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1.
Artigo em Russo | MEDLINE | ID: mdl-31407676

RESUMO

AIM: To define the mechanism of formation of orthostatic hypotension in patients with traumatic tetraplegia. MATERIAL AND METHODS: The study included 64 patients with chronic (more 6 month) and subacute (less 6 month) tetraplegia; the period of observation was about 30 days after admission to the rehabilitation center. Changes in the state of the autonomic nervous systems (heart rate variability at rest and head-up tilt test, sinus arrhythmia) were studied. RESULTS: In the first 6 months, all patients, and after 6-12 months, one third of the patients experienced orthostatic hypotension, which was accompanied by lower values of the normalized sympatovagal index (LFn/HFn) 0.35 (0.260; 0.650) and expiratory-inspiratory coefficient (RRmax/RRmin) 1.09 (1.040; 1200). An increase in expiratory-inspiratory coefficient as a result of physical rehabilitation up to 1.16 (1.120; 1.24) was noted only in patients less than 6 months after injury. CONCLUSION: Both sympathetic and parasympathetic parts of the autonomic nervous system are involved in the formation of orthostatic hypotension syndrome in patients with spinal tetraplegia.


Assuntos
Hipotensão Ortostática , Doenças da Medula Espinal , Sistema Nervoso Autônomo , Frequência Cardíaca , Humanos , Hipotensão Ortostática/etiologia , Doenças da Medula Espinal/complicações , Teste da Mesa Inclinada
2.
Lakartidningen ; 1162019 Feb 19.
Artigo em Sueco | MEDLINE | ID: mdl-31192373

RESUMO

Syncope is the chief complaint in 1-2 percent of emergency department visits. Syncope belongs to the broader category transient loss of consciousness (TLOC), defined as a short loss of consciousness with loss of awareness and responsiveness, and with subsequent amnesia for the event. Syncope is defined as TLOC due to cerebral hypoperfusion, with rapid onset and spontaneous complete recovery. The main categories of syncope are reflex syncope, orthostatic hypotension, and cardiac syncope. The 2018 guidelines by the European Society of Cardiology emphasizes the process of risk stratification in the initial management of suspected syncope. Risk stratification serves to separate the patients with likely orthostatic and reflex syncope with good prognosis from the patients with likely cardiac syncope and high short-term risk of an adverse outcome. It determines the appropriate next level of care. Further evaluation should be based on clinical suspicion and frequency of symptoms.


Assuntos
Síncope/diagnóstico , Cardiologia , Procedimentos Clínicos , Diagnóstico Diferencial , Gerenciamento Clínico , Europa (Continente) , Humanos , Hipotensão Ortostática/diagnóstico , Hipotensão Ortostática/etiologia , Hipotensão Ortostática/terapia , Guias de Prática Clínica como Assunto , Medição de Risco , Sociedades Médicas , Síncope/etiologia , Síncope/terapia , Síncope Vasovagal/diagnóstico , Síncope Vasovagal/etiologia , Síncope Vasovagal/terapia
3.
Intern Med ; 58(19): 2861-2864, 2019 Oct 01.
Artigo em Inglês | MEDLINE | ID: mdl-31178512

RESUMO

After experiencing upper respiratory-tract symptoms, a 41-year-old woman developed encephalitis with consciousness disturbance and respiratory failure. She had external ophthalmoplegia and facial diplegia. Magnetic resonance imaging revealed a brainstem lesion with spared longitudinal pontine bundles. Abnormal findings of the brainstem auditory-evoked potentials and blink reflex supported brainstem damage. The patient was positive for anti-N-methyl-D-aspartate receptor (NMDAR) antibodies. Repeated immunological treatments improved her symptoms, but severe orthostatic hypotension emerged. A head-up tilt test revealed no arginine vasopressin response to hypotension. The atypical symptoms of this case highlighted that the brainstem is one of the pivotal regions in anti-NMDAR encephalitis.


Assuntos
Encefalite Antirreceptor de N-Metil-D-Aspartato/diagnóstico , Tronco Encefálico/diagnóstico por imagem , Hipotensão Ortostática/etiologia , Adulto , Encefalite Antirreceptor de N-Metil-D-Aspartato/complicações , Eletroencefalografia , Feminino , Humanos , Hipotensão Ortostática/diagnóstico , Imagem por Ressonância Magnética
4.
Presse Med ; 48(2): 134-142, 2019 Feb.
Artigo em Francês | MEDLINE | ID: mdl-30728099

RESUMO

Hypotension and especially very low diastolic blood pressure could be an at-risk situation in very old and frail patients and in those with coronary heart disease. Chronic hypotension in people with heart failure is an indicator of poor prognosis and hinders the management of therapy. Orthostatic hypotension is a decrease in blood pressure>20mmHg for systolic and/or>10mmHg for diastolic within 3minutes after transition from supine to upright. Orthostatic hypotension may be symptomatic or not. The search for orthostatic hypotension is part of the clinical examination of elderly patients with hypertension, falling, diabetes and or polymedication. First intention treatment aims to correct modifiable modifying factors and to limit the circulatory consequences of orthostatism by elastic venous compression.


Assuntos
Hipotensão Ortostática/etiologia , Hipotensão Ortostática/prevenção & controle , Hipotensão/etiologia , Hipotensão/prevenção & controle , Acidentes por Quedas/prevenção & controle , Idoso , Insuficiência Cardíaca/complicações , Humanos , Hipotensão Ortostática/diagnóstico , Hipovolemia/complicações , Hipovolemia/terapia , Postura , Prognóstico , Síncope/etiologia , Síncope/prevenção & controle
5.
Presse Med ; 48(2): 127-133, 2019 Feb.
Artigo em Francês | MEDLINE | ID: mdl-30665788

RESUMO

After 80 years old, antihypertensive treatment significantly reduces cardiovascular events. In the elderly, blood pressure target depends on patients' frailty. After 80 years, French guidelines propose to aim a SBP<150 mmHg without orthostatic hypotension and without exceeding the prescription of more than three antihypertensive drugs. The target may be more ambitious for robust elderly patients. The new 2018 European guidelines set: a stricter target for robust elderly patient aged 80 years or older (SBP between 130 and 139 mmHg and DBP between 70 and 79 mmHg); this objective is less strict for frail elderly (with several comorbidities, with loss of autonomy, elderly living in nursing home or with orthostatic hypotension). A recent randomized controlled trial shows a significant reduction in mortality and cardiovascular events by achieving a low blood pressure goal in patients over the age of 75 years old. Five major drug classes can be used: thiazide diuretics, calcium channel blockers, angiotensin-converting enzyme inhibitors, angiotensin II receptor blockers and beta-blockers. Beta-blockers are less efficient to prevent stroke and are indicated in second line. However, beta-blockers represent first choice of treatment in cases of heart failure, coronary artery disease or atrial fibrillation. Appropriate follow-up and monitoring enable assessment of safety (recording BP while standing, ionogram, creatinine).


Assuntos
Anti-Hipertensivos/uso terapêutico , Hipertensão/complicações , Hipertensão/tratamento farmacológico , Idoso de 80 Anos ou mais , Disfunção Cognitiva/diagnóstico , Disfunção Cognitiva/etiologia , Comorbidade , Fragilidade/diagnóstico , Avaliação Geriátrica , Insuficiência Cardíaca/etiologia , Insuficiência Cardíaca/prevenção & controle , Humanos , Hipertensão/diagnóstico , Hipotensão Ortostática/diagnóstico , Hipotensão Ortostática/etiologia , Guias de Prática Clínica como Assunto , Acidente Vascular Cerebral/etiologia , Acidente Vascular Cerebral/prevenção & controle
6.
Intern Med ; 58(5): 713-718, 2019 Mar 01.
Artigo em Inglês | MEDLINE | ID: mdl-30333406

RESUMO

We herein report the case of an 84-year-old woman with transthyretin (TTR) Val30Met-associated familial amyloid polyneuropathy (FAP-ATTR Val30Met), representing a very old case. The patient had muscle weakness and sensory disturbances in her extremities caused by severe peripheral neuropathy. She also had vitreous opacity and orthostatic hypotension, and pyrophosphate scintigraphy showed a myocardial accumulation. Esophagogastroduodenoscopy revealed mucosal amyloid deposits, positive in anti-TTR antibody staining. A TTR gene analysis isolated the Val30Met mutation. More than a few cases of FAP-ATTR develop late, like our own, and their familial histories are often obscure in non-endemic areas, which might make a diagnosis difficult.


Assuntos
Neuropatias Amiloides Familiares/diagnóstico , Idoso de 80 Anos ou mais , Amiloide/análise , Neuropatias Amiloides Familiares/complicações , Neuropatias Amiloides Familiares/genética , Cardiomiopatias/diagnóstico , Cardiomiopatias/genética , Oftalmopatias/etiologia , Feminino , Humanos , Hipotensão Ortostática/etiologia , Mutação , Pré-Albumina/genética , Cintilografia , Corpo Vítreo
7.
PM R ; 10(9 Suppl 2): S249-S263, 2018 09.
Artigo em Inglês | MEDLINE | ID: mdl-30269810

RESUMO

Spinal cord injury (SCI) often results in the devastating loss of motor, sensory, and autonomic function. After SCI, the interruption of descending sympathoexcitatory pathways disrupts supraspinal control of blood pressure (BP). A common clinical consequence of cardiovascular dysfunction after SCI is orthostatic hypotension (OH), a debilitating condition characterized by rapid profound decreases in BP when assuming an upright posture. OH can result in a diverse array of insidious and pernicious health consequences. Acute effects of OH include decreased cardiac filling, cerebral hypoperfusion, and associated presyncopal symptoms such as lightheadedness and dizziness. Over the long term, repetitive exposure to OH is associated with a drastically increased prevalence of heart attack and stroke, which are leading causes of death in those with SCI. Current recommendations for managing BP after SCI primarily include pharmacologic interventions with prolonged time to effect. Because most episodes of OH occur in less than 3 minutes, this delay in action often renders most pharmacologic interventions ineffective. New innovative technologies such as epidural and transcutaneous spinal cord stimulation are being explored to solve this problem. It might be possible to electrically stimulate sympathetic circuitry caudal to the injury and elicit rapid modulation of BP to manage OH. This review describes autonomic control of the cardiovascular system before injury, resulting cardiovascular consequences after SCI such as OH, and the clinical assessment tools for evaluating autonomic dysfunction after SCI. In addition, current approaches for clinically managing OH are outlined, and new promising interventions are described for managing this condition.


Assuntos
Sistema Nervoso Autônomo/fisiopatologia , Gerenciamento Clínico , Hipotensão Ortostática/reabilitação , Traumatismos da Medula Espinal/complicações , Humanos , Hipotensão Ortostática/etiologia , Hipotensão Ortostática/fisiopatologia , Traumatismos da Medula Espinal/fisiopatologia , Traumatismos da Medula Espinal/reabilitação
8.
J Appl Physiol (1985) ; 125(4): 1210-1217, 2018 10 01.
Artigo em Inglês | MEDLINE | ID: mdl-30332348

RESUMO

Neurogenic orthostatic hypotension (NOH) is a cardinal feature of autonomic dysfunction. The cortical autonomic network (CAN) is a network of brain regions associated with autonomic function. Therefore, our objective was to investigate whether impairment of CAN structures is involved in the pathophysiology of NOH. Fifteen controls (63 ± 13 yr) and 15 NOH patients (67 ± 6 yr; P = 0.2) with peripheral autonomic dysfunction completed standard tests of parasympathetic [deep breathing (DB)] and sympathetic [Valsalva maneuver (VM)] activation during a functional MRI. Blood-oxygen-level dependent (BOLD) contrasts were obtained and contrasted. Compared with controls, patients had significantly smaller heart rate responses to DB (control: 15.23 ± 9.6 vs. NOH: 5.7 ± 2.1) and Valsalva ratios (control: 2.1 ± 0.47 vs. NOH: 1.2 ± 0.1; P < 0.001). NOH patients had absent adrenergic phases (late phase II and phase IV) during VM as per a qualitative analysis. During VM, controls had greater activation in the right hippocampus (T-value: 8.03), left posterior cingulate (TL: 7.6), and bilateral thalamus (TR: 7.41, TL: 8.45; P < 0.05). During phase IV, controls had greater activation in the right hippocampus (TR: 5.78l P < 0.05). Following subtraction analysis, no significant differences were evident during DB. In conclusion, NOH patients have significantly less CAN activation during sympathetic, but not parasympathetic, activation. Impaired CANs associated with sympathetic activation may be involved in the pathophysiology of NOH. NEW & NOTEWORTHY Neurogenic orthostatic hypotension (NOH) is a cardinal feature of autonomic dysfunction characterized by failure of reflexive sympathetic activation. Our result reveal that patients with autonomic dysfunction caused by postganglionic sympathetic impairment also have impaired activation of structures within the cortical autonomic network. Impaired activation is evident during a test of sympathetic, but not parasympathetic, activation. Impaired cortical autonomic networks associated with sympathetic activation may be involved in the pathophysiology of NOH.


Assuntos
Sistema Nervoso Autônomo/fisiopatologia , Córtex Cerebral/fisiopatologia , Hipotensão Ortostática/fisiopatologia , Idoso , Estudos de Casos e Controles , Córtex Cerebral/diagnóstico por imagem , Humanos , Hipotensão Ortostática/diagnóstico por imagem , Hipotensão Ortostática/etiologia , Imagem por Ressonância Magnética , Pessoa de Meia-Idade , Exame Neurológico
9.
Eur Neurol ; 80(1-2): 78-81, 2018.
Artigo em Inglês | MEDLINE | ID: mdl-30343305

RESUMO

BACKGROUND: Orthostatic hypotension (OH) is the key manifestation of autonomic dysfunction with many causes. Systemic neurological causes such as paraneoplastic syndrome are usually ignored. METHODS: We retrospectively analyzed clinical and examination data of 2 patients who were hospitalized, with onset symptom of OH and who were diagnosed as paraneoplastic syndrome. RESULTS: The patients were characteristic of an initial symptom of OH, positive anti-Hu antibody and albuminocytologic dissociation in the cerebrospinal fluid. Patient 2 died and Patient 1 worsened during follow-up. CONCLUSIONS: The diagnosis of paraneoplastic syndrome is usually neglected when the onset symptoms are autonomic dysfunctions such as OH. Neurologists should improve their knowledge to diagnose accurately.


Assuntos
Hipotensão Ortostática/etiologia , Síndromes Paraneoplásicas/complicações , Idoso , Albuminas/líquido cefalorraquidiano , Humanos , Hipotensão Ortostática/líquido cefalorraquidiano , Masculino , Pessoa de Meia-Idade , Síndromes Paraneoplásicas/líquido cefalorraquidiano , Estudos Retrospectivos
10.
Neurology ; 91(16): e1539-e1544, 2018 10 16.
Artigo em Inglês | MEDLINE | ID: mdl-30232253

RESUMO

OBJECTIVE: To test whether the plasma levels of norepinephrine (NE) in patients with neurogenic orthostatic hypotension (nOH) predict their pressor response to droxidopa. METHODS: This was an observational study, which included patients with nOH. All patients had standardized autonomic function testing including determination of venous plasma catecholamine levels drawn through an indwelling catheter while resting supine. This was followed by a droxidopa titration with 100 mg increments in successive days until relief of symptoms, side effects, or the maximum dose of 600 mg was reached. No response was defined as an increase of <10 mm Hg in systolic blood pressure (BP) after 3-minute standing 1 hour after droxidopa administration. Nonlinear regression models were used to determine the relationship between BP response and plasma NE levels. RESULTS: We studied 20 patients with nOH due to Parkinson disease, pure autonomic failure, multiple system atrophy, or autoimmune autonomic neuropathies. Their supine plasma NE levels ranged from 44 to 850 pg/mL. Lower supine plasma NE levels were associated with greater pressor effect 1 hour after dose (R2 = 0.49) and higher standing BP (R2 = 0.45). Patients with no pressor response to droxidopa had higher NE levels (382 ± 100 vs 115 ± 20 pg/mL, p = 0.0014). A supine NE level of <219.5 pg/mL had 83% sensitivity and 93% specificity to predict a pressor response (area under the curve = 0.95, p = 0.0023). CONCLUSIONS: In patients with nOH, lower supine resting plasma NE levels are associated with a greater pressor effect of droxidopa treatment. This finding should help identify patients with nOH most likely to respond to standard doses of droxidopa. CLASSIFICATION OF EVIDENCE: This study provides Class I evidence that lower supine plasma NE levels accurately identify patients with nOH more likely to have a greater pressor effect from droxidopa.


Assuntos
Antiparkinsonianos/uso terapêutico , Droxidopa/uso terapêutico , Hipotensão Ortostática/sangue , Hipotensão Ortostática/tratamento farmacológico , Norepinefrina/sangue , Decúbito Dorsal , Adolescente , Adulto , Idoso , Idoso de 80 Anos ou mais , Antiparkinsonianos/administração & dosagem , Pressão Sanguínea , Criança , Droxidopa/administração & dosagem , Feminino , Humanos , Hipotensão Ortostática/etiologia , Masculino , Pessoa de Meia-Idade , Doença de Parkinson/complicações , Resultado do Tratamento , Adulto Jovem
12.
BMC Neurol ; 18(1): 125, 2018 Aug 25.
Artigo em Inglês | MEDLINE | ID: mdl-30144800

RESUMO

BACKGROUND: Neurogenic orthostatic hypotension (nOH) results from impaired vasoconstriction due to dysfunction of the autonomic nervous system and is commonly associated with Parkinson disease (PD), multiple system atrophy (MSA), and pure autonomic failure. nOH can increase the risk of falls due to symptoms that include postural lightheadedness or dizziness, presyncope, and syncope. The purpose of this study was to obtain information from patients and caregivers regarding the symptoms and burden of nOH to expand on limited knowledge regarding the impact of nOH on quality of life. METHODS: This author-designed survey included questions regarding nOH (e.g., frequency and impact of symptoms, management) and was conducted online by Harris Poll via distribution to individuals who agreed to participate in Harris Poll online surveys or who were members of relevant disease advocacy organizations. Eligible patients were aged ≥ 18 years with PD, MSA, or pure autonomic failure and ≥ 1 of the following: orthostatic hypotension (OH), nOH, low blood pressure upon standing, or OH/nOH symptoms. Eligible caregivers cared for such patients but were not necessarily linked to any patient participant. RESULTS: Survey responses were received from 363 patients and 128 caregivers. PD was the most frequent underlying disorder (90% of patients; 88% of individuals managed by the caregivers). Despite meeting survey diagnosis criteria, a formal diagnosis of OH or nOH was reported by only 36% of patients and 16% of caregivers. The most frequent symptoms of nOH were dizziness or lightheadedness, fatigue when standing, and difficulty walking. A negative impact on patient quality of life caused by nOH symptoms was reported by 59% of patients and 75% of caregivers. Most respondents (≥87%) reported that nOH symptoms adversely affected patients' ability to perform everyday activities (most frequently physical activity/exercise, housework, and traveling). Falls (≥1) in the previous year due to nOH symptoms were reported by 57% of patients and 80% of caregivers. CONCLUSIONS: These survey results support the premise that nOH symptoms have a substantial negative impact on patient function and quality of life. The relatively low rates of formal nOH/OH diagnosis suggest the need for heightened awareness regarding the condition and its symptom burden.


Assuntos
Cuidadores/estatística & dados numéricos , Hipotensão Ortostática , Adulto , Humanos , Hipotensão Ortostática/diagnóstico , Hipotensão Ortostática/epidemiologia , Hipotensão Ortostática/etiologia , Hipotensão Ortostática/fisiopatologia , Doença de Parkinson/complicações , Qualidade de Vida
15.
Intern Med ; 57(23): 3365-3370, 2018 Dec 01.
Artigo em Inglês | MEDLINE | ID: mdl-29984770

RESUMO

Objective The autonomic functions of hereditary transthyretin (ATTRm) amyloidosis, traditionally referred to as familial amyloid polyneuropathy, have primarily been investigated in patients with Val30Met mutations, and information regarding non-Val30Met patients is scarce. The aim of this study was to systematically investigate the cardiac and peripheral vasomotor autonomic functions in non-Val30Met patients. Methods The coefficient of variation of R-R intervals (CVR-R), responses to the Valsalva manoeuvre, head-up tilt test results, noradrenaline infusion test results, and the (123) I-metaiodobenzylguanidine (MIBG) uptake on myocardial scintigraphy were assessed in five patients. The predominant manifestations were neuropathy in three patients (Val94Gly, Val71Ala, and Pro24Ser), cardiomyopathy in one (Thr60Ala), and oculoleptomeningeal involvement in one (Tyr114Cys). Results Although one patient with predominant cardiomyopathy did not manifest orthostatic hypotension during the head-up tilt test, the CVR-R, responses to the Valsalva manoeuvre, and myocardial MIBG uptake indicated the presence of cardiac sympathetic and parasympathetic dysfunction in all patients. The total peripheral resistance at 60° tilt did not increase from the baseline values in any of the examined patients. An infusion of low-dose noradrenaline induced an increase in the systolic blood pressure, except in one patient with mild neuropathy. Conclusion Cardiac and peripheral vasomotor autonomic dysfunctions were prevalent in non-Val30Met patients, irrespective of their phenotype, suggesting a common pathology of autonomic involvement. However, the vasoconstrictor function was preserved, even in a patient with advanced neuropathy.


Assuntos
Neuropatias Amiloides Familiares/complicações , Neuropatias Amiloides Familiares/fisiopatologia , Doenças do Sistema Nervoso Autônomo/etiologia , Cardiomiopatias/etiologia , 3-Iodobenzilguanidina , Adulto , Idoso , Neuropatias Amiloides Familiares/genética , Pressão Sanguínea , Feminino , Humanos , Hipotensão Ortostática/etiologia , Masculino , Pessoa de Meia-Idade , Mutação , Norepinefrina , Fenótipo , Teste da Mesa Inclinada , Manobra de Valsalva
16.
Parkinsonism Relat Disord ; 55: 97-102, 2018 10.
Artigo em Inglês | MEDLINE | ID: mdl-29880316

RESUMO

INTRODUCTION: Plasma norepinephrine concentration reflects lesions causing OH. We investigate whether patients with high norepinephrinergic orthostatic hypotension (OH) whose supine plasma norepinephrine concentration (NEsupine) is above the mean value in all patients with Parkinson's disease (PD) have central sympathetic denervation. METHODS: We analyzed data from 110 non-demented patients with early de novo PD who underwent cardiovascular examinations. We divided the patients into three groups according to the presence or absence of orthostatic hypotension and NEsupine: patients without OH, patients with OH+high NEsupine, and patients with OH+low NEsupine. RESULTS: The mean NEsupine in all patients was 251.6 pg/ml. Twelve patients (10.9%) had OH+high NEsupine (≥251.6 pg/ml), and 45 patients (40.9%) had OH+low NEsupine (<251.6 pg/ml). OH was more pronounced in patients with OH+high NEsupine than in those with OH+low NEsupine (p = 0.024). Vasopressin release and percent increase of NE after orthostatic stress were well preserved in patients with OH+low NEsupine, but not in patients with OH+high NEsupine. Cognition was lower in patients with OH+high NEsupine than in patients with OH+low NEsupine (p = 0.019) and was associated with vasopressin release during orthostatic stress on multiple regression analysis. The degree of cardiac sympathetic denervation did not differ between two groups with OH. CONCLUSIONS: Patient with PD and high norepinephrinergic OH are a subset of patients who have early cognitive decline and impaired vasopressin release. Vasopressin release after orthostatic stress was closely related to global cognition in PD.


Assuntos
Hipotensão Ortostática/sangue , Hipotensão Ortostática/etiologia , Doença de Parkinson/complicações , Sesquiterpenos/sangue , 3-Iodobenzilguanidina/farmacocinética , Idoso , Idoso de 80 Anos ou mais , Pressão Sanguínea , Transtornos Cognitivos/etiologia , Feminino , Frequência Cardíaca/fisiologia , Humanos , Hipotensão Ortostática/diagnóstico , Masculino , Testes de Estado Mental e Demência , Pessoa de Meia-Idade , Cintilografia , Teste da Mesa Inclinada/métodos , Vasopressinas/metabolismo
17.
Ugeskr Laeger ; 180(18)2018 Apr 30.
Artigo em Dinamarquês | MEDLINE | ID: mdl-29720343

RESUMO

Neurogenic autonomic dysfunction (NAD) is underdiagnosed, and it is likely in patients, who have orthostatic hypotension and symptoms from multiple organ systems as well as abnormal results from a neurological examination. A clinical and neurophysiological examination of the autonomic nervous system combined with a standardised paraclinical evaluation should be performed. NAD may be present in neurodegenerative disorders, vitamin deficiency, toxicity, infection, and in paraneoplastic, metabolic, hereditary and immune-mediated conditions.


Assuntos
Doenças do Sistema Nervoso Autônomo , Adulto , Algoritmos , Doenças do Sistema Nervoso Autônomo/complicações , Doenças do Sistema Nervoso Autônomo/diagnóstico , Doenças do Sistema Nervoso Autônomo/etiologia , Doenças do Sistema Nervoso Autônomo/terapia , Humanos , Hipotensão Ortostática/etiologia , Sistema Nervoso Parassimpático/anatomia & histologia , Sistema Nervoso Simpático/anatomia & histologia
19.
Neurol Sci ; 39(8): 1459-1462, 2018 Aug.
Artigo em Inglês | MEDLINE | ID: mdl-29627942

RESUMO

Orthostatic hypotension is a frequent non-motor symptom of Parkinson's disease, with negative prognostic role on cognitive functions. Here we measured the acute effects of orthostatic hypotension on executive functions in Parkinson's disease patients devoid of hypertension, carotid artery stenosis, and significant chronic cerebrovascular pathology. Measurements were carried out during regular visits in outpatient setting. Twenty-eight Parkinson's disease patients were recruited and studied along scheduled outpatient visits. They were divided into two groups (n = 14 each) based on the presence or lack of orthostatic hypotension. This was diagnosed according to international guidelines. All patients were submitted to the Stroop's test and to the phonological and semantic verbal fluency test after 10-min resting in supine position and immediately upon standing in upright position. Testing lasted less than 5 min in either position. In upright position, subjects with orthostatic hypotension displayed significantly worse performances at the Stroop's test word reading time (22.1 ± 4.1 vs. 14.9 ± 4.0 s), interference time (56.1 ± 12.3 vs. 41.4 ± 11.8 s), and number of errors at the interference section (5.8 ± 3.2 vs. 1.3 ± 2.1) as compared to those without orthostatic hypotension. These results demonstrate that worsening of attentive function upon standing can be measured in Parkinson's disease patients with orthostatic hypotension during routine outpatient visits. These findings suggest that clinically asymptomatic orthostatic hypotension in Parkinson's disease patients may acutely worsen neuropsychological performances with possible negative impact on daily functioning.


Assuntos
Transtornos Cognitivos/complicações , Transtornos Cognitivos/etiologia , Função Executiva/fisiologia , Hipotensão Ortostática/etiologia , Doença de Parkinson/complicações , Idoso , Pressão Sanguínea , Feminino , Humanos , Hipotensão Ortostática/diagnóstico , Masculino , Testes Neuropsicológicos , Leitura , Aprendizagem Verbal
20.
J Neurol Sci ; 385: 168-174, 2018 02 15.
Artigo em Inglês | MEDLINE | ID: mdl-29406900

RESUMO

BACKGROUND: Orthostatic hypotension (OH) is a commonly reported sign of the cardiovascular autonomic dysfunctions associated with Parkinson's disease (PD). Patients might suffer from a variety of the clinical symptoms of OH, including dizziness, lightheadedness, or problems with vision and fatigue. OBJECTIVES: To determine the prevalence of, and factors associated with, symptomatic orthostatic hypotension (OH) in Parkinson's disease (PD) and to identify any relationships between the clinical symptoms of OH and balance confidence in this patient population. METHODS: Symptomatic OH was defined as a systolic or diastolic BP fall of ≥20 or ≥10mmHg respectively, within 3min of standing and an Orthostatic Hypotension Questionnaire (OHQ) score of more than zero. Factors related to symptomatic OH were identified from a multivariate logistic regression analysis. Pearson's correlation test was used to reveal any relationships between the clinical symptoms of OH and a patient's confidence in their ability to balance, assessed using the Activities-specific Balance Confidence (ABC) scale. RESULTS: 100 Thai PD patients were consecutively recruited into this study. The prevalence of symptomatic OH was 18%, asymptomatic OH was 4%, while 78% were patients without OH. Factors associated with symptomatic OH were age (OR, 95%CI: 1.06, 1.003-1.115, p=0.038) and hypertension (OR, 95%CI: 6.16, 1.171-32.440, p=0.032). A significant and negative correlation (r=-0.229, p=0.022) between OHQ composite scores and item 3 of the ABC scale (picking up slippers from floor), one of the movements in a vertical orientation, was found. CONCLUSION: Elderly PD patients and with a co-morbidity of essential hypertension should be closely evaluated for the presence of symptomatic OH. In addition, they should be advised to change positions slowly, especially those in a vertical orientation.


Assuntos
Hipotensão Ortostática/epidemiologia , Hipotensão Ortostática/etiologia , Doença de Parkinson/complicações , Doença de Parkinson/epidemiologia , Equilíbrio Postural , Idoso , Pressão Sanguínea , Estudos Transversais , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Prevalência , Índice de Gravidade de Doença , Estatísticas não Paramétricas , Inquéritos e Questionários
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