Impaired cardiac autonomic control in response to active standing in parkinson’s disease with orthostatic hypotension

Parkinson’s disease (PD) is a neurodegenerative disorder that affects postural and cardiac autonomic control. However, since it is unknown whether these changes are associated, the objective of this study was to determine whether such a relationship exists. Twenty-three patients with PD participated. The RR intervals were recorded in different positions and heart rate variability (HRV) was analyzed. Postural sway was analyzed based on the center of pressure. No significant differences on HRV indices were induced by postural change. A correlation was found between these indices and postural control, high frequency (HF), and anterior-posterior (AP) root mean square (RMS-AP) (r = 0.422, p = 0.045), low frequency (LF)/HF, and AP mean velocity (r = 0.478, p = 0.021). A correlation was found between HRV induced by postural change and postural control, Δ LF/HF and RMS-AP (r = 0.448, p = 0.032), Δ LF/HF and ellipse area (r = 0.505, p = 0.014), Δ LF/HF and AP mean velocity (r = −0.531; p = 0.009), and Δ LF and AP mean velocity (r = −0.424, p = 0.044). There is an association between the autonomic and postural systems, such that PD patients with blunted cardiac autonomic function in both the supine and orthostatic positions have worse postural control.

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Effect of the combination of automated peripheral mechanical stimulation and physical exercise on aerobic functional capacity and cardiac autonomic control in patients with Parkinson’s disease: a randomized clinical trial protocol

Trials ◽

10.1186/s13063-021-05177-w ◽

2021 ◽

Vol 22 (1) ◽

Author(s):

Nicolle Zelada-Astudillo ◽

Vinicius Christianini Moreno ◽

Andrea Herrera-Santelices ◽

Fabio Augusto Barbieri ◽

Antonio Roberto Zamunér

Keyword(s):

Quality Of Life ◽

Parkinson’S Disease ◽

Clinical Trial ◽

Parkinson's Disease ◽

Physical Exercise ◽

Mechanical Stimulation ◽

Autonomic Control ◽

Cardiac Autonomic Control ◽

Gait Parameters

Abstract Background Automated peripheral mechanical stimulation (AMPS) has been proposed as a new complementary therapy with potential for improving motor and cardiovascular abnormalities in Parkinson’s disease (PD). However, AMPS long-term effects and its combination with physical exercise are unknown. Thus, this study aims to compare the effects of a program of 12 weeks of physical exercise with a 12-week intervention program combining physical exercise and AMPS on the aerobic capacity, cardiac autonomic control, and gait parameters in patients with PD. Methods A randomized, controlled clinical trial will be conducted. Older volunteers with PD will be randomly assigned to one of the two groups studied: (1) exercise or (2) AMPS + exercise. Both groups will undergo an exercise program of 24 sessions, for 12 weeks, performed twice a week. Before exercise sessions, the group AMPS + exercise will receive a session of active AMPS, while the group exercise will receive an AMPS sham intervention. Shapiro-Wilk’s and Levene’s tests will be used to check for data normality and homogeneity, respectively. In case parametric assumptions are fulfilled, per-protocol and intention-to-treat analyses will be performed using a mixed model analysis of variance to check for group*time interaction. Significance level will be set at 5%. Discussion Several non-pharmacological treatment modalities have been proposed for PD, focusing primarily on the reduction of motor and musculoskeletal disorders. Regular exercise and motor training have been shown to be effective in improving quality of life. However, treatment options in general remain limited given the high prevalence and adverse impact of these disorders. So, developing new strategies that can potentiate the improvement of motor disabilities and also improve non-motor symptoms in PD is relevant. It is expected that the participants from both groups will improve their quality of life, gait parameters, and their cardiac autonomic control, with greater improvements being observed in the group combining active AMPS and physical exercise. Trial registration ClinicalTrials.gov NCT04251728. Registered on February 05, 2020.

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Lower vascular tone and larger plasma volume in Parkinson's disease with orthostatic hypotension

Journal of Applied Physiology ◽

10.1152/japplphysiol.00069.2011 ◽

2011 ◽

Vol 111 (2) ◽

pp. 443-448 ◽

Cited By ~ 7

Author(s):

J. T. Groothuis ◽

R. A. J. Esselink ◽

J. P. H. Seeger ◽

M. J. H. van Aalst ◽

M. T. E. Hopman ◽

...

Keyword(s):

Parkinson’S Disease ◽

Parkinson's Disease ◽

Blood Flow ◽

Orthostatic Hypotension ◽

Vascular Resistance ◽

Plasma Volume ◽

Venous Pressure ◽

Dilution Method ◽

Significant Difference ◽

Head Up Tilt

The pathophysiology of orthostatic hypotension in Parkinson's disease (PD) is incompletely understood. The primary focus has thus far been on failure of the baroreflex, a central mediated vasoconstrictor mechanism. Here, we test the role of two other possible factors: 1) a reduced peripheral vasoconstriction (which may contribute because PD includes a generalized sympathetic denervation); and 2) an inadequate plasma volume (which may explain why plasma volume expansion can manage orthostatic hypotension in PD). We included 11 PD patients with orthostatic hypotension (PD + OH), 14 PD patients without orthostatic hypotension (PD − OH), and 15 age-matched healthy controls. Leg blood flow was examined using duplex ultrasound during 60° head-up tilt. Leg vascular resistance was calculated as the arterial-venous pressure gradient divided by blood flow. In a subset of 9 PD + OH, 9 PD − OH, and 8 controls, plasma volume was determined by indicator dilution method with radiolabeled albumin (125I-HSA). The basal leg vascular resistance was significantly lower in PD + OH (0.7 ± 0.3 mmHg·ml−1·min) compared with PD − OH (1.3 ± 0.6 mmHg·ml−1·min, P < 0.01) and controls (1.3 ± 0.5 mmHg·ml−1·min, P < 0.01). Leg vascular resistance increased significantly during 60° head-up tilt with no significant difference between the groups. Plasma volume was significantly larger in PD + OH (3,869 ± 265 ml) compared with PD − OH (3,123 ± 377 ml, P < 0.01) and controls (3,204 ± 537 ml, P < 0.01). These results indicate that PD + OH have a lower basal leg vascular resistance in combination with a larger plasma volume compared with PD − OH and controls. Despite the increase in leg vascular resistance during 60° head-up tilt, PD + OH are unable to maintain their blood pressure.

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2.282 FACTORS RELATED TO ORTHOSTATIC HYPOTENSION IN PARKINSON'S DISEASE

Parkinsonism & Related Disorders ◽

10.1016/s1353-8020(11)70605-8 ◽

2012 ◽

Vol 18 ◽

pp. S136

Author(s):

S. Perez-Lloret ◽

M.V. Rey ◽

N. Fabre ◽

F. Ory ◽

U. Spampinato, ◽

...

Keyword(s):

Parkinson’S Disease ◽

Parkinson's Disease ◽

Orthostatic Hypotension

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Initial circulatory response to active standing in Parkinson's disease without typical orthostatic hypotension

Arquivos de Neuro-Psiquiatria ◽

10.1590/0004-282x20130247 ◽

2014 ◽

Vol 72 (3) ◽

pp. 208-213

Author(s):

Guillermo Delgado ◽

Bruno Estañol ◽

Mayela Rodríguez-Violante ◽

Jesús Antonio González-Hermosillo ◽

Óscar Infante-Vázquez

Keyword(s):

Parkinson’S Disease ◽

Parkinson's Disease ◽

Orthostatic Hypotension ◽

Initial Response ◽

Upright Position ◽

Resistance Response ◽

Circulatory Response ◽

Volume Clamp Method ◽

Sample Points ◽

Prolonged Latency

While the circulatory response to orthostatic stress has been already evaluated in Parkinson's disease patients without typical orthostatic hypotension (PD-TOH), there is an initial response to the upright position which is uniquely associated with active standing (AS). We sought to assess this response and to compare it to that seen in young healthy controls (YHC). Method In 10 PD-TOH patients (8 males, 60±7 years, Hoehn and Yahr ≤3) the changes in systolic blood pressure (SBP) and heart rate that occur in the first 30 seconds (sec) of standing were examined. Both parameters were non-invasively and continuously monitored using the volume-clamp method by Peñáz and the Physiocal criteria by Wesseling. The choice of sample points was prompted by the results of previous studies. These sample points were compared to those of 10 YHC (8 males, 32±8 years). Results The main finding of the present investigation was an increased time between the AS onset and SBP overshoot in PD-TOH group (24±4 vs. 19±3 sec; p<0.05). Conclusion This delay might reflect a prolonged latency in the baroreflex-mediated vascular resistance response, but more studies are needed to confirm this preliminary hypothesis.

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