Complex nonlinear autonomic nervous system modulation link cardiac autonomic neuropathy and peripheral vascular disease

Background: Neuropathy is a common complication of diabetes mellitus and it may affect both the peripheral nerves and autonomic nervous system. It’s prevalence ranges from 1% to 90%. The present study is therefore designed to investigate autonomic nervous system involvement in diabetes mellitus by using simple bedside tests and to study its association with other diabetic angiopathies.Methods: 100 patients of diabetes mellitus were selected in the study. In Autonomic function tests for evaluating parasympathetic damage E: I ratio, 30:75 ratio and Valsalva ratio test was performed. Sympathetic damage was diagnosed by Blood pressure response to standing test and Blood pressure response to sustained handgrip test.Results: Abnormal E:I ratio was noticed in only 24 patients. The 30:15 ratio was found to be abnormal in 38 patients while the Valsalva Ratio was abnormal in 34 patients. Postural hypotension was observed in only 8% patients. The sustained hand grip test was abnormal in 10 patients. The prevalence of cardiac autonomic neuropathy was 58%. The association between the presence of autonomic neuropathy and peripheral neuropathy was statistically significant. However, the association between autonomic neuropathy and retinopathy and nephropathy was not statistically significant.Conclusions: The overall prevalence of autonomic neuropathy in diabetes mellitus was 58%. There was parasympathetic preponderance over sympathetic nervous system in the involvement of diabetic autonomic neuropathy. There was statistically significant association of diabetic autonomic neuropathy with peripheral neuropathy as compared to retinopathy and nephropathy.

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Autonomic nervous system and risk factors for vascular disease. Effects of autonomic unbalance in schizophrenia and Parkinson’s disease

Neurological Sciences ◽

10.1007/s10072-008-0853-1 ◽

2008 ◽

Vol 29 (1) ◽

pp. 15-21 ◽

Cited By ~ 9

Author(s):

Giulio Scigliano ◽

Gabriele Ronchetti ◽

Floriano Girotti

Keyword(s):

Risk Factors ◽

Parkinson’S Disease ◽

Parkinson's Disease ◽

Nervous System ◽

Autonomic Nervous System ◽

Vascular Disease ◽

Autonomic Nervous

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DYSREGULATION OF THE AUTONOMIC NERVOUS SYSTEM IN THE MECHANISMS OF METABOLIC SYNDROME DEVELOPMENT

Siberian Medical Journal ◽

10.29001/2073-8552-2018-33-4-119-124 ◽

2019 ◽

Vol 33 (4) ◽

pp. 119-124

Author(s):

S. I. Kseneva ◽

E. V. Borodulina ◽

O. Yu. Trifonova ◽

V. V. Udut

Keyword(s):

Insulin Resistance ◽

Metabolic Syndrome ◽

Nervous System ◽

Autonomic Nervous System ◽

Gastroesophageal Reflux Disease ◽

Gastroesophageal Reflux ◽

Reflux Disease ◽

Cardiac Autonomic Neuropathy ◽

Autonomic Nervous ◽

High Incidence

The concept of metabolic syndrome as a cluster of risk factors for type 2 diabetes and cardiovascular diseases has undergone a number of evolutionary transformations over the past years. Incorporation of autonomic nervous system dysfunction into the pathogenesis of metabolic syndrome opens an opportunity for inclusion of a number of clinical entities in the cluster of metabolic syndrome as they mutually affect the course and clinical manifestations of pathologies involved in metabolic syndrome. To confirm this notion, a cross-sectional transverse study of a continuous sample of 158 patients with metabolic syndrome was performed. The study showed that, in the presence of metabolic syndrome, the incidence of cardiac autonomic neuropathy reaches 37.5%. A number of features of gastroesophageal reflux disease in patients with metabolic syndrome were found in the structure of complaints where regurgitation predominated. Fibrogastroduodenoscopy demonstrated endoscopically negative form of the disease in 38%, and, according to high DeMeester index by daily pH-metry, the alkaline reflux was present in patients in lying position over 25% of time. Young men with metabolic syndrome had high incidence of prostatic enlargement (increased prostate size and volume) as well as high incidence of the IPSS questionnaire score corresponding to the initial manifestations of prostatic hyperplasia in the presence of insulin resistance and normal androgen levels. The study showed that dysfunction of the autonomic nervous system (along with insulin resistance) was the main converging point in the development of metabolic syndrome. This suggests that cardiac autonomic neuropathy, lower urinary tract symptoms, and gastroesophageal reflux disease may be included in the metabolic syndrome cluster.

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Morning blood pressure surge is associated with autonomic neuropathy and peripheral vascular disease in patients with diabetes

Journal of Human Hypertension ◽

10.1038/s41371-019-0270-3 ◽

2019 ◽

Vol 34 (7) ◽

pp. 495-504

Author(s):

Federica Di Gennaro ◽

Cinzia D’Amato ◽

Roberto Morganti ◽

Carla Greco ◽

Susanna Longo ◽

...

Keyword(s):

Blood Pressure ◽

Vascular Disease ◽

Peripheral Vascular Disease ◽

Autonomic Neuropathy ◽

Peripheral Vascular ◽

Patients With Diabetes ◽

Morning Blood Pressure Surge ◽

Morning Blood Pressure ◽

Pressure Surge

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When do the symptoms of autonomic nervous system malfunction appear in patients with Parkinson’s disease?

Vojnosanitetski pregled ◽

10.2298/vsp1404346d ◽

2014 ◽

Vol 71 (4) ◽

pp. 346-351 ◽

Cited By ~ 9

Author(s):

Luka De ◽

Marina Svetel ◽

Tatjana Pekmezovic ◽

Branislav Milovanovic ◽

Vladimir Kostic

Keyword(s):

Nervous System ◽

Autonomic Nervous System ◽

Autonomic Neuropathy ◽

Rating Scale ◽

Clinical Presentation ◽

De Novo ◽

The Body ◽

Factors Affecting ◽

Autonomic Nervous ◽

Sympathetic Dysfunction

Background/Aim. Dysautonomia appears in almost all patients with Parkinson?s disease (PD) in a certain stage of their condition. The aim of our study was to detect the development and type of autonomic disorders, find out the factors affecting their manifestation by analyzing the potential association with demographic variables related to clinical presentation, as well as the symptoms of the disease in a PD patient cohort. Methods. The patients with PD treated at the Clinic of Neurology in Belgrade during a 2-year period, divided into 3 groups were studied: 25 de novo patients, 25 patients already treated and had no long-term levodopa therapy-related complications and 22 patients treated with levodopa who manifested levodopa-induced motor complications. Simultaneously, 35 healthy control subjects, matched by age and sex, were also analyzed. Results. Autonomic nervous system malfunction was defined by Ewing diagnostic criteria. The tests, indicators of sympathetic and parasympathetic nervous systems, were significantly different in the PD patients as compared with the controls, suggesting the failure of both systems. However, it was shown, in the selected groups of patients, that the malfunction of both systems was present in two treated groups of PD patients, while de novo group manifested only sympathetic dysfunction. For this reason, the complete autonomic neuropathy was diagnosed only in the treated PD patients, while de novo patients were defined as those with the isolated sympathetic dysfunction. The patients with the complete autonomic neuropathy differed from the subjects without such neuropathy in higher cumulative and motor unified Parkinson?s disease rating score (UPDRS) (p < 0.01), activities of daily living scores (p < 0.05), Schwab-England scale (p < 0.001) and Hoehn-Yahr scale. There was no difference between the patients in other clinical-demographic characteristics (sex, age at the time of diagnosis, actual age, duration of disease, involved side of the body, pain and freezing), but mini mental status (MMS) score and Hamilton depression and anxiety rating scale were significantly lower (p < 0.05). Conclusion. Our results confirm a high prevalence of autonomic nervous system disturbances among PD patients from the near onset of disease, with a predominant sympathetic nervous system involvement. The patients who developed complete autonomic neuropathy (both sympathetic and parasympathetic) were individuals with considerable level of functional failure, more severe clinical presentation and the existing anxiety and depression.

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Diabetic Autonomic Neuropathy

Journal of Pharmacy Practice ◽

10.1177/089719009901200207 ◽

1999 ◽

Vol 12 (2) ◽

pp. 142-154

Author(s):

Roy C. Parish

Keyword(s):

Nervous System ◽

Autonomic Nervous System ◽

Drug Therapy ◽

Autonomic Neuropathy ◽

Cardiac Arrhythmias ◽

Diabetic Autonomic Neuropathy ◽

Diabetic Patients ◽

Specific Information ◽

Autonomic Nervous ◽

Increased Risk

Diabetic autonomic neuropathy (DAN) occurs in approximately half of Caucasian patients with diabetes and perhaps three-fourths of black diabetic patients. This may be asymptomatic for several years, but the majority of patients with DAN eventually exhibit symptoms of diarrhea, cardiac arrhythmias, sexual dysfunction, and abnormal sweating. Prolonged hyperglycemia results in damage to the autonomic nervous system (ANS), particularly the vagus nerve and other parts of the parasympathetic division. DAN is associated with increased risk of sudden death, high-risk cardiac arrhythmias, myocardial infarction, and death from other causes. Objective testing of autonomic nervous system function yields specific information that affects treatment decisions. Drug therapy can effect improvements in ANS function and reduce these risks. Complications of diabetes that result from ANS dysfunction can be partly reversed or their progress can be slowed by appropriate drug therapy. Features, implications, and therapy of the most common complications resulting from DAN are reviewed, and suggestions for pharmacist involvement in the care of these difficult patients are offered.

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