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Journal of Neurology, Neurosurgery, and Psychiatry logoLink to Journal of Neurology, Neurosurgery, and Psychiatry
. 1993 Oct;56(10):1090–1095. doi: 10.1136/jnnp.56.10.1090

Autonomic nervous system dysfunction in Parkinson's disease: relationships with age, medication, duration, and severity.

J G van Dijk 1, J Haan 1, K Zwinderman 1, B Kremer 1, B J van Hilten 1, R A Roos 1
PMCID: PMC1015238  PMID: 8410008

Abstract

Heart rate variability at rest, during deep breathing, or standing up and with the Valsalva manoeuvre did not differ significantly between 67 patients with idiopathic Parkinson's disease (PD) and 31 healthy age matched controls. Blood pressure (BP) responses to standing up and sustained handgrip revealed diminished autonomic function in the PD group. In a preliminary analysis of the PD group older age, anti-Parkinson medication and higher Hoehn and Yahr (HY) stages were each associated with poor autonomic responsiveness. Disease duration was only related to the systolic BP fall on standing up. Multiple stepwise regression analysis showed that older age explained most of the variance of heart rate variability (up to 36%), and the only significant PD related factor was the use of medication, which explained less than 7%. The HY stage accounted for 12.7% of the variance in the standing up BP test, and the use of medication explained 10.6% of the variance of the systolic BP change in the sustained hand grip test. The unmedicated PD subgroup (n = 33), who had mild disease of short duration, showed no evidence of autonomic dysfunction. Cardiovascular autonomic dysfunction in PD is mild, mainly affects blood pressure responses, and occurs only in advanced cases.

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Selected References

These references are in PubMed. This may not be the complete list of references from this article.

  1. Appenzeller O., Goss J. E. Autonomic deficits in Parkinson's syndrome. Arch Neurol. 1971 Jan;24(1):50–57. doi: 10.1001/archneur.1971.00480310078007. [DOI] [PubMed] [Google Scholar]
  2. Baratti M., Calzetti S. Fluctuation of arterial blood pressure during end-of-dose akinesia in Parkinson's disease. J Neurol Neurosurg Psychiatry. 1984 Nov;47(11):1241–1243. doi: 10.1136/jnnp.47.11.1241. [DOI] [PMC free article] [PubMed] [Google Scholar]
  3. Calne D. B., Brennan J., Spiers A. S., Stern G. M. Hypotension caused by L-dopa. Br Med J. 1970 Feb 21;1(5694):474–475. doi: 10.1136/bmj.1.5694.474. [DOI] [PMC free article] [PubMed] [Google Scholar]
  4. Camerlingo M., Aillon C., Bottacchi E., Gambaro P., D'Alessandro G., Franceschi M., Devoti G., Mamoli A. Parasympathetic assessment in Parkinson's disease. Adv Neurol. 1987;45:267–269. [PubMed] [Google Scholar]
  5. Den Heijer J. C., Bollen W. L., Reulen J. P., van Dijk J. G., Kramer C. G., Roos R. A., Buruma O. J. Autonomic nervous function in Huntington's disease. Arch Neurol. 1988 Mar;45(3):309–312. doi: 10.1001/archneur.1988.00520270087025. [DOI] [PubMed] [Google Scholar]
  6. Forno L. S., Norville R. L. Ultrastructure of Lewy bodies in the stellate ganglion. Acta Neuropathol. 1976 Mar 30;34(3):183–197. doi: 10.1007/BF00688674. [DOI] [PubMed] [Google Scholar]
  7. Goetz C. G., Lutge W., Tanner C. M. Autonomic dysfunction in Parkinson's disease. Neurology. 1986 Jan;36(1):73–75. doi: 10.1212/wnl.36.1.73. [DOI] [PubMed] [Google Scholar]
  8. Gross M., Bannister R., Godwin-Austen R. Orthostatic hypotension in Parkinson's disease. Lancet. 1972 Jan 22;1(7743):174–176. doi: 10.1016/s0140-6736(72)90571-5. [DOI] [PubMed] [Google Scholar]
  9. Hunter S. The rostral mesencephalon in Parkinson's disease and Alzheimer's disease. Acta Neuropathol. 1985;68(1):53–58. doi: 10.1007/BF00688956. [DOI] [PubMed] [Google Scholar]
  10. Iwasaki S., Hamaguchi K., Iwasaki A., Takakusagi M., Narabayashi Y. Hypotensive effect of long-term levodopa in patients with Parkinson's disease. Eur Neurol. 1990;30(4):194–199. doi: 10.1159/000117344. [DOI] [PubMed] [Google Scholar]
  11. Kuroiwa Y., Shimada Y., Toyokura Y. Postural hypotension and low R-R interval variability in parkinsonism, spino-cerebellar degeneration, and Shy-Drager syndrome. Neurology. 1983 Apr;33(4):463–467. doi: 10.1212/wnl.33.4.463. [DOI] [PubMed] [Google Scholar]
  12. Langston J. W., Forno L. S. The hypothalamus in Parkinson disease. Ann Neurol. 1978 Feb;3(2):129–133. doi: 10.1002/ana.410030207. [DOI] [PubMed] [Google Scholar]
  13. Meco G., Pratesi L., Bonifati V. Cardiovascular reflexes and autonomic dysfunction in Parkinson's disease. J Neurol. 1991 Jul;238(4):195–199. doi: 10.1007/BF00314779. [DOI] [PubMed] [Google Scholar]
  14. Ohama E., Ikuta F. Parkinson's disease: distribution of Lewy bodies and monoamine neuron system. Acta Neuropathol. 1976 Apr 26;34(4):311–319. doi: 10.1007/BF00696560. [DOI] [PubMed] [Google Scholar]
  15. Oppenheimer D. R. Lateral horn cells in progressive autonomic failure. J Neurol Sci. 1980 Jun;46(3):393–404. doi: 10.1016/0022-510x(80)90064-7. [DOI] [PubMed] [Google Scholar]
  16. Piha S. J., Rinne J. O., Rinne U. K., Seppänen A. Autonomic dysfunction in recent onset and advanced Parkinson's disease. Clin Neurol Neurosurg. 1988;90(3):221–226. doi: 10.1016/0303-8467(88)90025-x. [DOI] [PubMed] [Google Scholar]
  17. Rajput A. H., Rozdilsky B. Dysautonomia in Parkinsonism: a clinicopathological study. J Neurol Neurosurg Psychiatry. 1976 Nov;39(11):1092–1100. doi: 10.1136/jnnp.39.11.1092. [DOI] [PMC free article] [PubMed] [Google Scholar]
  18. Reid J. L., Calne D. B., George C. F., Pallis C., Vakil S. D. Cardiovascular reflexes in Parkinsonism. Clin Sci. 1971 Jul;41(1):63–67. doi: 10.1042/cs0410063. [DOI] [PubMed] [Google Scholar]
  19. Sachs C., Berglund B., Kaijser L. Autonomic cardiovascular responses in parkinsonism: effect of levodopa with dopa-decarboxylase inhibition. Acta Neurol Scand. 1985 Jan;71(1):37–42. doi: 10.1111/j.1600-0404.1985.tb03164.x. [DOI] [PubMed] [Google Scholar]
  20. Turkka J. T., Tolonen U., Myllylä V. V. Cardiovascular reflexes in Parkinson's disease. Eur Neurol. 1987;26(2):104–112. doi: 10.1159/000116319. [DOI] [PubMed] [Google Scholar]
  21. den HARTOG JAGER W. A., BETHLEM J. The distribution of Lewy bodies in the central and autonomic nervous systems in idiopathic paralysis agitans. J Neurol Neurosurg Psychiatry. 1960 Nov;23:283–290. doi: 10.1136/jnnp.23.4.283. [DOI] [PMC free article] [PubMed] [Google Scholar]
  22. van Dijk J. G., Haan J., Koenderink M., Roos R. A. Autonomic nervous function in progressive supranuclear palsy. Arch Neurol. 1991 Oct;48(10):1083–1084. doi: 10.1001/archneur.1991.00530220105028. [DOI] [PubMed] [Google Scholar]
  23. van Dijk J. G., Koenderink M., Zwinderman A. H., Haan J., Kramer C. G., den Heijer J. C. Autonomic nervous system tests depend on resting heart rate and blood pressure. J Auton Nerv Syst. 1991 Jul;35(1):15–24. doi: 10.1016/0165-1838(91)90034-z. [DOI] [PubMed] [Google Scholar]

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