeletal muscle and exercise intolerance. The underlying mechanisms remain unclear, but relevant alterations in several discrete central regions (e.g., dorsal motor nucleus of the vagus nerve, intermediolateral cell column) have been identified. Herein, we critically evaluate the clinically significant and complex associations between the autonomic dysfunction, fatigue and exercise capacity in PD.
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Affiliation(s)
- Jeann L Sabino-Carvalho
- NeuroV̇ASQ̇ - Integrative Physiology Laboratory, Faculty of Physical Education, University of Brasília, Brasília, Brazil
| | - James P Fisher
- Manaaki Mānawa - The Centre for Heart Research, Department of Physiology, Faculty of Medical and Health Sciences, The University of Auckland, Auckland, New Zealand
| | - Lauro C Vianna
- NeuroV̇ASQ̇ - Integrative Physiology Laboratory, Faculty of Physical Education, University of Brasília, Brasília, Brazil.,Graduate Program in Medical Sciences, Faculty of Medicine, University of Brasília, Brasília, Brazil
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Mechanical somatosensory stimulation decreases blood pressure in patients with Parkinson's disease. J Hypertens 2020; 37:1714-1721. [PMID: 31107357 DOI: 10.1097/hjh.0000000000002084] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
OBJECTIVE The current study aimed to assess the effects of five cycles of automated mechanical somatosensory stimulation (AMSS) of the fore-feet on blood pressure (BP) and cardiovascular autonomic control in Parkinson's Disease patients. METHODS Out of 23 patients, 16 underwent an AMSS session every 72 h, for a total of five sessions per patient. Electrocardiogram, noninvasive beat-to-beat blood pressure and respiratory activity were recorded for 20 min in supine position at baseline and after the AMSS sessions. Main outcomes were the changes in SBP and DBP, in the spectral indices of cardiac sympathetic (LFRRn.u.) and vagal (HFRR) modulatory activities, cardiac sympathovagal relationship (LF/HF), vascular sympathetic modulation (LFSAP) and arterial baroreflex sensitivity (sequence technique). Symbolic analysis of heart rate variability provided additional indices of cardiac sympathetic (0V%) and vagal (2UV%) modulation to the sinoatrial node. RESULTS After five AMSS trials a reduction in SBP (baseline: 131.2 ± 15.5 mmHg; post-AMSS: 122.4 ± 16.2 mmHg; P = 0.0004) and DBP (baseline: 73.2 ± 6.1 mmHg; post-AMSS: 68.9 ± 6.2 mmHg; P = 0.008) was observed. Post-AMSS, spectral and symbolic indices of cardiovascular sympathetic control decreased and arterial baroreflex sensitivity increased (baseline: 5.7 ± 1.3 ms/mmHg; post-AMSS: 11.27 ± 2.7 ms/mmHg). CONCLUSION AMSS sessions were effective in reducing BP, increasing baroreflex sensitivity and decreasing cardiovascular sympathetic modulation in Parkinson's disease patients. AMSS might be useful to control supine hypertension in Parkinson's disease.
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11
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Sabino-Carvalho JL, Vianna LC. Altered cardiorespiratory regulation during exercise in patients with Parkinson's disease: A challenging non-motor feature. SAGE Open Med 2020; 8:2050312120921603. [PMID: 32435491 PMCID: PMC7222646 DOI: 10.1177/2050312120921603] [Citation(s) in RCA: 19] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/03/2020] [Accepted: 04/03/2020] [Indexed: 01/27/2023] Open
Abstract
The incidence of Parkinson’s disease is increasing worldwide. The motor dysfunctions are the hallmark of the disease, but patients also experience non-motor impairments, and over 40% of the patients experience coexistent abnormalities, such as orthostatic hypotension. Exercise training has been suggested as a coping resource to alleviate Parkinson’s disease symptoms and delay disease progression. However, the body of knowledge is showing that the cardiovascular response to exercise in patients with Parkinson’s disease is altered. Adequate cardiovascular and hemodynamic adjustments to exercise are necessary to meet the metabolic demands of working skeletal muscle properly. Therefore, since Parkinson’s disease affects parasympathetic and sympathetic branches of the autonomic nervous system and the latter are crucial in ensuring these adjustments are adequately made, the understanding of these responses during exercise in this population is necessary. Several neural control mechanisms are responsible for the autonomic changes in the cardiovascular and hemodynamic systems seen during exercise. In this sense, the purpose of the present work is to review the current knowledge regarding the cardiovascular responses to dynamic and isometric/resistance exercise as well as the mechanisms by which the body maintains appropriate perfusion pressure to all organs during exercise in patients with Parkinson’s disease. Results from patients with Parkinson’s disease and animal models of Parkinson’s disease provide the reader with a well-rounded knowledge base. Through this, we will highlight what is known and not known about how the neural control of circulation is responding during exercise and the adaptations that occur when individuals exercise regularly.
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Affiliation(s)
- Jeann L Sabino-Carvalho
- NeuroV̇ASQ̇-Integrative Physiology Laboratory, Faculty of Physical Education, University of Brasília, Brasília, Brazil
| | - Lauro C Vianna
- NeuroV̇ASQ̇-Integrative Physiology Laboratory, Faculty of Physical Education, University of Brasília, Brasília, Brazil.,Graduate Program in Medical Sciences, Faculty of Medicine, University of Brasília, Brasília, Brazil
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12
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Erb MK, Karlin DR, Ho BK, Thomas KC, Parisi F, Vergara-Diaz GP, Daneault JF, Wacnik PW, Zhang H, Kangarloo T, Demanuele C, Brooks CR, Detheridge CN, Shaafi Kabiri N, Bhangu JS, Bonato P. mHealth and wearable technology should replace motor diaries to track motor fluctuations in Parkinson's disease. NPJ Digit Med 2020; 3:6. [PMID: 31970291 PMCID: PMC6969057 DOI: 10.1038/s41746-019-0214-x] [Citation(s) in RCA: 61] [Impact Index Per Article: 15.3] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/10/2019] [Accepted: 12/05/2019] [Indexed: 11/18/2022] Open
Abstract
Accurately monitoring motor and non-motor symptoms as well as complications in people with Parkinson's disease (PD) is a major challenge, both during clinical management and when conducting clinical trials investigating new treatments. A variety of strategies have been relied upon including questionnaires, motor diaries, and the serial administration of structured clinical exams like part III of the MDS-UPDRS. To evaluate the potential use of mobile and wearable technologies in clinical trials of new pharmacotherapies targeting PD symptoms, we carried out a project (project BlueSky) encompassing four clinical studies, in which 60 healthy volunteers (aged 23-69; 33 females) and 95 people with PD (aged 42-80; 37 females; years since diagnosis 1-24 years; Hoehn and Yahr 1-3) participated and were monitored in either a laboratory environment, a simulated apartment, or at home and in the community. In this paper, we investigated (i) the utility and reliability of self-reports for describing motor fluctuations; (ii) the agreement between participants and clinical raters on the presence of motor complications; (iii) the ability of video raters to accurately assess motor symptoms, and (iv) the dynamics of tremor, dyskinesia, and bradykinesia as they evolve over the medication cycle. Future papers will explore methods for estimating symptom severity based on sensor data. We found that 38% of participants who were asked to complete an electronic motor diary at home missed ~25% of total possible entries and otherwise made entries with an average delay of >4 h. During clinical evaluations by PD specialists, self-reports of dyskinesia were marked by ~35% false negatives and 15% false positives. Compared with live evaluation, the video evaluation of part III of the MDS-UPDRS significantly underestimated the subtle features of tremor and extremity bradykinesia, suggesting that these aspects of the disease may be underappreciated during remote assessments. On the other hand, live and video raters agreed on aspects of postural instability and gait. Our results highlight the significant opportunity for objective, high-resolution, continuous monitoring afforded by wearable technology to improve upon the monitoring of PD symptoms.
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Affiliation(s)
- M. Kelley Erb
- Early Clinical Development, Pfizer, Inc, Cambridge, MA USA
| | - Daniel R. Karlin
- Early Clinical Development, Pfizer, Inc, Cambridge, MA USA
- Department of Psychiatry, Tufts University School of Medicine, Boston, MA USA
| | - Bryan K. Ho
- Department of Neurology, Tufts University School of Medicine, Boston, MA USA
| | - Kevin C. Thomas
- Department of Anatomy and Neurobiology, Boston University School of Medicine, Boston, MA USA
| | - Federico Parisi
- Department of Physical Medicine and Rehabilitation, Harvard Medical School, Spaulding Rehabilitation Hospital, Charlestown, MA USA
- Wyss Institute for Biologically Inspired Engineering, Harvard University, Boston, MA USA
| | - Gloria P. Vergara-Diaz
- Department of Physical Medicine and Rehabilitation, Harvard Medical School, Spaulding Rehabilitation Hospital, Charlestown, MA USA
| | - Jean-Francois Daneault
- Department of Physical Medicine and Rehabilitation, Harvard Medical School, Spaulding Rehabilitation Hospital, Charlestown, MA USA
| | - Paul W. Wacnik
- Early Clinical Development, Pfizer, Inc, Cambridge, MA USA
| | - Hao Zhang
- Early Clinical Development, Pfizer, Inc, Cambridge, MA USA
| | | | | | - Chris R. Brooks
- Department of Anatomy and Neurobiology, Boston University School of Medicine, Boston, MA USA
| | - Craig N. Detheridge
- Department of Anatomy and Neurobiology, Boston University School of Medicine, Boston, MA USA
| | - Nina Shaafi Kabiri
- Department of Anatomy and Neurobiology, Boston University School of Medicine, Boston, MA USA
| | - Jaspreet S. Bhangu
- Department of Anatomy and Neurobiology, Boston University School of Medicine, Boston, MA USA
| | - Paolo Bonato
- Department of Physical Medicine and Rehabilitation, Harvard Medical School, Spaulding Rehabilitation Hospital, Charlestown, MA USA
- Wyss Institute for Biologically Inspired Engineering, Harvard University, Boston, MA USA
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13
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Carricarte Naranjo C, Marras C, Visanji NP, Cornforth DJ, Sanchez-Rodriguez L, Schüle B, Goldman SM, Estévez M, Stein PK, Lang AE, Jelinek HF, Machado A. Increased markers of cardiac vagal activity in leucine-rich repeat kinase 2-associated Parkinson's disease. Clin Auton Res 2019; 29:603-614. [PMID: 31444591 DOI: 10.1007/s10286-019-00632-w] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/03/2019] [Accepted: 08/10/2019] [Indexed: 02/07/2023]
Abstract
PURPOSE Cardiac autonomic dysfunction manifests as reduced heart rate variability (HRV) in idiopathic Parkinson's disease (PD), but no significant reduction has been found in PD patients who carry the LRRK2 mutation. Novel HRV features have not been investigated in these individuals. We aimed to assess cardiac autonomic modulation through standard and novel approaches to HRV analysis in individuals who carry the LRRK2 G2019S mutation. METHODS Short-term electrocardiograms were recorded in 14 LRRK2-associated PD patients, 25 LRRK2-non-manifesting carriers, 32 related non-carriers, 20 idiopathic PD patients, and 27 healthy controls. HRV measures were compared using regression modeling, controlling for age, sex, mean heart rate, and disease duration. Discriminant analysis highlighted the feature combination that best distinguished LRRK2-associated PD from controls. RESULTS Beat-to-beat and global HRV measures were significantly increased in LRRK2-associated PD patients compared with controls (e.g., deceleration capacity of heart rate: p = 0.006) and idiopathic PD patients (e.g., 8th standardized moment of the interbeat interval distribution: p = 0.0003), respectively. LRRK2-associated PD patients also showed significantly increased irregularity of heart rate dynamics, as quantified by Rényi entropy, when compared with controls (p = 0.002) and idiopathic PD patients (p = 0.0004). Ordinal pattern statistics permitted the identification of LRRK2-associated PD individuals with 93% sensitivity and 93% specificity. Consistent results were found in a subgroup of LRRK2-non-manifesting carriers when compared with controls. CONCLUSIONS Increased beat-to-beat HRV in LRRK2 G2019S mutation carriers compared with controls and idiopathic PD patients may indicate augmented cardiac autonomic cholinergic activity, suggesting early impairment of central vagal feedback loops in LRRK2-associated PD.
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Affiliation(s)
- Claudia Carricarte Naranjo
- Facultad de Biología, Universidad de La Habana, Calle 25 No. 455, Vedado, Plaza de la Revolución, 10400, La Habana, Cuba.
| | - Connie Marras
- Edmond J Safra Program in Parkinson's Disease and the Morton and Gloria Shulman Movement Disorders Clinic, Toronto Western Hospital, 399 Bathurst St, Toronto, ON, M5T 2S8, Canada
| | - Naomi P Visanji
- Edmond J Safra Program in Parkinson's Disease and the Morton and Gloria Shulman Movement Disorders Clinic, Toronto Western Hospital, 399 Bathurst St, Toronto, ON, M5T 2S8, Canada
| | - David J Cornforth
- School of Electrical Engineering and Computing, University of Newcastle, University Dr, Callaghan, NSW, 2308, Australia
| | - Lazaro Sanchez-Rodriguez
- Department of Radiology, University of Calgary, 330 Hospital Dr NW, Calgary, AB, T2N 4N1, Canada
| | - Birgitt Schüle
- Department of Pathology, Stanford School of Medicine, 300 Pasteur Dr, R271, Stanford, CA, 94305, USA
| | - Samuel M Goldman
- Department of Neurology, University of California, 3333 California St, San Francisco, CA, 94118, USA
| | - Mario Estévez
- Departamento de Neurofisiología Clínica, Instituto de Neurología y Neurocirugía, Calle 29 No. 139, Vedado, Plaza de la Revolución, 10400, La Habana, Cuba
| | - Phyllis K Stein
- School of Medicine, Washington University, 660 S Euclid Ave, St. Louis, MO, 63110, USA
| | - Anthony E Lang
- Edmond J Safra Program in Parkinson's Disease and the Morton and Gloria Shulman Movement Disorders Clinic, Toronto Western Hospital, 399 Bathurst St, Toronto, ON, M5T 2S8, Canada
| | - Herbert F Jelinek
- School of Community Health, Charles Sturt University, Elizabeth Mitchell Dr, Albury, NSW, 2640, Australia
| | - Andrés Machado
- Facultad de Biología, Universidad de La Habana, Calle 25 No. 455, Vedado, Plaza de la Revolución, 10400, La Habana, Cuba
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14
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Tessa C, Toschi N, Orsolini S, Valenza G, Lucetti C, Barbieri R, Diciotti S. Central modulation of parasympathetic outflow is impaired in de novo Parkinson's disease patients. PLoS One 2019; 14:e0210324. [PMID: 30653564 PMCID: PMC6336270 DOI: 10.1371/journal.pone.0210324] [Citation(s) in RCA: 17] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/01/2018] [Accepted: 12/20/2018] [Indexed: 01/09/2023] Open
Abstract
Task- and stimulus-based neuroimaging studies have begun to unveil the central autonomic network which modulates autonomic nervous system activity. In the present study, we aimed to evaluate the central autonomic network without the bias constituted by the use of a task. Additionally, we assessed whether this circuitry presents signs of dysregulation in the early stages of Parkinson’s disease (PD), a condition which may be associated with dysautonomia. We combined heart-rate-variability based methods for time-varying assessments of the autonomic nervous system outflow with resting-state fMRI in 14 healthy controls and 14 de novo PD patients, evaluating the correlations between fMRI time-series and the instantaneous high-frequency component of the heart-rate-variability power spectrum, a marker of parasympathetic outflow. In control subjects, the high-frequency component of the heart-rate-variability power spectrum was significantly anti-correlated with fMRI time-series in several cortical, subcortical and brainstem regions. This complex central network was not detectable in PD patients. In between-group analysis, we found that in healthy controls the brain activation related to the high-frequency component of the heart-rate-variability power spectrum was significantly less than in PD patients in the mid and anterior cingulum, sensorimotor cortex and supplementary motor area, insula and temporal lobe, prefrontal cortex, hippocampus and in a region encompassing posterior cingulum, precuneus and parieto-occipital cortex. Our results indicate that the complex central network which modulates parasympathetic outflow in the resting state is impaired in the early clinical stages of PD.
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Affiliation(s)
- Carlo Tessa
- Department of Radiology and Nuclear Medicine, Versilia Hospital, Azienda USL Toscana Nord Ovest, Lido di Camaiore (Lu), Italy
- * E-mail:
| | - Nicola Toschi
- Medical Physics Section, Department of Biomedicine and Prevention, University of Rome “Tor Vergata”, Rome, Italy
- Department of Radiology, Athinoula A. Martinos Center for Biomedical Imaging and Harvard Medical School, Massachusetts General Hospital, Boston, MA, United States of America
| | - Stefano Orsolini
- Department of Electrical, Electronic, and Information Engineering “Guglielmo Marconi”, University of Bologna, Cesena, Italy
| | - Gaetano Valenza
- Department of Anesthesia, Massachusetts General Hospital, Boston, MA, United States of America
- Research Center E. Piaggio and Department of Information Engineering, School of Engineering, University of Pisa, Pisa, Italy
| | - Claudio Lucetti
- Division of Neurology, Versilia Hospital, Azienda USL Toscana Nord Ovest, Lido di Camaiore (Lu), Italy
| | - Riccardo Barbieri
- Department of Anesthesia, Massachusetts General Hospital, Boston, MA, United States of America
- Department of Electronics, Informatics and Bioengineering, Politecnico di Milano, Milano, Italy
| | - Stefano Diciotti
- Department of Electrical, Electronic, and Information Engineering “Guglielmo Marconi”, University of Bologna, Cesena, Italy
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15
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Knudsen K, Hartmann B, Fedorova TD, Østergaard K, Krogh K, Møller N, Holst JJ, Borghammer P. Pancreatic Polypeptide in Parkinson's Disease: A Potential Marker of Parasympathetic Denervation. JOURNAL OF PARKINSONS DISEASE 2018; 7:645-652. [PMID: 28922171 DOI: 10.3233/jpd-171189] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
BACKGROUND AND OBJECTIVES Parkinson's disease (PD) patients experience several non-motor symptoms from the gastrointestinal tract that may partly be caused by parasympathetic deficiency. The pancreas is densely innervated by the vagus nerve, which mediates early meal-induced secretion of pancreatic polypeptide (PP). Early secretion after sham feeding has been validated as a marker of vagal integrity. Thus, the aim was to evaluate the ratio of increased PP plasma levels after sham feeding in PD and correlate findings with gastrointestinal transit time (GITT). METHODS Twenty-five PD patients and 17 controls were included. PP, insulin, and blood glucose levels were measured before, during, and after sham feeding with white bread and chocolate spread. GITT was measured using radiopaque markers. Furthermore, faeces samples were analyzed for pancreatic elastase enzyme as a marker of exocrine pancreatic function. RESULTS PD patients showed significantly lower PP ratio levels after sham feeding, which was most pronounced at 10 minutes. No significant association was seen between attenuated PP response and GITT in PD patients. No between-group differences were seen in glucose or insulin levels over time, but PD patients showed generally lower insulin levels compared to controls. No difference was found in faeces pancreatic elastase. CONCLUSIONS Early-to-moderate stage PD patients demonstrated significantly decreased PP response after sham feeding suggestive of vagal denervation.
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Affiliation(s)
- Karoline Knudsen
- Department of Nuclear Medicine and PET Centre, Aarhus University Hospital, Denmark
| | - Bolette Hartmann
- NNF Center for Basic Metabolic Research and Department of Medical Sciences, University of Copenhagen, Denmark
| | - Tatyana D Fedorova
- Department of Nuclear Medicine and PET Centre, Aarhus University Hospital, Denmark
| | | | - Klaus Krogh
- Department of Hepatology and Gastroenterology, Aarhus University Hospital, Denmark
| | - Niels Møller
- Medical Research Laboratory, Department of Clinical Medicine, Health, Aarhus University, Denmark and Department of Endocrinology and Internal Medicine, Aarhus University Hospital, Denmark
| | - Jens J Holst
- NNF Center for Basic Metabolic Research and Department of Medical Sciences, University of Copenhagen, Denmark
| | - Per Borghammer
- Department of Nuclear Medicine and PET Centre, Aarhus University Hospital, Denmark
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16
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Reinertsen E, Clifford GD. A review of physiological and behavioral monitoring with digital sensors for neuropsychiatric illnesses. Physiol Meas 2018; 39:05TR01. [PMID: 29671754 PMCID: PMC5995114 DOI: 10.1088/1361-6579/aabf64] [Citation(s) in RCA: 68] [Impact Index Per Article: 11.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/15/2023]
Abstract
Physiological, behavioral, and psychological changes associated with neuropsychiatric illness are reflected in several related signals, including actigraphy, location, word sentiment, voice tone, social activity, heart rate, and responses to standardized questionnaires. These signals can be passively monitored using sensors in smartphones, wearable accelerometers, Holter monitors, and multimodal sensing approaches that fuse multiple data types. Connection of these devices to the internet has made large scale studies feasible and is enabling a revolution in neuropsychiatric monitoring. Currently, evaluation and diagnosis of neuropsychiatric disorders relies on clinical visits, which are infrequent and out of the context of a patient's home environment. Moreover, the demand for clinical care far exceeds the supply of providers. The growing prevalence of context-aware and physiologically relevant digital sensors in consumer technology could help address these challenges, enable objective indexing of patient severity, and inform rapid adjustment of treatment in real-time. Here we review recent studies utilizing such sensors in the context of neuropsychiatric illnesses including stress and depression, bipolar disorder, schizophrenia, post traumatic stress disorder, Alzheimer's disease, and Parkinson's disease.
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Affiliation(s)
- Erik Reinertsen
- Department of Biomedical Engineering, Georgia Institute of Technology, Atlanta, GA, United States of America
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17
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ten Harmsen BL, van Rumund A, Aerts MB, Bergkamp MI, Esselink RA, Richard E, Meijer FJ, Bloem BR, van Wamelen DJ. Clinical correlates of cerebral white matter abnormalities in patients with Parkinson's disease. Parkinsonism Relat Disord 2018; 49:28-33. [DOI: 10.1016/j.parkreldis.2017.12.029] [Citation(s) in RCA: 22] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/05/2017] [Revised: 12/12/2017] [Accepted: 12/24/2017] [Indexed: 10/18/2022]
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18
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Ke JQ, Shao SM, Zheng YY, Fu FW, Zheng GQ, Liu CF. Sympathetic skin response and heart rate variability in predicting autonomic disorders in patients with Parkinson disease. Medicine (Baltimore) 2017; 96:e6523. [PMID: 28471954 PMCID: PMC5419900 DOI: 10.1097/md.0000000000006523] [Citation(s) in RCA: 25] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/27/2022] Open
Abstract
The purpose of this study was to evaluate sympathetic skin response (SSR) and heart rate variability (HRV) in determining autonomic nervous system (ANS) involvement in patients with Parkinson disease (PD). Forty-eight idiopathic PD patients and 30 healthy controls participated in this study. SSR, HRV, Unified Parkinson's Disease Rating Scale (UPDRS) III, the Scales for outcomes in Parkinson's Disease-Autonomic (SCOPA-AUT), Hoehn and Yahr (H&Y) scale were evaluated. Absent lower limb SSR was determined unilaterally in 2, bilaterally in 1 of 3 advanced PD patients; there was significant difference between PD and control groups in terms of the SSR (P < 0.01), significant prolonged SSR latencies and decreased SSR amplitudes from bilateral hands and feet. Significant difference was noted in HRV between PD and control groups except for root mean square of successive differences (rMSSD) and high-frequency (HF) power (P < 0.05). There was a significant different correlation between the parameters of SSR and the SCOPA-AUT, and between the parameters (except HF power) of HRV and the SCOPA-AUT. Some parameters of SSR were relevantly associated with HRV. The right hand SSR amplitude correlated positively with the (SD) of all R-R interval, total spectral power, very low frequency. The right foot amplitude correlated positively with total spectral power. Both SSR and HRV parameters are sensitive in determining ANS dysfunction not only in late but also in the early stage of PD, which can be used for early detection of autonomic dysfunction in patients with PD and have the potential to serve as electrophysiological markers of dysautonomia of PD.
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Affiliation(s)
- Jiang-Qiong Ke
- Department of Neurology and Suzhou Clinical Research Center of Neurological Disease, the Second Affiliated Hospital of Soochow University, Suzhou
- Department of Neurology, the Second Affiliated Hospital and Yuying Children's Hospital of Wenzhou Medical University, Wenzhou, China
| | - Sheng-Min Shao
- Department of Neurology, the Second Affiliated Hospital and Yuying Children's Hospital of Wenzhou Medical University, Wenzhou, China
| | - Yuan-Yuan Zheng
- Department of Neurology, the Second Affiliated Hospital and Yuying Children's Hospital of Wenzhou Medical University, Wenzhou, China
| | - Fang-Wang Fu
- Department of Neurology, the Second Affiliated Hospital and Yuying Children's Hospital of Wenzhou Medical University, Wenzhou, China
| | - Guo-Qing Zheng
- Department of Neurology, the Second Affiliated Hospital and Yuying Children's Hospital of Wenzhou Medical University, Wenzhou, China
| | - Chun-Feng Liu
- Department of Neurology and Suzhou Clinical Research Center of Neurological Disease, the Second Affiliated Hospital of Soochow University, Suzhou
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19
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Visanji NP, Bhudhikanok GS, Mestre TA, Ghate T, Udupa K, AlDakheel A, Connolly BS, Gasca-Salas C, Kern DS, Jain J, Slow EJ, Faust-Socher A, Kim S, Azhu Valappil R, Kausar F, Rogaeva E, William Langston J, Tanner CM, Schüle B, Lang AE, Goldman SM, Marras C. Heart rate variability in leucine-rich repeat kinase 2-associated Parkinson's disease. Mov Disord 2017; 32:610-614. [PMID: 28071824 DOI: 10.1002/mds.26896] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/05/2016] [Revised: 11/15/2016] [Accepted: 11/20/2016] [Indexed: 11/07/2022] Open
Abstract
BACKGROUND Heart rate variability is reduced in idiopathic PD, indicating cardiac autonomic dysfunction likely resulting from peripheral autonomic synucleinopathy. Little is known about heart rate variability in leucine-rich repeat kinase 2-associated PD. OBJECTIVES This study investigated heart rate variability in LRRK2-associated PD. METHODS Resting electrocardiograms were obtained from 20 individuals with LRRK2-associated PD, 37 nonmanifesting carriers, 48 related noncarriers, 26 idiopathic PD patients, and 32 controls. Linear regression modelling compared time and frequency domain values, adjusting for age, sex, heart rate, and disease duration. RESULTS Low-frequency power and the ratio of low-high frequency power were reduced in idiopathic PD versus controls (P < .008, P < .029 respectively). In contrast, individuals with LRRK2-associated PD were not statistically different from controls in any parameter measured. Furthermore, all parameters trended toward being higher in LRRK2-associated PD when compared with idiopathic PD. CONCLUSIONS Heart rate variability may remain intact in LRRK2-associated PD, adding to a growing literature supporting clinical-pathologic differences between LRRK2-associated and idiopathic PD. © 2017 International Parkinson and Movement Disorder Society.
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Affiliation(s)
- Naomi P Visanji
- Morton and Gloria Shulman Movement Disorders Centre and Edmund J Saffra Program in Parkinson's Disease, Tornto Western Hospital, Toronto, Ontario, Canada
| | | | - Tiago A Mestre
- Morton and Gloria Shulman Movement Disorders Centre and Edmund J Saffra Program in Parkinson's Disease, Tornto Western Hospital, Toronto, Ontario, Canada
| | - Taneera Ghate
- Morton and Gloria Shulman Movement Disorders Centre and Edmund J Saffra Program in Parkinson's Disease, Tornto Western Hospital, Toronto, Ontario, Canada
| | - Kaviraj Udupa
- Krembil Research Institute, Toronto Western Hospital, Toronto, Ontario, Canada
| | - Amaal AlDakheel
- Morton and Gloria Shulman Movement Disorders Centre and Edmund J Saffra Program in Parkinson's Disease, Tornto Western Hospital, Toronto, Ontario, Canada
| | - Barbara S Connolly
- Morton and Gloria Shulman Movement Disorders Centre and Edmund J Saffra Program in Parkinson's Disease, Tornto Western Hospital, Toronto, Ontario, Canada
| | - Carmen Gasca-Salas
- Morton and Gloria Shulman Movement Disorders Centre and Edmund J Saffra Program in Parkinson's Disease, Tornto Western Hospital, Toronto, Ontario, Canada
| | - Drew S Kern
- Morton and Gloria Shulman Movement Disorders Centre and Edmund J Saffra Program in Parkinson's Disease, Tornto Western Hospital, Toronto, Ontario, Canada
| | - Jennifer Jain
- Morton and Gloria Shulman Movement Disorders Centre and Edmund J Saffra Program in Parkinson's Disease, Tornto Western Hospital, Toronto, Ontario, Canada
| | - Elizabeth J Slow
- Morton and Gloria Shulman Movement Disorders Centre and Edmund J Saffra Program in Parkinson's Disease, Tornto Western Hospital, Toronto, Ontario, Canada
| | - Achinoam Faust-Socher
- Morton and Gloria Shulman Movement Disorders Centre and Edmund J Saffra Program in Parkinson's Disease, Tornto Western Hospital, Toronto, Ontario, Canada
| | - Sam Kim
- The Parkinson's Institute and Clinical Center, Sunnyvale, California, USA
| | | | - Farah Kausar
- The Parkinson's Institute and Clinical Center, Sunnyvale, California, USA
| | - Ekaterina Rogaeva
- Tanz Centre for Research in Neurodegenerative Diseases, University of Toronto, Toronto, Ontario, Canada
| | - J William Langston
- The Parkinson's Institute and Clinical Center, Sunnyvale, California, USA
| | - Caroline M Tanner
- University of California, San Francisco, San Francisco, California, USA.,San Francisco Veterans Affairs Health Care System, San Francisco, California, USA
| | - Birgitt Schüle
- The Parkinson's Institute and Clinical Center, Sunnyvale, California, USA
| | - Anthony E Lang
- Morton and Gloria Shulman Movement Disorders Centre and Edmund J Saffra Program in Parkinson's Disease, Tornto Western Hospital, Toronto, Ontario, Canada
| | - Samuel M Goldman
- University of California, San Francisco, San Francisco, California, USA.,San Francisco Veterans Affairs Health Care System, San Francisco, California, USA
| | - Connie Marras
- Morton and Gloria Shulman Movement Disorders Centre and Edmund J Saffra Program in Parkinson's Disease, Tornto Western Hospital, Toronto, Ontario, Canada
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20
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Videnovic A, Golombek D. Circadian Dysregulation in Parkinson's Disease. Neurobiol Sleep Circadian Rhythms 2017; 2:53-58. [PMID: 28713867 PMCID: PMC5509072 DOI: 10.1016/j.nbscr.2016.11.001] [Citation(s) in RCA: 38] [Impact Index Per Article: 5.4] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/31/2016] [Revised: 10/19/2016] [Accepted: 11/03/2016] [Indexed: 12/27/2022] Open
Abstract
Parkinson's disease (PD) is the second most common neurodegenerative disorder that affects over one million individuals in the US alone. PD is characterized by a plethora of motor and non-motor manifestations, resulting from a progressive degeneration of dopaminergic neurons and disbalance of several other neurotransmitters. A growing body of evidence points to significant alterations of the circadian system in PD. This is not surprising given the pivotal role that dopamine plays in circadian regulation as well as the role of circadian influences in dopamine metabolism. In this review we present basic and clinical investigations that examined the function of the circadian system in PD.
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Affiliation(s)
- Aleksandar Videnovic
- Movement Disorders Unit and Division of Sleep Medicine, Massachusetts General Hospital Harvard Medical School, MGH Neurological Clinical Research Institute, 165 Cambridge Street, Suite 600, Boston, MA 02446, United States
| | - Diego Golombek
- Department of Science and Technology, National University of Quilmes/CONICET, R.S. Peña 352, 1876 Bernal, Buenos Aires, Argentina
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A New Perspective for Parkinson's Disease: Circadian Rhythm. Neurosci Bull 2016; 33:62-72. [PMID: 27995565 DOI: 10.1007/s12264-016-0089-7] [Citation(s) in RCA: 45] [Impact Index Per Article: 5.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/29/2016] [Accepted: 10/14/2016] [Indexed: 12/31/2022] Open
Abstract
Circadian rhythm is manifested by the behavioral and physiological changes from day to night, which is controlled by the pacemaker and its regulator. The former is located at the suprachiasmatic nuclei (SCN) in the anterior hypothalamus, while the latter is composed of clock genes present in all tissues. Circadian desynchronization influences normal patterns of day-night rhythms such as sleep and alertness cycles, rest and activity cycles. Parkinson's disease (PD) exhibits diurnal fluctuations. Circadian dysfunction has been observed in PD patients and animal models, which may result in negative consequences to the homeostasis and even exacerbate the disease progression. Therefore, circadian therapies, including light stimulation, physical activity, dietary and social schedules, may be helpful for PD patients. However, the cellular and molecular mechanisms that underlie the circadian dysfunction in PD remain elusive. Further research on circadian patterns is needed. This article summarizes the existing research on the circadian rhythms in PD, focusing on the clinical symptom variations, molecular changes, as well as the available treatment options.
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Suzuki M, Nakamura T, Hirayama M, Ueda M, Katsuno M, Sobue G. Cardiac parasympathetic dysfunction in the early phase of Parkinson's disease. J Neurol 2016; 264:333-340. [PMID: 27900499 DOI: 10.1007/s00415-016-8348-0] [Citation(s) in RCA: 28] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/29/2016] [Revised: 11/16/2016] [Accepted: 11/17/2016] [Indexed: 01/02/2023]
Abstract
Cardiac parasympathetic function is strongly affected by aging. Although sympathetic dysfunction has been well documented in Parkinson's disease (PD), cardiac parasympathetic dysfunction has not been well studied. The objective of this study was to clarify the development of cardiac parasympathetic dysfunction in the early phase of PD and to explore the age-corrected correlation between cardiac parasympathetic dysfunction and cardiac sympathetic dysfunction. We reviewed 25 healthy controls and 56 patients with idiopathic PD of Hoehn and Yahr stages I-III. We evaluated cardiac parasympathetic function using the Valsalva ratio, the baroreflex sensitivity (BRS) and the coefficient of variation of RR intervals in the resting state (resting-CVRR) and during deep breathing (DB-CVRR). In addition, we measured cardiac 123I-metaiodobenzylguanidine (MIBG) uptake to investigate the relationship between cardiac sympathetic and parasympathetic dysfunction in PD. Compared with healthy controls, patients with PD showed significantly decreased cardiac parasympathetic parameters (resting-CVRR 2.8 ± 1.3 vs. 1.7 ± 0.6%, p < 0.001; DB-CVRR 5.8 ± 2.3 vs. 3.8 ± 1.7%, p < 0.001; Valsalva ratio 1.52 ± 0.26 vs. 1.34 ± 0.17, p < 0.01; BRS 10.6 ± 9.5 vs. 5.0 ± 5.4 ms/mmHg, p < 0.01). In particular, resting-CVRR and DB-CVRR were significantly decreased in the early phase of PD. In age-corrected analyses, none of the parasympathetic indices correlated with the delayed cardiac 123I-MIBG uptake. These observations indicate that cardiac parasympathetic dysfunction occurs in the early phase of PD, but not necessarily in parallel with cardiac sympathetic dysfunction.
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Affiliation(s)
- Masashi Suzuki
- Department of Neurology, Nagoya University Graduate School of Medicine, 65 Tsurumai-cho Showa-ku, Nagoya, 466-8550, Japan
| | - Tomohiko Nakamura
- Department of Neurology, Nagoya University Graduate School of Medicine, 65 Tsurumai-cho Showa-ku, Nagoya, 466-8550, Japan.
| | - Masaaki Hirayama
- Department of Pathophysiological Laboratory Science, Nagoya University Graduate School of Medicine, Nagoya, Japan
| | - Miki Ueda
- Department of Neurology, Nagoya University Graduate School of Medicine, 65 Tsurumai-cho Showa-ku, Nagoya, 466-8550, Japan
| | - Masahisa Katsuno
- Department of Neurology, Nagoya University Graduate School of Medicine, 65 Tsurumai-cho Showa-ku, Nagoya, 466-8550, Japan
| | - Gen Sobue
- Department of Neurology, Nagoya University Graduate School of Medicine, 65 Tsurumai-cho Showa-ku, Nagoya, 466-8550, Japan. .,Research Division of Dementia and Neurodegeneration Disease, Nagoya University Graduate School of Medicine, Nagoya, Japan.
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French IT, Muthusamy KA. A Review of Sleep and Its Disorders in Patients with Parkinson's Disease in Relation to Various Brain Structures. Front Aging Neurosci 2016; 8:114. [PMID: 27242523 PMCID: PMC4876118 DOI: 10.3389/fnagi.2016.00114] [Citation(s) in RCA: 41] [Impact Index Per Article: 5.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/04/2015] [Accepted: 04/29/2016] [Indexed: 11/13/2022] Open
Abstract
Sleep is an indispensable normal physiology of the human body fundamental for healthy functioning. It has been observed that Parkinson's disease (PD) not only exhibits motor symptoms, but also non-motor symptoms such as metabolic irregularities, altered olfaction, cardiovascular dysfunction, gastrointestinal complications and especially sleep disorders which is the focus of this review. A good understanding and knowledge of the different brain structures involved and how they function in the development of sleep disorders should be well comprehended in order to treat and alleviate these symptoms and enhance quality of life for PD patients. Therefore it is vital that the normal functioning of the body in relation to sleep is well understood before proceeding on to the pathophysiology of PD correlating to its symptoms. Suitable treatment can then be administered toward enhancing the quality of life of these patients, perhaps even discovering the cause for this disease.
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Affiliation(s)
- Isobel T French
- Department of Surgery, University Malaya Kuala Lumpur, Malaysia
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Song J, Kim J. Degeneration of Dopaminergic Neurons Due to Metabolic Alterations and Parkinson's Disease. Front Aging Neurosci 2016; 8:65. [PMID: 27065205 PMCID: PMC4811934 DOI: 10.3389/fnagi.2016.00065] [Citation(s) in RCA: 32] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/10/2016] [Accepted: 03/17/2016] [Indexed: 12/25/2022] Open
Abstract
The rates of metabolic diseases, such as type 2 diabetes mellitus (T2DM), obesity, and cardiovascular disease (CVD), markedly increase with age. In recent years, studies have reported an association between metabolic changes and various pathophysiological mechanisms in the central nervous system (CNS) in patients with metabolic diseases. Oxidative stress and hyperglycemia in metabolic diseases lead to adverse neurophysiological phenomena, including neuronal loss, synaptic dysfunction, and improper insulin signaling, resulting in Parkinson’s disease (PD). In addition, several lines of evidence suggest that alterations of CNS environments by metabolic changes influence the dopamine neuronal loss, eventually affecting the pathogenesis of PD. Thus, we reviewed recent findings relating to degeneration of dopaminergic neurons during metabolic diseases. We highlight the fact that using a metabolic approach to manipulate degeneration of dopaminergic neurons can serve as a therapeutic strategy to attenuate pathology of PD.
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Affiliation(s)
- Juhyun Song
- Department of Biomedical Engineering, Dongguk University Seoul, South Korea
| | - Jongpil Kim
- Department of Biomedical Engineering, Dongguk University Seoul, South Korea
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Yalcin A, Atmis V, Cengiz OK, Cinar E, Aras S, Varli M, Atli T. Evaluation of Cardiac Autonomic Functions in Older Parkinson's Disease Patients: a Cross-Sectional Study. Aging Dis 2016; 7:28-35. [PMID: 26816661 DOI: 10.14336/ad.2015.0819] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/15/2015] [Accepted: 08/19/2015] [Indexed: 12/16/2022] Open
Abstract
In Parkinson's disease (PD), non-motor symptoms may occur such as autonomic dysfunction. We aimed to evaluate both parasympathetic and sympathetic cardiovascular autonomic dysfunction in older PD cases. 84 PD cases and 58 controls, for a total of 142, participated in the study. Parasympathetic tests were performed using electrocardiography. Sympathetic tests were assessed by blood pressure measurement and 24-hour ambulatory blood pressure measurement. The prevalence of orthostatic hypotension in PD patients was 40.5% in PD patients and 24.1% in the control group (p> 0.05). The prevalence of postprandial hypotension was 47.9% in the PD group and 27.5% in the controls (p <0.05). The prevalence of impairment in heart rate response to deep breathing was 26.2% in the PD group and 6.9% in the control group (p <0.05). The prevalence of postprandial hypotension in PD with orthostatic hypotension was 94% and 16% in PD patients without orthostatic hypotension (p <0.05). The prevalence of impairment in heart rate response to deep breathing was 52.9% in PD patients with orthostatic hypotension and 8% in PD cases without orthostatic hypotension (p<0.05). The prevalence of impairment in heart rate response to postural change was 41% in PD cases with orthostatic hypotension and 12% in PD cases without orthostatic hypotension (p <0.05).Although there are tests for assessing cardiovascular autonomic function that are more reliable, they are more complicated, and evaluation of orthostatic hypotension by blood pressure measurement and cardiac autonomic tests by electrocardiography are recommended since these tests are cheap and easy.
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Affiliation(s)
- Ahmet Yalcin
- Department of Geriatric Medicine, Ankara University School of Medicine İbn-I Sina Hospital, Samanpazarı, Altındağ, Ankara, Turkey
| | - Volkan Atmis
- Department of Geriatric Medicine, Ankara University School of Medicine İbn-I Sina Hospital, Samanpazarı, Altındağ, Ankara, Turkey
| | - Ozlem Karaarslan Cengiz
- Department of Geriatric Medicine, Ankara University School of Medicine İbn-I Sina Hospital, Samanpazarı, Altındağ, Ankara, Turkey
| | - Esat Cinar
- Department of Geriatric Medicine, Ankara University School of Medicine İbn-I Sina Hospital, Samanpazarı, Altındağ, Ankara, Turkey
| | - Sevgi Aras
- Department of Geriatric Medicine, Ankara University School of Medicine İbn-I Sina Hospital, Samanpazarı, Altındağ, Ankara, Turkey
| | - Murat Varli
- Department of Geriatric Medicine, Ankara University School of Medicine İbn-I Sina Hospital, Samanpazarı, Altındağ, Ankara, Turkey
| | - Teslime Atli
- Department of Geriatric Medicine, Ankara University School of Medicine İbn-I Sina Hospital, Samanpazarı, Altındağ, Ankara, Turkey
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Myocardial (123)I-MIBG Uptake and Cardiovascular Autonomic Function in Parkinson's Disease. PARKINSONS DISEASE 2015; 2015:805351. [PMID: 26649224 PMCID: PMC4663005 DOI: 10.1155/2015/805351] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 08/13/2015] [Accepted: 10/25/2015] [Indexed: 11/17/2022]
Abstract
Introduction. Patients with Parkinson's disease (PD) showed reduced myocardial 123I-MIBG uptake, which may affect autonomic regulation. We investigated correlation between MIBC accumulation and cardiovascular autonomic function in PD. Methods. We performed myocardial MIBG scintigraphy, heart rate variability (HRV) analysis, and the head-up tilt test (HUT) in 50 PD patients (66.4 ± 7.8 years; duration 5.5 ± 5.9 years). Autonomic function tests were also performed in 50 healthy controls (66.5 ± 8.9 years). As HRV parameters, a high-frequency power (HF, 0.15–0.4 Hz), a low-frequency power (LF, 0.04–0.15 Hz), and LF/HF ratio were used. Results. Our PD patients had a significant reduction in LF and HF compared with the controls (P = 0.005 and P = 0.01). In HUT, systolic and diastolic blood pressure falls in the PD group were significantly greater than those in the controls (P = 0.02 and P = 0.02). The washout rate of MIBG was negatively correlated with blood pressure changes during HUT. Conclusion. Our PD patients showed reduced HRV, blood pressure dysregulation, and reduced MIBG accumulation, which was correlated with blood pressure dysregulation. Orthostatic hypotension in PD may be mainly caused by sympathetic postganglionic degeneration.
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Abstract
Circadian rhythms have a major role in physiology and behavior. Circadian disruption has negative consequences for physiologic homeostasis at molecular, cellular, organ-system, and whole-organism levels. The onset of many cerebrovascular insults shows circadian temporal trends. Impaired sleep-wake cycle, the most robust output rhythms of the circadian system, is significantly affected by neurodegenerative disorders, may precede them by decades, and may also affect their progression. Emerging evidence suggests that circadian disruption may be a risk factor for these neurologic disorders. This article discusses the implications of circadian rhythms in brain disorders, with an emphasis on cerebrovascular and neurodegenerative disorders.
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Affiliation(s)
- Aleksandar Videnovic
- Department of Neurology, Massachusetts General Hospital, Harvard Medical School, 165 Cambridge Street, Suite 600, Boston, MA 02114, USA.
| | - Phyllis C Zee
- Northwestern University Feinberg School of Medicine, Abbott Hall 11th Floor, 710 North Lake Shore Drive, Chicago, IL 60611, USA
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Visanji N, Marras C. The relevance of pre-motor symptoms in Parkinson’s disease. Expert Rev Neurother 2015; 15:1205-17. [DOI: 10.1586/14737175.2015.1083423] [Citation(s) in RCA: 25] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
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Rocchi C, Pierantozzi M, Galati S, Chiaravalloti A, Pisani V, Prosperetti C, Lauretti B, Stampanoni Bassi M, Olivola E, Schillaci O, Stefani A. Autonomic Function Tests and MIBG in Parkinson's Disease: Correlation to Disease Duration and Motor Symptoms. CNS Neurosci Ther 2015. [PMID: 26205884 DOI: 10.1111/cns.12437] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/18/2023] Open
Abstract
AIMS Disorders of the autonomic nervous system (ANS) have a variable degree of clinical relevance in patients with Parkinson's disease (PD). Here, we assessed whether subclinical autonomic dysfunction, as evaluated by a complete battery of autonomic function tests (AFTs), correlates with PD progression. METHODS A series of 27 consecutive patients with PD underwent extensive ANS investigations including the head-up tilt test (HUTT), Valsalva maneuver, deep-breathing test, and handgrip test (HG); further, they performed 123I-meta-iodobenzylguanidine (MIBG) scintigraphy. RESULTS Seven of the 27 patients showed orthostatic hypotension (OH) at HUTT and pathological responses to the deep-breathing and HG test and Valsalva maneuver. The majority of the remaining 20 patients with PD showed pathological responses to deep-breathing (n = 13) and/or HG (n = 11). Only 3 of 27 suffered relevant OH. MIBG uptake of myocardium was decreased in 19 patients with PD (H/M ratio 1.3 ± 0.2). Prolonged clinical observation (>3 years), persistent response to levodopa, and MIBG repetition allowed us to exclude negative MIBG as attributable to atypical Parkinsonism. MIBG uptake did not correlate with OH and other AFTs. Both HG test response and MIBG did correlate with the Unified Parkinson's Disease Rating Scale (UPDRS) motor score and disease duration. A positive correlation emerged between diastolic blood pressure (DBP) response to HG test and MIBG and with systolic blood pressure (SBP) response at tilt test. CONCLUSIONS Our investigation suggests that ANS impairment affects the majority of patients with PD, even those PD patients showing negative MIBG, irrespective of clinical neurovegetative symptoms. The strict correlation that has been revealed with disease progression supports the routine utilization of AFTs as a reliable and inexpensive tool for monitoring peripheral sympathetic dysfunction in PD and optimizing therapy.
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Affiliation(s)
- Camilla Rocchi
- Department of System Medicine, Neurology, University of Rome "Tor Vergata", Rome, Italy
| | | | | | | | | | | | - Benedetta Lauretti
- Department of System Medicine, Neurology, University of Rome "Tor Vergata", Rome, Italy
| | | | - Enrica Olivola
- Department of System Medicine, Neurology, University of Rome "Tor Vergata", Rome, Italy
| | - Orazio Schillaci
- Department of Biomedicine and Prevention, University of Rome Tor Vergata, Rome, Italy
| | - Alessandro Stefani
- Department of System Medicine, Neurology, University of Rome "Tor Vergata", Rome, Italy.,IRCCS Fondazione S. Lucia, Rome, Italy
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The range and nature of non-motor symptoms in drug-naive Parkinson's disease patients: a state-of-the-art systematic review. NPJ PARKINSONS DISEASE 2015; 1:15013. [PMID: 28725682 PMCID: PMC5516558 DOI: 10.1038/npjparkd.2015.13] [Citation(s) in RCA: 58] [Impact Index Per Article: 6.4] [Reference Citation Analysis] [Abstract] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 03/09/2015] [Revised: 05/16/2015] [Accepted: 06/03/2015] [Indexed: 12/21/2022]
Abstract
Non-motor symptoms (NMS) are a key component of Parkinson’s disease (PD). A range of NMS, most notably impaired sense of smell, sleep dysfunction, and dysautonomia are present from the ‘pre-motor’ phase to the final palliative stage. Theories as to the pathogenesis of PD such as those proposed by Braak and others also support the occurrence of NMS in PD years before motor symptoms start. However, research addressing the range and nature of NMS in PD has been confounded by the fact that many NMS arise as part of drug-related side effects. Thus, drug-naive PD (DNPD) patients provide an ideal population to study the differences in the presentation of NMS. The aim of this paper is therefore to systematically review all the available studies of NMS in DNPD patients. We believe this is the first review of its kind. The current review confirms the increasing research being conducted into NMS in DNPD patients as well as the necessity for further investigation into less-studied NMS, such as pain. Moreover, the data confirms non-motor heterogeneity among PD patients, and, therefore, further research into the concept of non-motor subtyping is encouraged. The review suggests that the clinical assessment of NMS should be integral to any assessment of PD in clinical and research settings.
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Kasanuki K, Iseki E, Fujishiro H, Ando S, Sugiyama H, Kitazawa M, Chiba Y, Sato K, Arai H. Impaired heart rate variability in patients with dementia with Lewy bodies: Efficacy of electrocardiogram as a supporting diagnostic marker. Parkinsonism Relat Disord 2015; 21:749-54. [DOI: 10.1016/j.parkreldis.2015.04.024] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/10/2015] [Revised: 04/27/2015] [Accepted: 04/28/2015] [Indexed: 10/23/2022]
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Chang JS, Hwang SSH, Yi SH, Kim Y, Lee YS, Kim YS, Jung HY. Evaluating subjective domains of antipsychotic-induced adverse effects using heart rate variability. Psychiatry Clin Neurosci 2015; 69:283-91. [PMID: 25066617 DOI: 10.1111/pcn.12226] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/22/2014] [Revised: 06/18/2014] [Accepted: 07/23/2014] [Indexed: 11/26/2022]
Abstract
AIMS Antipsychotic-induced autonomic dysregulation may lead to a wide range of subjective side-effects in schizophrenia patients. Using heart rate variability (HRV) measures, we prospectively examined the relationship between subjective side-effects and cardiac autonomic regulation in unmedicated schizophrenia patients. METHODS Forty-five unmedicated schizophrenia patients were assessed for antipsychotic-associated side-effects and HRV parameters at baseline and after 6 weeks of treatment. Psychiatric symptoms and subjective side-effects were assessed using the Positive and Negative Syndrome Scale (PANSS) and the Liverpool University Neuroleptic Side-effect Rating Scale (LUNSERS). RESULTS Correlations between subjective adverse effects and HRV measures at baseline and at week 6 varied. Nonetheless, the changes in the psychic side-effects domain were significantly correlated with the changes in time-domain HRV measures and sample entropy (SampEn). In addition, the change in SampEn was significantly associated with that in the scores of extrapyramidal, anticholinergic, miscellaneous, and red herring domains as well as the mean total LUNSERS score. CONCLUSION Baseline HRV measures may predict clinical response and adverse events associated with treatment adherence. Also, subjective side-effects may correspond well with the changes in neurocardiac dynamics, and the changes in SampEn may effectively reflect subjective discomfort in patients receiving antipsychotic treatment.
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Affiliation(s)
- Jae Seung Chang
- Department of Psychiatry, Seoul National University Bundang Hospital, Seongnam, Korea
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Gjerløff T, Fedorova T, Knudsen K, Munk OL, Nahimi A, Jacobsen S, Danielsen EH, Terkelsen AJ, Hansen J, Pavese N, Brooks DJ, Borghammer P. Imaging acetylcholinesterase density in peripheral organs in Parkinson's disease with 11C-donepezil PET. ACTA ACUST UNITED AC 2014; 138:653-63. [PMID: 25539902 DOI: 10.1093/brain/awu369] [Citation(s) in RCA: 110] [Impact Index Per Article: 11.0] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/27/2023]
Abstract
Parkinson's disease is associated with early parasympathetic dysfunction leading to constipation and gastroparesis. It has been suggested that pathological α-synuclein aggregations originate in the gut and ascend to the brainstem via the vagus. Our understanding of the pathogenesis and time course of parasympathetic denervation in Parkinson's disease is limited and would benefit from a validated imaging technique to visualize the integrity of parasympathetic function. The positron emission tomography tracer 5-[(11)C]-methoxy-donepezil was recently validated for imaging acetylcholinesterase density in the brain and peripheral organs. Donepezil is a high-affinity ligand for acetylcholinesterase-the enzyme that catabolizes acetylcholine in cholinergic synapses. Acetylcholinesterase histology has been used for many years for visualizing cholinergic neurons. Using 5-[(11)C]-methoxy-donepezil positron emission tomography, we studied 12 patients with early-to-moderate Parkinson's disease (three female; age 64 ± 9 years) and 12 age-matched control subjects (three female; age 62 ± 8 years). We collected clinical information about motor severity, constipation, gastroparesis, and other parameters. Heart rate variability measurements and gastric emptying scintigraphies were performed in all subjects to obtain objective measures of parasympathetic function. We detected significantly decreased (11)C-donepezil binding in the small intestine (-35%; P = 0.003) and pancreas (-22%; P = 0.001) of the patients. No correlations were found between the (11)C-donepezil signal and disease duration, severity of constipation, gastric emptying time, and heart rate variability. In Parkinson's disease, the dorsal motor nucleus of the vagus undergoes severe degeneration and pathological α-synuclein aggregations are also seen in nerve fibres innervating the gastro-intestinal tract. In contrast, the enteric nervous system displays little or no loss of cholinergic neurons. Decreases in (11)C-donepezil binding may, therefore, represent a marker of parasympathetic denervation of internal organs, but further validation studies are needed.
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Affiliation(s)
- Trine Gjerløff
- 1 Department of Nuclear Medicine and PET Centre, Aarhus University Hospital, Denmark
| | - Tatyana Fedorova
- 1 Department of Nuclear Medicine and PET Centre, Aarhus University Hospital, Denmark
| | - Karoline Knudsen
- 1 Department of Nuclear Medicine and PET Centre, Aarhus University Hospital, Denmark
| | - Ole L Munk
- 1 Department of Nuclear Medicine and PET Centre, Aarhus University Hospital, Denmark
| | - Adjmal Nahimi
- 1 Department of Nuclear Medicine and PET Centre, Aarhus University Hospital, Denmark
| | - Steen Jacobsen
- 1 Department of Nuclear Medicine and PET Centre, Aarhus University Hospital, Denmark
| | | | | | - John Hansen
- 3 Department of Health Science and Technology, Aalborg University, Denmark
| | - Nicola Pavese
- 1 Department of Nuclear Medicine and PET Centre, Aarhus University Hospital, Denmark 4 Division of Brain Sciences, Imperial College, London, UK
| | - David J Brooks
- 1 Department of Nuclear Medicine and PET Centre, Aarhus University Hospital, Denmark 4 Division of Brain Sciences, Imperial College, London, UK
| | - Per Borghammer
- 1 Department of Nuclear Medicine and PET Centre, Aarhus University Hospital, Denmark
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Videnovic A, Lazar AS, Barker RA, Overeem S. 'The clocks that time us'--circadian rhythms in neurodegenerative disorders. Nat Rev Neurol 2014; 10:683-93. [PMID: 25385339 PMCID: PMC4344830 DOI: 10.1038/nrneurol.2014.206] [Citation(s) in RCA: 254] [Impact Index Per Article: 25.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/02/2023]
Abstract
Circadian rhythms are physiological and behavioural cycles generated by an endogenous biological clock, the suprachiasmatic nucleus. The circadian system influences the majority of physiological processes, including sleep-wake homeostasis. Impaired sleep and alertness are common symptoms of neurodegenerative disorders, and circadian dysfunction might exacerbate the disease process. The pathophysiology of sleep-wake disturbances in these disorders remains largely unknown, and is presumably multifactorial. Circadian rhythm dysfunction is often observed in patients with Alzheimer disease, in whom it has a major impact on quality of life and represents one of the most important factors leading to institutionalization of patients. Similarly, sleep and circadian problems represent common nonmotor features of Parkinson disease and Huntington disease. Clinical studies and experiments in animal models of neurodegenerative disorders have revealed the progressive nature of circadian dysfunction throughout the course of neurodegeneration, and suggest strategies for the restoration of circadian rhythmicity involving behavioural and pharmacological interventions that target the sleep-wake cycle. In this Review, we discuss the role of the circadian system in the regulation of the sleep-wake cycle, and outline the implications of disrupted circadian timekeeping in neurodegenerative diseases.
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Affiliation(s)
- Aleksandar Videnovic
- Neurological Clinical Research Institute, Department of Neurology, Massachusetts General Hospital, Harvard Medical School, 165 Cambridge Street Suite 650, Boston, MA 02114, USA
| | - Alpar S Lazar
- University of Cambridge, John van Geest Centre for Brain Repair, Department of Clinical Neurosciences, Forvie Site, Cambridge CB2 2PY, UK
| | - Roger A Barker
- University of Cambridge, John van Geest Centre for Brain Repair, Department of Clinical Neurosciences, Forvie Site, Cambridge CB2 2PY, UK
| | - Sebastiaan Overeem
- Department of Neurology, Radboud University Medical Centre, P.O. Box 9101, Nijmegen 6500 HB, Netherlands
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dos Santos AB, Kohlmeier KA, Barreto GE. Are Sleep Disturbances Preclinical Markers of Parkinson’s Disease? Neurochem Res 2014; 40:421-7. [DOI: 10.1007/s11064-014-1488-7] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/14/2014] [Revised: 11/21/2014] [Accepted: 11/24/2014] [Indexed: 10/24/2022]
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36
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Goldstein DS. Concepts of scientific integrative medicine applied to the physiology and pathophysiology of catecholamine systems. Compr Physiol 2014; 3:1569-610. [PMID: 24265239 DOI: 10.1002/cphy.c130006] [Citation(s) in RCA: 21] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/20/2022]
Abstract
This review presents concepts of scientific integrative medicine and relates them to the physiology of catecholamine systems and to the pathophysiology of catecholamine-related disorders. The applications to catecholamine systems exemplify how scientific integrative medicine links systems biology with integrative physiology. Concepts of scientific integrative medicine include (i) negative feedback regulation, maintaining stability of the body's monitored variables; (ii) homeostats, which compare information about monitored variables with algorithms for responding; (iii) multiple effectors, enabling compensatory activation of alternative effectors and primitive specificity of stress response patterns; (iv) effector sharing, accounting for interactions among homeostats and phenomena such as hyperglycemia attending gastrointestinal bleeding and hyponatremia attending congestive heart failure; (v) stress, applying a definition as a state rather than as an environmental stimulus or stereotyped response; (vi) distress, using a noncircular definition that does not presume pathology; (vii) allostasis, corresponding to adaptive plasticity of feedback-regulated systems; and (viii) allostatic load, explaining chronic degenerative diseases in terms of effects of cumulative wear and tear. From computer models one can predict mathematically the effects of stress and allostatic load on the transition from wellness to symptomatic disease. The review describes acute and chronic clinical disorders involving catecholamine systems-especially Parkinson disease-and how these concepts relate to pathophysiology, early detection, and treatment and prevention strategies in the post-genome era.
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Affiliation(s)
- David S Goldstein
- Clinical Neurocardiology Section, Clinical Neurosciences Program, Division of Intramural Research, National Institute of Neurological Disorders and Stroke, National Institutes of Health, Bethesda, Maryland
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Delgado G, Estañol B, Rodríguez-Violante M, Martínez-Memije R, Infante-Vázquez Ó, Bertado-Ramírez N. Cardiovascular variability in Mexican patients with Parkinson's disease. ARQUIVOS DE NEURO-PSIQUIATRIA 2014; 72:762-7. [DOI: 10.1590/0004-282x20140125] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/28/2014] [Accepted: 07/15/2014] [Indexed: 11/22/2022]
Abstract
Cardiovascular variability (CVV) has been evaluated in patients with Parkinson's disease (PD) in other countries and exhibit ethnic differences. Objective We investigated heart rate variability (HRV) and blood pressure variability (BPV) in Mexican patients with PD. Method We further compared HRV and BPV between this group and young healthy controls (YHC) in order to estimate, for the first time in our country, the magnitude of the difference. Twenty patients were examined. Time- and frequency-domain CVV parameters were studied during supine rest (SR), active standing (AS) and controlled breathing. These measurements were compared to those of 20 YHC. Results In the three conditions tested, our study showed a decrease in almost all HRV parameters in PD patients; on the contrary, decreased BPV parameters were found less frequently and only during SR and AS. Conclusion Our results indicate that HRV is impaired in PD. Some BPV parameters are also diminished.
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Affiliation(s)
- Guillermo Delgado
- National Institute of Medical Sciences and Nutrition Salvador Zubirán, Mexico
| | - Bruno Estañol
- National Institute of Medical Sciences and Nutrition Salvador Zubirán, Mexico
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Camargo SMR, Vuille-dit-Bille RN, Mariotta L, Ramadan T, Huggel K, Singer D, Götze O, Verrey F. The Molecular Mechanism of Intestinal Levodopa Absorption and Its Possible Implications for the Treatment of Parkinson’s Disease. J Pharmacol Exp Ther 2014; 351:114-23. [DOI: 10.1124/jpet.114.216317] [Citation(s) in RCA: 51] [Impact Index Per Article: 5.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/29/2022] Open
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Time- and frequency-domain parameters of heart rate variability and sympathetic skin response in Parkinson's disease. J Neural Transm (Vienna) 2014; 122:419-25. [PMID: 25038873 DOI: 10.1007/s00702-014-1276-1] [Citation(s) in RCA: 33] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/02/2013] [Accepted: 07/15/2014] [Indexed: 10/25/2022]
Abstract
The autonomic nervous system (ANS) is regularly affected in Parkinson's disease (PD). Information on autonomic dysfunction can be derived from e.g. altered heart rate variability (HRV) and sympathetic skin response (SSR). Such parameters can be quantified easily and measured repeatedly which might be helpful for evaluating disease progression and therapeutic outcome. In this 2-center study, HRV and SSR of 45 PD patients and 26 controls were recorded. HRV was measured during supine metronomic breathing and analyzed in time- and frequency-domains. SSR was evoked by repetitive auditory stimulation. Various ANS parameters were compared (1) between patients and healthy controls, (2) to clinical scales (Unified Parkinson's disease rating scale, Mini-Mental State Examination, Becks Depression Inventory), and (3) to disease duration. Root mean square of successive differences (RMSSD) and low frequency/high frequency (LF/HF) ratio differed significantly between PD and controls. Both, HRV and SSR parameters showed low or no association with clinical scores. Time-domain parameters tended to be affected already at early PD stages but did not consistently change with longer disease duration. In contrast, frequency-domain parameters were not altered in early PD phases but tended to be lower (LF, LF/HF ratio), respectively higher (HF) with increasing disease duration. This report confirms previous results of altered ANS parameters in PD. In addition, it suggests that (1) these ANS parameters are not relevantly associated with motor, behavioral, and cognitive changes in PD, (2) time-domain parameters are useful for the assessment of early PD, and (3) frequency-domain parameters are more closely associated with disease duration.
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Bassani T, Bari V, Marchi A, Tassin S, Dalla Vecchia L, Canesi M, Barbic F, Furlan R, Porta A. Model-free causality analysis of cardiovascular variability detects the amelioration of autonomic control in Parkinson's disease patients undergoing mechanical stimulation. Physiol Meas 2014; 35:1397-408. [PMID: 24875165 DOI: 10.1088/0967-3334/35/7/1397] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
We tested the hypothesis that causality analysis, applied to the spontaneous beat-to-beat variability of heart period (HP) and systolic arterial pressure (SAP), can identify the improvement of autonomic control linked to plantar mechanical stimulation in patients with Parkinson's disease (PD). A causality index, measuring the strength of the association from SAP to HP variability, and derived according to the Granger paradigm (i.e. SAP causes HP if the inclusion of SAP into the set of signals utilized to describe cardiovascular interactions improves the prediction of HP series), was calculated using both linear model-based (MB) and nonlinear model-free (MF) approaches. Univariate HP and SAP variability indices in time and frequency domains, and bivariate descriptors of the HP-SAP variability interactions were computed as well. We studied ten PD patients (age range: 57-78 years; Hoehn-Yahr scale: 2-3; six males, four females) without orthostatic hypotension or symptoms of orthostatic intolerance and 'on-time' according to their habitual pharmacological treatment. PD patients underwent recordings at rest in a supine position and during a head-up tilt before, and 24 h after, mechanical stimulation was applied to the plantar surface of both feet. The MF causality analysis indicated a greater involvement of baroreflex in regulating HP-SAP variability interactions after mechanical stimulation. Remarkably, MB causality and more traditional univariate or bivariate techniques could not detect changes in cardiovascular regulation after mechanical stimulation, thus stressing the importance of accounting for nonlinear dynamics in PD patients. Due to the higher statistical power of MF causality we suggest its exploitation to monitor the baroreflex control improvement in PD patients, and we encourage the clinical application of the Granger causality approach to evaluate the modification of the autonomic control in relation to the application of a pharmacological treatment, a rehabilitation procedure or external intervention.
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Affiliation(s)
- Tito Bassani
- Department of Internal Medicine, Humanitas Clinical and Research Center, Rozzano, Milan, Italy
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Perez-Lloret S, Rey MV, Pavy-Le Traon A, Rascol O. Droxidopa for the treatment of neurogenic orthostatic hypotension and other symptoms of neurodegenerative disorders. Expert Opin Orphan Drugs 2014. [DOI: 10.1517/21678707.2014.901167] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/06/2023]
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Orthostatic hypotension in patients with Parkinson's disease and atypical parkinsonism. PARKINSONS DISEASE 2014; 2014:475854. [PMID: 24634790 PMCID: PMC3929346 DOI: 10.1155/2014/475854] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 10/15/2013] [Accepted: 12/11/2013] [Indexed: 12/23/2022]
Abstract
Orthostatic hypotension (OH) is one of the commonly occurring nonmotor symptoms in patients with idiopathic Parkinson's disease (IPD) and atypical parkinsonism (AP). We aimed to review current evidences on epidemiology, diagnosis, treatment, and prognosis of OH in patients with IPD and AP. Major electronic medical databases were assessed including PubMed/MEDLINE and Embase up to February 2013. English-written original or review articles with keywords such as "Parkinson's disease," "atypical parkinsonism," and "orthostatic hypotension" were searched for relevant evidences. We addressed different issues such as OH definition, epidemiologic characteristics, pathophysiology, testing and diagnosis, risk factors for symptomatic OH, OH as an early sign of IPD, prognosis, and treatment options of OH in parkinsonian syndromes. Symptomatic OH is present in up to 30% of IPD, 80% of multiple system atrophy (MSA), and 27% of other AP patients. OH may herald the onset of PD before cardinal motor symptoms and our review emphasises the importance of its timely diagnosis (even as one preclinical marker) and multifactorial treatment, starting with patient education and lifestyle approach. Advancing age, male sex, disease severity, and duration and subtype of motor symptoms are predisposing factors. OH increases the risk of falls, which affects the quality of life in PD patients.
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Perez-Lloret S, Rey MV, Pavy-Le Traon A, Rascol O. Orthostatic hypotension in Parkinson’s disease. Neurodegener Dis Manag 2013. [DOI: 10.2217/nmt.13.30] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/15/2022] Open
Abstract
SUMMARY Orthostatic hypotension (OH) is a frequent non-motor symptom in Parkinson’s disease (PD), affecting between 22.9 and 38.4% of patients. In PD, OH is related to an increased risk of falls, and possibly to cognitive dysfunction and increased mortality. These data emphasize the importance of its prompt recognition and treatment. OH is related to pre- and post-ganglionic adrenergic denervation, but other factors, such as drugs, heat, meals or alcohol intake, might also induce or aggravate it. Evidence about the efficacy and safety of pharmacological or nonpharmacological strategies for OH treatment in PD is weak. Nonpharmacological measures include liberal addition of salt to the diet, exercise, compression stockings or physical maneuvers. Severe cases may be treated with midodrine or fludrocortisone. Some results suggest that droxidopa and fipamezole may be effective treatments. We finish this review article by discussing the most important unanswered questions about PD-related OH, which may be the focus of future research.
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Affiliation(s)
- Santiago Perez-Lloret
- Clinical Pharmacology & Epidemiology Laboratory, Pontifical Catholic University, Buenos Aires, Argentina
- Departments of Clinical Pharmacology & Neurosciences, & Clinical Investigation Center CIC9302, Institut National de la Santé & de la Recherche Médicale & University Hospital, University of Toulouse III, 37 Allées Jules Guesde, 31000, Toulouse, France
| | - María Verónica Rey
- Departments of Clinical Pharmacology & Neurosciences, & Clinical Investigation Center CIC9302, Institut National de la Santé & de la Recherche Médicale & University Hospital, University of Toulouse III, 37 Allées Jules Guesde, 31000, Toulouse, France
- Clinical Pharmacology & Epidemiology Laboratory, Pontifical Catholic University, Buenos Aires, Argentina
| | - Anne Pavy-Le Traon
- Departments of Clinical Pharmacology & Neurosciences, & Clinical Investigation Center CIC9302, Institut National de la Santé & de la Recherche Médicale & University Hospital, University of Toulouse III, 37 Allées Jules Guesde, 31000, Toulouse, France
| | - Olivier Rascol
- Departments of Clinical Pharmacology & Neurosciences, & Clinical Investigation Center CIC9302, Institut National de la Santé & de la Recherche Médicale & University Hospital, University of Toulouse III, 37 Allées Jules Guesde, 31000, Toulouse, France
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Willison LD, Kudo T, Loh DH, Kuljis D, Colwell CS. Circadian dysfunction may be a key component of the non-motor symptoms of Parkinson's disease: insights from a transgenic mouse model. Exp Neurol 2013; 243:57-66. [PMID: 23353924 PMCID: PMC3994881 DOI: 10.1016/j.expneurol.2013.01.014] [Citation(s) in RCA: 45] [Impact Index Per Article: 4.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/22/2012] [Revised: 12/20/2012] [Accepted: 01/15/2013] [Indexed: 01/09/2023]
Abstract
Sleep disorders are nearly ubiquitous among patients with Parkinson's disease (PD), and they manifest early in the disease process. While there are a number of possible mechanisms underlying these sleep disturbances, a primary dysfunction of the circadian system should be considered as a contributing factor. Our laboratory's behavioral phenotyping of a well-validated transgenic mouse model of PD reveals that the electrical activity of neurons within the master pacemaker of the circadian system, the suprachiasmatic nuclei (SCN), is already disrupted at the onset of motor symptoms, although the core features of the intrinsic molecular oscillations in the SCN remain functional. Our observations suggest that the fundamental circadian deficit in these mice lies in the signaling output from the SCN, which may be caused by known mechanisms in PD etiology: oxidative stress and mitochondrial disruption. Disruption of the circadian system is expected to have pervasive effects throughout the body and may itself lead to neurological and cardiovascular disorders. In fact, there is much overlap in the non-motor symptoms experienced by PD patients and in the consequences of circadian disruption. This raises the possibility that the sleep and circadian dysfunction experienced by PD patients may not merely be a subsidiary of the motor symptoms, but an integral part of the disease. Furthermore, we speculate that circadian dysfunction can even accelerate the pathology underlying PD. If these hypotheses are correct, more aggressive treatment of the circadian misalignment and sleep disruptions in PD patients early in the pathogenesis of the disease may be powerful positive modulators of disease progression and patient quality of life.
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Affiliation(s)
- L David Willison
- Division of Child and Adolescent Psychiatry, Laboratory of Circadian and Sleep Medicine, University of California, Los Angeles, David Geffen School of Medicine, Los Angeles, CA, USA
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Palma JA, Urrestarazu E, Alegre M, Pastor MA, Valencia M, Artieda J, Iriarte J. Cardiac autonomic impairment during sleep is linked with disease severity in Parkinson's disease. Clin Neurophysiol 2013; 124:1163-8. [PMID: 23375381 DOI: 10.1016/j.clinph.2012.12.042] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/22/2012] [Revised: 11/28/2012] [Accepted: 12/17/2012] [Indexed: 01/31/2023]
Abstract
OBJECTIVE Cardiac physiology during sleep in Parkinson's disease (PD) remains poorly explored. We studied heart rate variability (HRV) across sleep stages in PD patients and correlated the results with clinical features. METHODS Cross-sectional study comprising 33 patients with PD and 29 controls matched for age, gender, and number of apneas/hypopneas per hour. HRV measures, (mean R-R interval, SDNN, ULF, VLF, LF, HF and LF/HF) were calculated separately for all sleep stages as well as wakefulness just before and after sleep during one-night polysomnography. Correlation analysis was performed between HRV values and PD patients' characteristics. RESULTS The mean R-R interval was lower in all sleep stages in PD patients when compared with controls. VLF and LF were lower during REM sleep in PD patients. HF during N1-N2 stage was higher in PD. We found inverse correlations between VLF and LF during REM sleep and UPDRS-ON and UPDRS-OFF. CONCLUSION VLF and LF during REM sleep might constitute surrogate markers of disease severity. SIGNIFICANCE These findings provide additional clinical evidence of the autonomic impairment commonly observed in PD, and prove that cardiac autonomic dysfunction during REM sleep is correlated with disease severity.
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Affiliation(s)
- Jose-Alberto Palma
- Sleep Unit and Clinical Neurophysiology Section, University Clinic of Navarra, Pamplona, Spain.
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Abstract
Heart rate variability (HRV) provides indirect insight into autonomic nervous system tone, and has a well-established role as a marker of cardiovascular risk. Recent decades brought an increasing interest in HRV assessment as a diagnostic tool in detection of autonomic impairment, and prediction of prognosis in several neurological disorders. Both bedside analysis of simple markers of HRV, as well as more sophisticated HRV analyses including time, frequency domain and nonlinear analysis have been proven to detect early autonomic involvement in several neurological disorders. Furthermore, altered HRV parameters were shown to be related with cardiovascular risk, including sudden cardiac risk, in patients with neurological diseases. This chapter aims to review clinical and prognostic application of HRV analysis in diabetes, stroke, multiple sclerosis, muscular dystrophies, Parkinson's disease and epilepsy.
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Affiliation(s)
- Iwona Cygankiewicz
- Department of Electrocardiology, Medical University of Lodz, Lodz, Poland.
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Porta A, Castiglioni P, Rienzo MD, Bari V, Bassani T, Marchi A, Takahashi ACM, Tobaldini E, Montano N, Catai AM, Barbic F, Furlan R, Cividjian A, Quintin L. Short-term complexity indexes of heart period and systolic arterial pressure variabilities provide complementary information. J Appl Physiol (1985) 2012; 113:1810-20. [DOI: 10.1152/japplphysiol.00755.2012] [Citation(s) in RCA: 64] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
It is unclear whether the complexity of the variability of the systolic arterial pressure (SAP) provides complementary information to that of the heart period (HP). The complexity of HP and SAP variabilities was assessed from short beat-to-beat recordings (i.e., 256 cardiac beats). The evaluation was made during a pharmacological protocol that induced vagal blockade with atropine or a sympathetic blockade (beta-adrenergic blockade with propranolol or central sympathetic blockade with clonidine) alone or in combination, during a graded head-up tilt, and in patients with Parkinson's disease (PD) without orthostatic hypotension undergoing orthostatic challenge. Complexity was quantified according to the mean square prediction error (MSPE) derived from univariate autoregressive (AR) and multivariate AR (MAR) models. We found that: 1) MSPEMAR did not provide additional information to that of MSPEAR; 2) SAP variability was less complex than that of HP; 3) because HP complexity was reduced by either vagal blockade or vagal withdrawal induced by head-up tilt and was unaffected by beta-adrenergic blockade, HP was under vagal control; 4) because SAP complexity was increased by central sympathetic blockade and was unmodified by either vagal blockade or vagal withdrawal induced by head-up tilt, SAP was under sympathetic control; 5) SAP complexity was increased in patients with PD; and 6) during orthostatic challenge, the complexity of both HP and SAP variabilities in patients with PD remained high, thus indicating both vagal and sympathetic impairments. Complexity indexes derived from short HP and SAP beat-to-beat series provide complementary information and are helpful in detecting early autonomic dysfunction in patients with PD well before circulatory symptoms become noticeable.
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Affiliation(s)
- A. Porta
- Department of Biomedical Sciences for Health, Galeazzi Orthopedic Institute, University of Milan, Milan, Italy
| | | | | | - V. Bari
- Gruppo Ospedaliero San Donato Foundation, Milan, Italy
- Department of Bioengineering, Politecnico di Milano, Milan, Italy
| | - T. Bassani
- Department of Biomedical Sciences for Health, Galeazzi Orthopedic Institute, University of Milan, Milan, Italy
| | - A. Marchi
- Department of Emergency, L. Sacco Hospital, Milan, Italy
| | - A. C. M. Takahashi
- Department of Physiotherapy, Federal University of São Carlos, São Carlos, Brazil
| | - E. Tobaldini
- Department of Biomedical and Clinical Sciences, Internal Medicine II, L. Sacco Hospital, University of Milan, Milan, Italy
| | - N. Montano
- Department of Biomedical and Clinical Sciences, Internal Medicine II, L. Sacco Hospital, University of Milan, Milan, Italy
| | - A. M. Catai
- Department of Physiotherapy, Federal University of São Carlos, São Carlos, Brazil
| | - F. Barbic
- Medical Clinics, Istituto Clinico Humanitas, Rozzano, Milan, Italy
| | - R. Furlan
- Department of Medical Biotechnologies and Translation Medicine, Medical Clinics, Istituto Clinico Humanitas, University of Milan, Rozzano, Milan, Italy; and
| | - A. Cividjian
- Physiology (EA 4612: Neurocardiology), University of Lyon, Lyon, France
| | - L. Quintin
- Physiology (EA 4612: Neurocardiology), University of Lyon, Lyon, France
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Waragai M, Sekiyama K, Fujita M, Tokuda T, Hashimoto M. Biomarkers for the diagnosis and management of Parkinson's disease. ACTA ACUST UNITED AC 2012; 7:71-83. [PMID: 23530844 DOI: 10.1517/17530059.2013.733694] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
Abstract
INTRODUCTION Parkinson's disease (PD) is the most common neurodegenerative disease leading to movement disorders, and is characterized neuropathologically by the progressive loss of dopaminergic neurons, intracellular α-synuclein deposition and the formation of Lewy bodies. The difficulty of making a definitive diagnosis of PD itself, as opposed to other neurodegenerative diseases associated with parkinsonism, is a central issue in clinical PD research. However, recent advances in diagnostic methods, encompassing imaging techniques, genetic testing and measurement of biological markers may permit earlier diagnosis, and thus potentially improved management of PD. AREAS COVERED In addition to clinical symptoms and imaging techniques, a number of genetic and biological markers obtained from body fluids such as cerebrospinal fluids may hold promise for the early detection of PD. It is often difficult to make an accurate diagnosis and to distinguish PD from other diseases with features of parkinsonism, particularly during the early stages of the disease. In this regard, biomarkers which are specific for PD, in combination with observation of clinical symptoms, may facilitate the early diagnosis and improved management of PD. EXPERT OPINION Good biomarkers for PD could be helpful for early diagnosis, management and tracking of disease progression. Furthermore, combined analysis using several kinds of biomarkers may allow the detection of preclinical PD, which in turn may facilitate a prevention of disease onset with the use of disease-modifying drugs.
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Affiliation(s)
- Masaaki Waragai
- Tokyo Metropolitan Institute of Medical Science, Division of Sensory and Motor Systems, Tokyo 156-0057, Japan.
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Ziomber A, Thor P, Krygowska-Wajs A, Załęcki T, Moskała M, Romańska I, Michaluk J, Antkiewicz-Michaluk L. Chronic impairment of the vagus nerve function leads to inhibition of dopamine but not serotonin neurons in rat brain structures. Pharmacol Rep 2012; 64:1359-67. [DOI: 10.1016/s1734-1140(12)70933-7] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/14/2012] [Revised: 08/09/2012] [Indexed: 10/25/2022]
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Videnovic A, Golombek D. Circadian and sleep disorders in Parkinson's disease. Exp Neurol 2012; 243:45-56. [PMID: 22935723 DOI: 10.1016/j.expneurol.2012.08.018] [Citation(s) in RCA: 152] [Impact Index Per Article: 12.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/22/2012] [Revised: 08/08/2012] [Accepted: 08/14/2012] [Indexed: 01/17/2023]
Abstract
Impaired sleep and alertness, initially recognized by James Parkinson in his famous monograph "An Essay on the Shaking Palsy" in 1817, is one of the most common and disabling nonmotor symptoms of Parkinson's disease (PD). It is only recently, however, that sleep disturbances in PD have received the attention of medical and research community. Dopamine, the major neurotransmitter implicated in the pathogenesis of PD, plays a pivotal role in the regulation of sleep and circadian homeostasis. Sleep dysfunction affects up to 90% of patients with PD, and may precede the onset of the disease by decades. Sleep dysfunction in PD may be categorized into disturbances of overnight sleep and daytime alertness. Etiology of impaired sleep and alertness in PD is multifactorial. Co-existent primary sleep disorders, medication side effects, overnight re-emergence of motor symptoms, and primary neurodegeneration itself, are main causes of sleep disruption and excessive daytime sleepiness among patients with PD. Increasing body of evidence suggests that the circadian system becomes dysregulated in PD, which may lead to poor sleep and alertness. Treatment options are limited and frequently associated with unwanted side effects. Further studies that will examine pathophysiology of sleep dysfunction in PD, and focus on novel treatment approaches are therefore very much needed. In this article we review the role of dopamine in regulation of sleep and alertness and discuss main sleep and circadian disturbances associated with PD.
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Affiliation(s)
- Aleksandar Videnovic
- PD and Movement Disorders Center, Circadian Rhythms and Sleep Research Laboratory, Department of Neurology, Northwestern University, 710 N Lake Shore Dr #1106, Chicago, IL 60611, USA.
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