Impaired circadian heart rate variability in Parkinson's disease: A time-domain analysis in ambulatory setting

Background: Heart rate variability (HRV) decreases in Parkinson's disease (PD) and it can be considered a marker for cardiovascular dysautonomia. The purpose of this pilot study is to evaluate long-term time-domain analysis of HRV of PD patients and compare the results with those of matched healthy individuals. Methods: Idiopathic PD patients without comorbidity impairing HRV, and age-matched healthy individuals were recruited in a pilot study. A long-term time domain analysis of HRV using 24-h ambulatory ECG was performed. Results: Overall, 18 PD patients fulfilling inclusion criteria completed the evaluation (mean age was 55.6 ± 8.8, disease duration: 5.0 ± 4.7). Mean SCOPA-AUT score was 10.1 ± 7.3. Patients were on Hoehn & Yahr stage 1-2 and mean Levodopa Equivalent Dose (LED) was 311 ± 239.9. Mean of the 5-min standard deviation (SD) of R-R intervals distribution (SDNN) for all 5 min segments of the entire recording (ISDNN) was significantly lower in patients compared to controls. ISDNN was significantly different between Parkinson's disease patients and healthy controls. Conclusions: In our population characterized by mild to moderate disease severity, time-domain assessment of HRV seemed to be a potential tool to characterize cardiovascular dysautonomia. Decrease of ISDNN in PD may reflect an autonomic derangement extending all day and night long

In patient’s with Parkinson disease, autonomic symptoms are frequent and associated with other non-motor symptoms

Background: Autonomic symptoms and sleep disorders are common non-motor symptoms of Parkinson disease (PD), which are correlated with poor quality of life for patients. Purpose: To assess the frequency of autonomic symptoms in a consecutive series of PD patients and to correlate them with other motor and non-motor symptoms. Methods: All consecutive non-demented PD patients who underwent an extensive evaluation including Hoehn and Yahr staging, Unified Parkinson’s Disease Rating Scale, Beck’s Depression Inventory, Neuropsychiatric Inventory, PDQ-39 Scale, the Parkinson’s diseases Sleep Scale, the Epworth Sleepiness Scale and SCOPA-AUT scale were enrolled. Comorbidity has been also considered. Supine to standing position blood pressure and cardiac frequency changes were also measured. Results: 135 PD patients were included (mean age at interview 67.7; mean disease duration: 5.3 years). Patients were stratified according to mean SCOPA-AUT scale score (13.1). Those with higher SCOPA-AUT scale score were significantly older, had longer disease duration, worse disease stage, worse quality of sleep, were more severely affected, and were also taking a higher dosage of levodopa. At multivariate analysis, older age, longer disease duration, and worse quality of sleep were independently associated with higher SCOPA-AUT scale scores. Conclusions: Our results remark the role of autonomic symptoms in PD. In our patient population, characterized by mild to moderate disease severity, most of the patients complained of autonomic nervous system involvement (84 %). A significant association between autonomic symptoms and sleep disorders was also observed

Urinary dysfunction in Parkinson\u2019s disease patients

Background: Autonomic nervous system dysfunction that affects 70\u201380% of Parkinson\u2019s disease (PD) patients, causes significant morbidity and it is correlated with poor quality of life. Objective: We assessed in a consecutive series of PD patients frequency of autonomic symptoms by means of the Scale for Outcomes for Parkinson\u2019s disease AUTonomic (SCOPA-AUT) and we correlated it with the results of noninvasive urological studies (nUS). Methods: PD patients with known conditions that might have influenced urinary function were excluded. Clinical assessment of PD patients included the H&Y staging, UPDRS, BDI, NPI, PDQ- 39, PDSS, ESS, and the SCOPA-AUT scale. nUS consisted of uroflowmetry and ultrasound of the urinary tract with measurement of postvoid residual (PVR) urine volume. The quantitative parameters measured during the voiding phase included maximum flow rate (Qmax) and postvoid residual (PVR). Results: 45 PD patients (26 males and 19 females) were included (mean age at interview 62.1 \ub1 10.6; mean disease duration: 6.5 \ub1 4.3 years). PD patients had a mean SCOPA-AUT score of 14.1 \ub1 7.1. PD patients with urinary dysfunction, had higher SCOPA-AUT scale score, longer disease duration and an higher dosage of levodopa calculated as levodopa equivalent dose (LED). At least one clinical symptom of dysautonomia was found in all of our PD patients and urinary symptoms were the most common complain (92.8%). The mean Qmax was 17.9 ml/s (SD 9.1 ml/s), and the mean PVR was 33.7 ml (SD 68.7 ml), with no patient having a PVR>200 ml. Ultrasound documented possible causes of urinary disorders in 44% of patients (prostate hypertrophy was observed in 11 of 26 males). Conclusion: Our findings suggest that urinary symptoms and abnormal findings in nUS are common in PD patients. The autonomic dysfunction might be related to nigrostriatal degeneration, though urinary dysfunction in patients PD could be, especially in males,attributed to other condition