Cardiovagal Barorefex Sensitivity in Parkinson’s Disease and Multiple-System Atrophy
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Background and Purpose Parkinson’s disease (PD) and multiple-system atrophy of the parkinsonian type (MSA-P) are progressive neurodegenerative disorders that in addition to dysfunction of the motor system also present with features of dysautonomia, frequently manifesting as orthostatic hypotension (OH). Te pathophysiology of OH has been proposed to difer between these two disorders. Tis study investigated the spontaneous and cardiovagal barorefex sensitivity (BRS) in Parkinson’s disease patients with orthostatic hypotension (PDOH ) and multiple system atrophy of Parkinsonian type with orthostatic hypotension in an attempt to diferentiate the two disorders. Methods Two methods were used for determining the BRS: a spontaneous method (spontaneous BRS) and the refexive barorefex gain (cardiovagal BRS) from phases II and IV of the Valsalva maneuver (VM) in PDOH and MSA-POH . Results The spontaneous BRS (5.04±0.66 ms/mm Hg vs. 4.78±0.64 ms/mm Hg, p=0.54) and the cardiovagal BRS from phase II of the VM (0.96±0.75 ms/mm Hg vs. 1.34±1.51 ms/mm Hg, p=0.76) did not difer between PDOH and MSA-POH , but the cardiovagal BRS from phase IV of the VM (0.03±0.07 ms/mm Hg vs. 2.86±2.39 ms/mm Hg, p=0.004) was signifcantly lower in PDOH . Conclusions Te cardiovagal BRS from phase IV of the VM has potential for diferentiating PDOH and MSA-POH , indicating a diference in the pathophysiological mechanisms underlying the autonomic dysfunction in the two disorders.
Abstract
Background and Purpose Parkinson’s disease (PD) and multiple-system atrophy of the parkinsonian type (MSA-P) are progressive neurodegenerative disorders that in addition to dysfunction of the motor system also present with features of dysautonomia, frequently manifesting as orthostatic hypotension (OH). Te pathophysiology of OH has been proposed to difer between these two disorders. Tis study investigated the spontaneous and cardiovagal barorefex sensitivity (BRS) in Parkinson’s disease patients with orthostatic hypotension (PDOH ) and multiple system atrophy of Parkinsonian type with orthostatic hypotension in an attempt to diferentiate the two disorders. Methods Two methods were used for determining the BRS: a spontaneous method (spontaneous BRS) and the refexive barorefex gain (cardiovagal BRS) from phases II and IV of the Valsalva maneuver (VM) in PDOH and MSA-POH . Results The spontaneous BRS (5.04±0.66 ms/mm Hg vs. 4.78±0.64 ms/mm Hg, p=0.54) and the cardiovagal BRS from phase II of the VM (0.96±0.75 ms/mm Hg vs. 1.34±1.51 ms/mm Hg, p=0.76) did not difer between PDOH and MSA-POH , but the cardiovagal BRS from phase IV of the VM (0.03±0.07 ms/mm Hg vs. 2.86±2.39 ms/mm Hg, p=0.004) was signifcantly lower in PDOH . Conclusions Te cardiovagal BRS from phase IV of the VM has potential for diferentiating PDOH and MSA-POH , indicating a diference in the pathophysiological mechanisms underlying the autonomic dysfunction in the two disorders.
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