Subject(s)
Cognitive Dysfunction , Hypotension, Orthostatic , Parkinson Disease , Cognition , HumansABSTRACT
OBJECTIVE: To evaluate whether a battery of cardiovascular autonomic tests (Ewing's battery, EB) performed with a new integrated instrumental approach is useful in differentiating multiple system atrophy with predominant parkinsonism (MSA-P) from Parkinson's disease (PD) at an early stage. METHODS: We retrospectively analyzed EB tests of all the patients (n = 99) with a parkinsonian syndrome referred to our clinic who performed EB during the first diagnostic workup and were subsequently evaluated at least once a year until a final diagnosis of MSA-P (n = 34) or PD (n = 65). Thirty-eight controls matched for age and sex were included. EB consisted of head-up tilt test (HUTT), Valsalva manoeuvre (VM), deep breathing, and sustained handgrip whose correct execution and results were checked and obtained automatically. Results were compared between groups. Discriminant analysis was performed to identify MSA-P or PD patients. RESULTS: Orthostatic hypotension was found in 22 MSA-P and 3 PD patients. Cardiovascular reflexes indices were significantly more affected in MSA-P compared to PD and controls. EB presented a 91% sensitivity and 94% specificity in the differentiation of MSA-P and PD. HUTT + VM presented a 91% sensitivity and 92% specificity. CONCLUSIONS: Our results suggest that EB or HUTT + VM performed with an integrated instrumental approach and analyzed with the discriminant procedure may distinguish MSA-P from PD at an early stage and might improve the accuracy of current diagnostic criteria. However, a validation in separate samples and prospective studies is needed.
Subject(s)
Multiple System Atrophy/diagnosis , Multiple System Atrophy/physiopathology , Parkinson Disease/diagnosis , Parkinson Disease/physiopathology , Tilt-Table Test/methods , Adult , Aged , Aged, 80 and over , Autonomic Nervous System Diseases/diagnosis , Autonomic Nervous System Diseases/physiopathology , Blood Pressure/physiology , Diagnosis, Differential , Discriminant Analysis , Early Diagnosis , Female , Heart Rate/physiology , Humans , Male , Middle Aged , Retrospective Studies , Valsalva Maneuver/physiologyABSTRACT
OBJECTIVE: aims of the current study were 1) to evaluate global cognitive function in patients with autonomic failure (AF) of peripheral origin and 2) to investigate the effect of a documented fall in blood pressure (BP) fulfilling the criteria for orthostatic hypotension (OH) on cognitive performances. METHODS: we assessed 12 consecutive patients (10 males, 68±7 years old) with pure AF (PAF) or autoimmune autonomic neuropathy (AAN) and 12 age- and gender-matched controls. All patients had no clinical signs of central nervous system involvement and normal brain CT/MRI scan. Cognitive function was assessed on two consecutive days in 3 conditions: on day 1, while sitting, by means of a comprehensive battery of neuropsychological tests; on day 2, while tilted (HUT) and during supine rest (supine) in a randomized manner. BP and heart rate (HR) were continuously recorded non-invasively for the whole duration of the examination. RESULTS: patients with PAF or AAN displayed a preserved global cognitive function while sitting. However, compared to supine assessment, during HUT patients scored significantly worse during the Trail Making Test A and B, Barrage test, Analogies test, Immediate Visual Memory, Span Forward and Span Backward test. Pathological scores, with regard to Italian normative range values, were observed only during HUT in the Barrage test and in the Analogies test in 3 and 6 patients respectively. On the contrary, in healthy controls, results to neuropsychological tests were not significantly different, during HUT compared to supine rest. CONCLUSIONS: these data demonstrate that patients with PAF and AAN present a normal sitting global cognitive evaluation. However, their executive functions worsen significantly during the orthostatic challenge, possibly because of transient frontal lobes hypoperfusion.
Subject(s)
Autonomic Nervous System Diseases/physiopathology , Cognition/physiology , Aged , Blood Pressure/physiology , Female , Heart Rate/physiology , Humans , Male , Middle Aged , Neuropsychological Tests , Posture/physiologyABSTRACT
INTRODUCTION: The exact clinical and prognostic significance and the therapeutic implications of asystole induced by head-up tilt test are still a matter of debate. METHODS: We assessed, by means of a semi-structured interview, the long-term outcome of cardioinhibitory syncope in all the patients who presented a tilt-induced sinus arrest of more than 3 s in our Autonomic Unit between 1996 and 2010. CONCLUSIONS: Although syncopal recurrences were common, tilt-induced asystole did not imply a poor prognosis in terms of death or major therapeutic procedures.
Subject(s)
Heart Arrest/mortality , Heart Arrest/physiopathology , Heart/physiopathology , Syncope, Vasovagal/mortality , Syncope, Vasovagal/physiopathology , Tilt-Table Test/adverse effects , Adolescent , Adult , Child , Female , Follow-Up Studies , Heart/innervation , Heart Arrest/diagnosis , Humans , Male , Middle Aged , Syncope, Vasovagal/diagnosis , Tilt-Table Test/methods , Young AdultABSTRACT
Postural tachycardia syndrome associated with a vasovagal reaction was recorded in a young volleyball player after an excess intake of Red Bull as a refreshing energy drink. Considering the widespread use of Red Bull among young people who are often unaware of the drink's drug content, this case report suggest Red Bull be considered a possible cause of orthostatic intolerance.
