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Cardiac responses to orthostatic stress deteriorate in Parkinson disease patients who begin to fall
- Clinical Department of Neurology, Voivodeship Hospital in Olsztyn
- 1st Department of Medicine, Flór Ferenc Hospital, Kistarcsa, Hungary
- Department of Laryngology, Jagiellonian University Medical College, Krakow, Poland
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Abstract
It is not clear how cardiovascular autonomic nervous system dysfunction can affect falls in Parkinson disease (PD) patients. The aim of the study was to evaluate cardiovascular autonomic responses to orthostatic stress and occurrence of falls in PD patients over a period of 1-2 years.
Material and methodsIn 53 patients, who either experienced at least one fall during 12 months preceding the study onset (fallers) or did not fall (non-fallers), we monitored RR intervals (RRI), heart rate (HR) and systolic (SBP) and diastolic (DBP) blood pressure, and calculated the coefficient of variation of RRI (RRI-CoV) and the ratio of low to high frequency spectral powers of RRI oscillations (LF/HF) at rest and upon tilting at study entry and after at least 12 months. Based on the number of falls at study closure, we identified three subgroups: non-fallers, chronic fallers, and new fallers.
ResultsAt study entry, RR-CoV, SBP, or DBP did not differ between fallers and non-fallers, while LF/HF ratios were lower in fallers than non-fallers at rest and upon tilting. After the follow-up period, HR and RRI-CoV responses to head-up tilt were reduced in new fallers as compared to study entry, whereas these variables remained unchanged during the study in non-fallers and chronic fallers. Prevalence of orthostatic hypotension did not differ between subgroups of patients.
ConclusionsCardiac responses to orthostatic stress deteriorate in PD patients who begin to fall. Orthostatic blood pressure responses remain unchanged over time and are not associated with falls in PD.
Abstract
It is not clear how cardiovascular autonomic nervous system dysfunction can affect falls in Parkinson disease (PD) patients. The aim of the study was to evaluate cardiovascular autonomic responses to orthostatic stress and occurrence of falls in PD patients over a period of 1-2 years.
Material and methodsIn 53 patients, who either experienced at least one fall during 12 months preceding the study onset (fallers) or did not fall (non-fallers), we monitored RR intervals (RRI), heart rate (HR) and systolic (SBP) and diastolic (DBP) blood pressure, and calculated the coefficient of variation of RRI (RRI-CoV) and the ratio of low to high frequency spectral powers of RRI oscillations (LF/HF) at rest and upon tilting at study entry and after at least 12 months. Based on the number of falls at study closure, we identified three subgroups: non-fallers, chronic fallers, and new fallers.
ResultsAt study entry, RR-CoV, SBP, or DBP did not differ between fallers and non-fallers, while LF/HF ratios were lower in fallers than non-fallers at rest and upon tilting. After the follow-up period, HR and RRI-CoV responses to head-up tilt were reduced in new fallers as compared to study entry, whereas these variables remained unchanged during the study in non-fallers and chronic fallers. Prevalence of orthostatic hypotension did not differ between subgroups of patients.
ConclusionsCardiac responses to orthostatic stress deteriorate in PD patients who begin to fall. Orthostatic blood pressure responses remain unchanged over time and are not associated with falls in PD.
Keywords
Parkinson disease, autonomic nervous system, orthostatic hypotension, falls, syncope
Title
Cardiac responses to orthostatic stress deteriorate in Parkinson disease patients who begin to fall
Journal
Neurologia i Neurochirurgia Polska
Issue
Pages
339-349
Page views
402
Article views/downloads
418
DOI
10.1016/S0028-3843(14)60293-0
Bibliographic record
Neurol Neurochir Pol 2010;44(4):339-349.
Keywords
Parkinson disease
autonomic nervous system
orthostatic hypotension
falls
syncope
Authors
Hanna Czarkowska
Marcin Tutaj
Monika Rudzińska
Maciej Motyl
Mirosław Bryś
Sylwia Bukowczan
Anna Kyrcz
Katarzyna Zajdel
Andrzej Szczudlik