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Cardiovascular Autonomic Dysfunction

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Parkinson’s Disease and Nonmotor Dysfunction

Part of the book series: Current Clinical Neurology ((CCNEU))

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Abstract

Patients with Parkinson’s disease (PD) often have signs or symptoms indicating impaired reflexive cardiovascular regulation, including orthostatic intolerance from orthostatic hypotension. Orthostatic hypotension in PD has been thought to be a side effect of treatment with levodopa. However, recent studies have shown that virtually all patients with PD and orthostatic hypotension, regardless of levodopa treatment, have abnormal blood pressure responses to the Valsalva maneuver and markedly decreased baroreflex-cardiovagal gain. In contrast, only a minority of patients without orthostatic hypotension have abnormal Valsalva responses, and baroreflex-cardiovagal gain is often approximately normal. Plasma levels of the sympathetic neurotransmitter, norepinephrine, are lower in patients who have PD with rather than without orthostatic hypotension, suggesting a relatively smaller complement of sympathetic nerves. Almost all patients with PD and orthostatic hypotension have significantly reduced sympathetic noradrenergic innervation of the left ventricular myocardium, and most of those without orthostatic hypotension also have diffuse or localized loss of cardiac sympathetic innervation. These findings contrast with those in multiple system atrophy (MSA) with orthostatic hypotension, which can be difficult to distinguish clinically from PD. In MSA with orthostatic hypotension, sympathetic neurocirculatory failure occurs without evidence of sympathetic denervation of the heart. Therefore, PD involves not only a central catecholaminergic lesion, with the loss of dopamine cells of the nigrostriatal system, but also a peripheral catecholaminergic lesion, with the loss of postganglionic norepinephrine cells of the sympathetic nervous system, especially in the heart. The functional consequences of cardiac sympathetic denervation in PD, relationship between central dopaminergic and peripheral noradrenergic pathologies, and the bases for cardioselective sympathetic denervation in PD without orthostatic hypotension remain unknown.

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Authors and Affiliations

  1. Clinical Neurocardiology Section, National Institute of Neurological Disorders and Stroke, National Institutes of Health, Bethesda, MD

    David S. Goldstein MD, PhD

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  1. David S. Goldstein MD, PhD
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Editors and Affiliations

  1. Department of Neurology, University of Tennessee Health Science Center, Memphis, TN

    Ronald F. Pfeiffer MD

  2. Department of Neurology, State University of New York, Downstate Medical Center, Brooklyn, NY

    Ivan Bodis-Wollner MD, DSc

  3. Department of Ophthalmology, State University of New York, Downstate Medical Center, Brooklyn, NY

    Ivan Bodis-Wollner MD, DSc

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© 2005 Humana Press Inc., Totowa, NJ

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Goldstein, D.S. (2005). Cardiovascular Autonomic Dysfunction. In: Pfeiffer, R.F., Bodis-Wollner, I. (eds) Parkinson’s Disease and Nonmotor Dysfunction. Current Clinical Neurology. Humana Press. https://doi.org/10.1385/1-59259-859-5:149

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  • DOI: https://doi.org/10.1385/1-59259-859-5:149

  • Publisher Name: Humana Press

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