Autonomic nervous system dysfunction in Parkinson’s disease patients
Keywords:Autonomic dysfunction, Hoehn and yahr stage, Parkinson’s disease
Background: Parkinson’s disease (PD) PD ranks second among the common neurodegenerative disease next only to Alzheimer’s dementia. Autonomic symptoms in Parkinson’s disease is very common. This study assesses the autonomic dysfunction in PD, their prevalence, type and severity in related to staging.
Methods: The study was conducted in Rajiv Gandhi government general hospital, Institute of neurology Madras medical college between 2011 to 2013, 141 patients fulfilling the criteria of Parkinson’s disease brain bank society were included in the study. All the patients were clinically examined with special attention to history, clinical features and symptoms and signs of Autonomic dysfunction. The patients were graded using the Hoehn and Yahr staging system.
Results: Among 141 patients, 118 (83.7%) had autonomic dysfunction. Among 87 males, 72 patients had ANS dysfunction and among 54 females, 46 patients had ANS dysfunction. Stage wise 39 patients of 53 patients (73.6%) belonging to Stage I; 37 of 44 (84.1%) belonging to Stage II; 26 of 28 (92.8%) belonging to Stage III and all patients belonging to Stage IV and V had ANS dysfunction.
Conclusions: ANS dysfunction in Parkinson’s disease is a common problem and the prevalence of it is 82.75% in males and 85.2% in females and overall in 83.7% of patients. The prevalence of ANS dysfunction in Males and females increases as the Hoehn and Yahr stage increases as evidenced by 68.7% of males and 80.9% of females have ANS dysfunction in stage I, while 100% of males and females in stage IV and V have ANS dysfunction. Sexual dysfunction (84.7%) ranks first followed by gastrointestinal (56.9%), and thermoregulatory (51.3%) autonomic disturbances in males and urinary disturbances (78.3%), ranks first followed by thermoregulatory (65.2%), and cardiovascular disturbances (56.5%) in females.
Massano J, Bhatia KP. Clinical approach to parkinson's disease: features, diagnosis, and principles of management cold. Spring Harb Perspect Med. 2012;2(6):10.1101.
Aminoff MJ, Wilcox CS. Assessment of autonomic function in patients with a parkinsonian syndrome. BMJ. 1971;4:80-4.
Goetz CG, Lutge W, Tanner CM. Autonomic dysfunction in Parkinson's disease. Neurol. 1986;36:73-5.
Korezyn AD. Autonomic nervous system dysfunction in Parkinson's disease. In: Calne DB, ed. Parkinsonism and aging. New York: Raven Press; 1989:211-219.
Daniel SE, Lees AJ. Parkinson’s Disease Society Brain Bank, London: overview and research. J Neural Transm. 1993;39: S165-72.
BRAIN ‘S diseases of the nervous system. In: Michael Donaghy, eds. 12th ed. 2009:1241-1252.
Camerlingo M, Ferraro B, Gazzaniga GC, Casto L, Cesana BM, Mamoli A. Cardiovascular reflexes in Parkinson’s disease: long-term effects of levodopa treatment on de novo patients. Acta Neurol Scand. 1990;81: 46-8.
Diehl RR, Linden D, Berlit P. Determinants of heart rate variability during deep breathing: basic findings and clinical applications. Clin Auton Res. 1997;7:131-5.
Gross M, Bannister R, Godwin-Austen R. Orthostatic hypotension in Parkinson's disease. Lancet. 1972;1:174-6.
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;33:463-7.
Ewing DJ, Burt AA, Williams IR, Campbell IW, Clarke BF. Peripheral motor nerve function in diabetic autonomic neuropathy J Neurol Neurosurg Psychiatry. 1976;39:453-60.
Katona PG, Jih F. Respiratory sinus arrhythmia: non-invasive measure of parasympathetic cardiac control. J Appl Physiol. 1975;39:801-5.
Karemaker JM. Analysis of blood pressure and heart rate variability. Theoretical considerations. In: Clinical Autonomic Disorders, 2nd ed. Lippincott-Raven Publ; Philadelphia: 1997:309-322.
Haapaniemi TH, Pursiainen V, Korpelainen JT, Huikuri HV, Sotaniemi KA, Myllyla VV. Ambulatory ECG and analysis of heart rate variability in Parkinson’s disease. J Neurol Neurosurg Psychiatry. 2001;70:305-10.
Hirsch JA, Bishop B. Respiratory sinus arrhythmia in humans: how breathing pattern modulates heart rate. Am J Physiol. 1981;241: H620-9.
Phillip A. Low laboratory evaluation of autonomic function. Supplements to Clin Neurophysiol. 2004;57(36):358-68.
Ravits JM. Autonomic nervous system testing. Muscle Nerve. 1997;20:919-37.
Turkka J. Autonomic dysfunction in Parkinson’s disease. Academic dissertation, Acta Universitatis Ouluensis, Series D Medica No. 142, Oulu, Finland. 1986.
Zesiewicz TA, Baker MJ, Wahba M, Hauser RA. Autonomic Nervous System Dysfunction in Parkinson's Disease. Curr Treat Options Neurol. 2003;5(2):149-60.
Kim BJ, Koh SB, Park KW. Autonomic dysfunction according to disease progression in Parkinson's disease. Parkinsonism Relat Disord. 2014;20(3):303-7.
Wüllner U, Schmitz-Hubsch T, Antony G, Fimmers R, Spottke A, Oertel WH, et al. Autonomic dysfunction in 3414 Parkinson's disease patients enrolled in the German Network on Parkinson's disease (KNP e.V.): the effect of ageing. Eur J Neurol. 2007;14(12):1405-8.
Singer C, Weiner WJ, Sanchez-Ramos JR. Autonomic dysfunction in men with Parkinson's disease. Eur Neurol. 1992;32(3):134-40.
Meco G, Pratesi L, Bonifati V. Cardiovascular reflexes and autonomic dysfunction in Parkinson's disease. J Neurol. 1991;238:195-9.
Ludin SM, Steiger UH, Ludin HP. Autonomic disturbances and cardiovascular reflexes in idiopathic Parkinson’s disease. J Neurol. 1987;235:10-5.
Goldstein DS, Dysautonomia in parkinson’s disease: neurocardiological abnormalities. Compr Physiol. 2014;4(2):805-26.
Piha SJ, Rinne JO, Rinne UK, Seppanen A. Autonomic dysfunction in recent onset and advanced Parkinson’s disease. Clin Neurol Neurosurg. 1988;90:221-6.
Piha SJ. Cardiovascular responses to various autonomic tests in males and females. Clin Auton Res. 1993;3:15-20.
Maezler W, Liepelt I, Berg D. Progression of Parkinson's disease in the clinical phase: potential markers. Lancet Neurol. 2009;8(12):1158-71.
Dijk JGV, Haan J, Zwinderman K, Kremer B, van Hilten BJ, Roos RAC. Autonomic nervous system dysfunction in Parkinson’s disease: relationship with age, medication, duration, and severity. J Neurol Neurosurg Psychiatry. 1993;56: 1090-5.
Dijk JGV, Haan J, Koenderink M, Roos RAC. Autonomic nervous function in progressive supranuclear palsy: A comparison with Parkinson patients and normal controls. Arch Neurol. 1991;48:1083-4.