Journal of Neural Transmission

, 115:1527

Baroreflex sensitivity and power spectral analysis in different extrapyramidal syndromes

  • C. Friedrich
  • H. Rüdiger
  • C. Schmidt
  • B. Herting
  • S. Prieur
  • S. Junghanns
  • K. Schweitzer
  • C. Globas
  • L. Schöls
  • D. Berg
  • H. Reichmann
  • T. Ziemssen
Parkinson's Disease and Allied Conditions - Original Article

Abstract

Cardiac autonomic abnormalities have been described in Parkinson’s disease and other extrapyramidal syndromes. To investigate baroreflex sensitivity as an important risk marker of cardiovascular mortality in patients with Parkinson’s disease and other extrapyramidal syndromes. We recorded continuously blood pressure, ECG and respiration in 35 patients with multiple system atrophy (MSA), 32 patients with progressive supranuclear palsy (PSP), 46 patients with idiopathic Parkinson’s disease (PD) and in 27 corresponding healthy subjects (Con). Recordings of 2 min at rest were used to calculate baroreflex and spectral analysis of heart rate and systolic blood pressure. Resting baroreflex sensitivity (BRS) was significantly lower in the MSA and the PSP group but not in the PD group in comparison to the Con group. With increasing Hoehn & Yahr stage, BRS significantly decreased in all patient groups. In spectral analysis, all patient groups had a significantly lower relative low frequency (LF)-band power than the healthy controls. Patients with extrapyramidal disorders frequently demonstrate pathologically decreased BRS values and abnormalities of spectral analysis. This may have fundamental impact on the cardiovascular prognosis of patients with extrapyramidal disease.

Keywords

Autonomic dysfunction Baroreflex sensitivity Extrapyramidal disease Spectral analysis 

References

  1. Appenzeller O, Goss JE (1971) Autonomic deficits in Parkinson’s syndrome. Arch Neurol 24:50–57PubMedGoogle Scholar
  2. Ben-Shlomo Y, Marmot MG (1995) Survival and cause of death in a cohort of patients with Parkinsonism: possible clues to aetiology? J Neurol Neurosurg Psychiatry 58:293–299PubMedCrossRefGoogle Scholar
  3. Bennett DA, Beckett LA, Murray AM, Shannon KM, Goetz CG, Pilgrim DM, Evans DA (1996) Prevalence of parkinsonian signs and associated mortality in a community population of older people. N Engl J Med 334:71–76PubMedCrossRefGoogle Scholar
  4. Bouhaddi M, Vuillier F, Fortrat JO, Cappelle S, Henriet MT, Rumbach L, Regnard J (2004) Impaired cardiovascular autonomic control in newly and long-term-treated patients with Parkinson’s disease: involvement of L-dopa therapy. Auton Neurosci 116:30–38PubMedCrossRefGoogle Scholar
  5. Braak H, Ghebremedhin E, Rub U, Bratzke H, Del Tredici K (2004) Stages in the development of Parkinson’s disease-related pathology. Cell Tissue Res 318:121–134PubMedCrossRefGoogle Scholar
  6. Carney RM, Freedland KE, Veith RC (2005) Depression, the autonomic nervous system, and coronary heart disease. Psychosom Med 67(Suppl 1):S29–S33CrossRefGoogle Scholar
  7. De Ferrari GM, Sanzo A, Bertoletti A, Specchia G, Vanoli E, Schwartz PJ (2007) Baroreflex sensitivity predicts long-term cardiovascular mortality after myocardial infarction even in patients with preserved left ventricular function. J Am Coll Cardiol 50:2285–2290PubMedCrossRefGoogle Scholar
  8. Gilman S, Low PA, Quinn N, Albanese A, Ben-Shlomo Y, Fowler CJ, Kaufmann H, Klockgether T, Lang AE, Lantos PL, Litvan I, Mathias CJ, Oliver E, Robertson D, Schatz I, Wenning GK (1999) Consensus statement on the diagnosis of multiple system atrophy. J Neurol Sci 163:94–98PubMedCrossRefGoogle Scholar
  9. Goldstein DS (2003) Dysautonomia in Parkinson’s disease: neurocardiological abnormalities. Lancet Neurol 2:669–676PubMedCrossRefGoogle Scholar
  10. Goldstein DS (2007) Cardiac denervation in patients with Parkinson disease. Cleve Clin J Med 74(Suppl 1):S91–S94Google Scholar
  11. Goldstein DS, Pechnik S, Holmes C, Eldadah B, Sharabi Y (2003) Association between supine hypertension and orthostatic hypotension in autonomic failure. Hypertension 42:136–142PubMedCrossRefGoogle Scholar
  12. Goldstein DS, Sharabi Y, Karp BI, Bentho O, Saleem A, Pacak K, Eisenhofer G (2007) Cardiac sympathetic denervation preceding motor signs in Parkinson disease. Clin Auton Res 17:118–121PubMedCrossRefGoogle Scholar
  13. Halliday GM, Li YW, Blumbergs PC, Joh TH, Cotton RG, Howe PR, Blessing WW, Geffen LB (1990) Neuropathology of immunohistochemically identified brainstem neurons in Parkinson’s disease. Ann Neurol 27:373–385PubMedCrossRefGoogle Scholar
  14. Hilz MJ, Dutsch M (2006) Quantitative studies of autonomic function. Muscle Nerve 33:6–20PubMedCrossRefGoogle Scholar
  15. Hughes AJ, Ben-Shlomo Y, Daniel SE, Lees AJ (2001) What features improve the accuracy of clinical diagnosis in Parkinson’s disease: a clinicopathologic study 1992. Neurology 57:S34–S38PubMedGoogle Scholar
  16. Karemaker JM, Wesseling KH (2008) Variability in cardiovascular control: the baroreflex reconsidered. Cardiovasc Eng 8:23–29PubMedCrossRefGoogle Scholar
  17. Kaufmann H (1996) Consensus statement on the definition of orthostatic hypotension, pure autonomic failure and multiple system atrophy. Clin Auton Res 6:125–126PubMedCrossRefGoogle Scholar
  18. La Rovere MT (2000) Baroreflex sensitivity as a new marker for risk stratification. Z Kardiol 89(Suppl 3):44–50Google Scholar
  19. Laude D, Elghozi JL, Girard A, Bellard E, Bouhaddi M, Castiglioni P, Cerutti C, Cividjian A, Di Rienzo M, Fortrat JO, Janssen B, Karemaker JM, Leftheriotis G, Parati G, Persson PB, Porta A, Quintin L, Regnard J, Rüdiger H, Stauss HM (2004) Comparison of various techniques used to estimate spontaneous baroreflex sensitivity (the EuroBaVar study). Am J Physiol Regul Integr Comp Physiol 286:R226–R231PubMedGoogle Scholar
  20. Litvan I, Agid Y, Calne D, Campbell G, Dubois B, Duvoisin RC, Goetz CG, Golbe LI, Grafman J, Growdon JH, Hallett M, Jankovic J, Quinn NP, Tolosa E, Zee DS (1996) Clinical research criteria for the diagnosis of progressive supranuclear palsy (Steele-Richardson-Olszewski syndrome): report of the NINDS–SPSP international workshop. Neurology 47:1–9PubMedCrossRefGoogle Scholar
  21. Malliani A, Montano N (2002) Heart rate variability as a clinical tool. Ital Heart J 3:439–445PubMedGoogle Scholar
  22. Mathias CJ (1998) Cardiovascular autonomic dysfunction in parkinsonian patients. Clin Neurosci 5:153–166PubMedGoogle Scholar
  23. Mesec A, Sega S, Kiauta T (1993) The influence of the type, duration, severity and levodopa treatment of Parkinson’s disease on cardiovascular autonomic responses. Clin Auton Res 3:339–344PubMedCrossRefGoogle Scholar
  24. Moak JP, Goldstein DS, Eldadah BA, Saleem A, Holmes C, Pechnik S, Sharabi Y (2007) Supine low-frequency power of heart rate variability reflects baroreflex function, not cardiac sympathetic innervation. Heart Rhythm 4:1523–1529PubMedCrossRefGoogle Scholar
  25. Oka H, Mochio S, Onouchi K, Morita M, Yoshioka M, Inoue K (2006a) Cardiovascular dysautonomia in de novo Parkinson’s disease. J Neurol Sci 241:59–65PubMedCrossRefGoogle Scholar
  26. Oka H, Mochio S, Yoshioka M, Morita M, Inoue K (2003) Evaluation of baroreflex sensitivity by the sequence method using blood pressure oscillations and R–R interval changes during deep respiration. Eur Neurol 50:230–243PubMedCrossRefGoogle Scholar
  27. Oka H, Mochio S, Yoshioka M, Morita M, Onouchi K, Inoue K (2006b) Cardiovascular dysautonomia in Parkinson’s disease and multiple system atrophy. Acta Neurol Scand 113:221–227PubMedCrossRefGoogle Scholar
  28. Parati G, Di Rienzo M, Mancia G (2000) How to measure baroreflex sensitivity: from the cardiovascular laboratory to daily life. J Hypertens 18:7–19PubMedGoogle Scholar
  29. Robinson TG, Dawson SL, Eames PJ, Panerai RB, Potter JF (2003) Cardiac baroreceptor sensitivity predicts long-term outcome after acute ischemic stroke. Stroke 34:705–712PubMedCrossRefGoogle Scholar
  30. Rodriguez M, Sabate M, Troncoso E (1996) Time and frequency domain analysis for the assessment of heart autonomic control in Parkinson’s disease. J Neural Transm 103:447–454PubMedCrossRefGoogle Scholar
  31. Rub U, Del Tredici K, Schultz C, de Vos RA, Jansen Steur EN, Arai K, Braak H (2002) Progressive supranuclear palsy: neuronal and glial cytoskeletal pathology in the higher order processing autonomic nuclei of the lower brainstem. Neuropathol Appl Neurobiol 28:12–22PubMedCrossRefGoogle Scholar
  32. Rüdiger H, Klinghammer L, Scheuch K (1999) The trigonometric regressive spectral analysis—a method for mapping of beat-to-beat recorded cardiovascular parameters on to frequency domain in comparison with Fourier transformation. Comput Methods Programs Biomed 58:1–15PubMedCrossRefGoogle Scholar
  33. Schmidt C, Herting B, Prieur S, Junghanns S, Schweitzer K, Globas C, Schols L, Antoni S, Ferger D, Reichmann H, Wilhelm H, Berg D, Ziemssen T (2007) Pupil diameter in darkness differentiates progressive supranuclear palsy (PSP) from other extrapyramidal syndromes. Mov Disord 22:2123–2126PubMedCrossRefGoogle Scholar
  34. Schmidt C, Herting B, Prieur S, Junghanns S, Schweitzer K, Globas C, Schöls L, Reichmann H, Berg D, Ziemssen T (2008a) Autonomic dysfunction in different subtypes of multiple system atrophy. Mov Disord (in press)Google Scholar
  35. Schmidt C, Herting B, Prieur S, Junghanns S, Schweitzer K, Reichmann H, Berg D, Ziemssen T (2008b) Cardiovascular autonomic dysfunction in patients with progressive supranuclear palsy (PSP). Mov Disord (in press)Google Scholar
  36. Schwartz PJ (1998) The autonomic nervous system and sudden death. Eur Heart J 19(Suppl F):F72–F80Google Scholar
  37. Szili-Torok T, Kalman J, Paprika D, Dibo G, Rozsa Z, Rudas L (2001) Depressed baroreflex sensitivity in patients with Alzheimer’s and Parkinson’s disease. Neurobiol Aging 22:435–438PubMedCrossRefGoogle Scholar
  38. Wakabayashi K, Takahashi H (2006) Cellular pathology in multiple system atrophy. Neuropathology 26:338–345PubMedCrossRefGoogle Scholar
  39. Ziemssen T, Gasch J, Rüdiger H (2008) Influence of ECG sampling frequency on spectral analysis of RR intervals and Baroreflex sensitivity using the EUROBAVAR data set. J Clin Monit Comput 22:159–168PubMedCrossRefGoogle Scholar
  40. Ziemssen T, Reichmann H (2007) Non-motor dysfunction in Parkinson’s disease. Parkinsonism Relat Disord 13:323–332PubMedCrossRefGoogle Scholar

Copyright information

© Springer-Verlag 2008

Authors and Affiliations

  • C. Friedrich
    • 1
  • H. Rüdiger
    • 1
  • C. Schmidt
    • 1
  • B. Herting
    • 2
  • S. Prieur
    • 1
  • S. Junghanns
    • 2
  • K. Schweitzer
    • 3
  • C. Globas
    • 3
  • L. Schöls
    • 3
  • D. Berg
    • 3
  • H. Reichmann
    • 2
  • T. Ziemssen
    • 1
  1. 1.Autonomic and Neuroendocrinological Laboratory, Department of NeurologyUniversity Clinic Carl Gustav Carus, Dresden University of TechnologyDresdenGermany
  2. 2.Movement Disorders Research Group, Department of NeurologyUniversity Clinic Carl Gustav Carus, Dresden University of TechnologyDresdenGermany
  3. 3.Department of Neurodegeneration, Center of Neurology, Hertie-Institute for Clinical Brain ResearchUniversity of TübingenTübingenGermany

Personalised recommendations