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Association Between Gait and Dysautonomia in Patients With De Novo Parkinson’s Disease: Forward Gait Versus Backward Gait
Seon-Min Lee, Mina Lee, Eun Ji Lee, Rae On Kim, Yongduk Kim, Kyum-Yil Kwon
Received March 25, 2022  Accepted June 27, 2022  Published online September 7, 2022  
DOI: https://doi.org/10.14802/jmd.22045    [Epub ahead of print]
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AbstractAbstract PDF
Objective
Studies on gait and autonomic dysfunction have been insufficient so far, particularly de novo Parkinson’s disease (PD). The aim of this study was to identify the association between gait dynamics and autonomic dysfunction in patients with de novo PD.
Methods
A total 38 patients with de novo PD were retrospectively included in this study. Details of patients’ dysautonomia were assessed using the Scales for Outcomes in Parkinson’s Disease-Autonomic Dysfunction (SCOPA-AUT). For assessment of gait, a computerized gait analysis was performed using the GAITRite system for forward gait and backward gait. High SCOPA-AUT score (PD-HSAS) group and low SCOPA-AUT score (PD-LSAS) group were identified according to their SCOPA-AUT scores.
Results
Nineteen (50%) patients with high SCOPA-AUT scores above median value (12.5) were assigned into the PD-HSAS group and others were assigned to the PD-LSAS group. Compared with the PD-LSAS group, the PD-HSAS group exhibited slower gait, shorter stride, decreased cadence, increased double support phase, decreased swing phase, and increased variability in swing time. Total SCOPA-AUT score showed significantly positive correlations with gait variability and instability but a negative correlation with gait hypokinesia. In subdomain analysis, urinary dysautonomia was highly associated with impairment of gait dynamics. All significant results were found to be more remarkable in backward gait than in forward gait.
Conclusion
Our findings suggest that alteration in gait dynamics, especially backward gait, is highly associated with autonomic dysfunction in patients with de novo PD.
Cardiovascular Autonomic Dysfunction in Mild and Advanced Parkinson’s Disease
Joong-Seok Kim, Si-Hoon Lee, Yoon-Sang Oh, Jeong-Wook Park, Jae-Young An, Sung-Kyung Park, Si-Ryung Han, Kwang-Soo Lee
J Mov Disord. 2016;9(2):97-103.   Published online March 28, 2016
DOI: https://doi.org/10.14802/jmd.16001
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  • 194 Download
  • 25 Citations
AbstractAbstract PDF
Objective
The purpose of the present study was to investigate cardiovascular autonomic dysfunction in patients with Parkinson’s disease (PD) with mild to severe stages of motor symptoms and to compare cardiovascular autonomic dysfunction between drug-naïve and dopaminergic drug-treated groups.
Methods
This study included 188 PD patients and 25 age-matched healthy controls who underwent head-up tilt-testing, 24-h ambulatory blood pressure (BP) monitoring and 24-h Holter monitoring. Autonomic function test results were evaluated among groups categorized by motor symptom severities (mild vs. moderate vs. severe) and treatment (drug-naïve or dopaminergic drug treatment).
Results
Orthostatic hypotension and supine hypertension were more frequent in patients with PD than in healthy controls. The frequencies of orthostatic hypotension, supine hypertension, nocturnal hypertension and non-dipping were not different among groups. Additionally, no significant differences were detected in supine BP, orthostatic BP change, nighttime BP, nocturnal BP dipping, or heart rate variabilities among groups.
Conclusions
Cardiovascular autonomic dysfunction is not confined to moderate to severe PD patients, and starts early in the course of the disease in a high proportion of PD patients. In addition, dopaminergic drug treatments do not affect cardiovascular autonomic function.

Citations

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    Mehmet Balal, Meltem Demirkiran, Saime Paydas, Seyed-Mohammad Fereshtehnejad
    Parkinson's Disease.2022; 2022: 1.     CrossRef
  • Blood Pressure Patterns in Patients with Parkinson’s Disease: A Systematic Review
    Delia Tulbă, Liviu Cozma, Paul Bălănescu, Adrian Buzea, Cristian Băicuș, Bogdan Ovidiu Popescu
    Journal of Personalized Medicine.2021; 11(2): 129.     CrossRef
  • Inverted circadian variation of arterial pressure in a geriatric patient: an indicator of autonomic dysfunction
    Siddhartha Lieten, Aziz Debain, Bert Bravenboer, Tony Mets
    BMC Geriatrics.2021;[Epub]     CrossRef
  • Autonomic dysfunction and heart rate variability with Holter monitoring: a diagnostic look at autonomic regulation
    Beatrice De Maria, Laura Adelaide Dalla Vecchia, Alberto Porta, Maria Teresa La Rovere
    Herzschrittmachertherapie + Elektrophysiologie.2021; 32(3): 315.     CrossRef
  • Heart Rate Variability Analyses in Parkinson’s Disease: A Systematic Review and Meta-Analysis
    Konstantin G. Heimrich, Thomas Lehmann, Peter Schlattmann, Tino Prell
    Brain Sciences.2021; 11(8): 959.     CrossRef
  • Association of orthostatic hypotension with Parkinson’s disease: a meta-analysis
    Feifei Mu, Qian Jiao, Xixun Du, Hong Jiang
    Neurological Sciences.2020; 41(6): 1419.     CrossRef
  • Dizziness in patients with early stages of Parkinson's disease: Prevalence, clinical characteristics and implications
    Kyum‐Yil Kwon, Suyeon Park, Mina Lee, Hyunjin Ju, Kayeong Im, Byung‐Euk Joo, Kyung Bok Lee, Hakjae Roh, Moo‐Young Ahn
    Geriatrics & Gerontology International.2020; 20(5): 443.     CrossRef
  • The Dysfunctional Autonomic Function and “Dysfunctional” Fatigue in Drug Naïve Parkinson’s Disease
    Jong Hyeon Ahn, Minkyeong Kim, Jun Kyu Mun, Yoonsu Cho, Ji Sun Kim, Jinyoung Youn, Joong-Seok Kim, Jin Whan Cho
    Journal of Parkinson's Disease.2020; 10(2): 605.     CrossRef
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    Ji-Hyun Choi, Jong-Min Kim, Hee Kyung Yang, Hyo-Jung Lee, Cheol Min Shin, Seong Jin Jeong, Won-Seok Kim, Ji Won Han, In-Young Yoon, Yoo Sung Song, Yun Jung Bae
    Journal of Korean Medical Science.2020;[Epub]     CrossRef
  • Autonomic Dysfunction in Parkinson’s Disease
    Ronald F. Pfeiffer
    Neurotherapeutics.2020; 17(4): 1464.     CrossRef
  • Dysautonomia Is Linked to Striatal Dopamine Deficits and Regional Cerebral Perfusion in Early Parkinson Disease
    Hae-Won Shin, Seok Jong Chung, Sangwon Lee, Jungho Cha, Young H. Sohn, Mijin Yun, Phil Hyu Lee
    Clinical Nuclear Medicine.2020; 45(8): e342.     CrossRef
  • Characteristics of the 24-h ambulatory blood pressure monitoring in patients with Parkinson's disease – the SFC BP multicentre study in China
    Shi-Wu Chen, Yu-Kai Wang, Rong-Hua Dou, Xin-Yi Xie, Yong-Bo Hu, Nan Ding, Guo-Hua Zhang, Hai-Fang Jing, Wei-Dong Zhao, Yan Xue, Yan Li, Gang Wang
    Journal of Hypertension.2020; 38(11): 2270.     CrossRef
  • Parkinson’s disease with orthostatic hypotension: analyses of clinical characteristics and influencing factors
    Lixia Li, Peng Guo, Duyu Ding, Tenghong Lian, Lijun Zuo, Fenghe Du, Wei Zhang
    Neurological Research.2019; 41(8): 734.     CrossRef
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    Jeremy K. Cutsforth-Gregory, Phillip A. Low
    Neurology and Therapy.2019; 8(2): 307.     CrossRef
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    Claudia Carricarte Naranjo, Connie Marras, Naomi P. Visanji, David J. Cornforth, Lazaro Sanchez-Rodriguez, Birgitt Schüle, Samuel M. Goldman, Mario Estévez, Phyllis K. Stein, Anthony E. Lang, Herbert F. Jelinek, Andrés Machado
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  • Increased risk of all‐cause mortality associated with domperidone use in Parkinson's patients: a population‐based cohort study in the UK
    Marina Simeonova, Frank Vries, Sander Pouwels, Johanna H. M. Driessen, Hubert G.M. Leufkens, Suzanne M. Cadarette, Andrea M. Burden
    British Journal of Clinical Pharmacology.2018; 84(11): 2551.     CrossRef
  • Validation of the Korean Version of the Scale for Outcomes in Parkinson’s Disease-Autonomic
    Ji-Young Kim, In-Uk Song, Seong-Beom Koh, Tae-Beom Ahn, Sang Jin Kim, Sang-Myung Cheon, Jin Whan Cho, Yun Joong Kim, Hyeo-Il Ma, Mee-Young Park, Jong Sam Baik, Phil Hyu Lee, Sun Ju Chung, Jong-Min Kim, Han-Joon Kim, Young-Hee Sung, Do Young Kwon, Jae-Hyeo
    Journal of Movement Disorders.2017; 10(1): 29.     CrossRef
  • Cardiovascular Autonomic Dysfunction in Patients with Drug-Induced Parkinsonism
    Joong-Seok Kim, Dong-Woo Ryu, Ju-Hee Oh, Yang-Hyun Lee, Sung-Jin Park, Kipyung Jeon, Jong-Yun Lee, Seong Hee Ho, Jungmin So, Jin Hee Im, Kwang-Soo Lee
    Journal of Clinical Neurology.2017; 13(1): 15.     CrossRef
  • Normal ‘heart’ in Parkinson's disease: is this a distinct clinical phenotype?
    J.-S. Kim, H.-E. Park, I.-S. Park, Y.-S. Oh, D.-W. Ryu, I.-U. Song, Y.-A. Jung, I. R. Yoo, H.-S. Choi, P. H. Lee, K.-S. Lee
    European Journal of Neurology.2017; 24(2): 349.     CrossRef
  • The composite autonomic symptom scale 31 is a useful screening tool for patients with Parkinsonism
    Younsoo Kim, Jin Myoung Seok, Jongkyu Park, Kun-Hyun Kim, Ju-Hong Min, Jin Whan Cho, Suyeon Park, Hyun-jin Kim, Byoung Joon Kim, Jinyoung Youn, Pedro Gonzalez-Alegre
    PLOS ONE.2017; 12(7): e0180744.     CrossRef
  • Cardiac sympathetic denervation predicts PD in at-risk individuals
    David S. Goldstein, Courtney Holmes, Grisel J. Lopez, Tianxia Wu, Yehonatan Sharabi
    Parkinsonism & Related Disorders.2017;[Epub]     CrossRef
  • Loss of cutaneous large and small fibers in naive and l-dopa–treated PD patients
    Maria Nolano, Vincenzo Provitera, Fiore Manganelli, Rosa Iodice, Annamaria Stancanelli, Giuseppe Caporaso, Annamaria Saltalamacchia, Francesca Califano, Bernardo Lanzillo, Marina Picillo, Paolo Barone, Lucio Santoro
    Neurology.2017; 89(8): 776.     CrossRef
  • Arterial Stiffness and Cardiovascular Autonomic Dysfunction in Patients with Parkinson's Disease
    Joong-Seok Kim, Si-Hoon Lee, Yoon-Sang Oh, Jeong-Wook Park, Jae-Young An, Hyun-Seok Choi, Kwang-Soo Lee
    Neurodegenerative Diseases.2017; 17(2-3): 89.     CrossRef
  • Prevalence and Prescribed Treatments of Orthostatic Hypotension in Institutionalized Patients with Parkinson’s Disease
    ALAJ Hommel, MJ Faber, NJ Weerkamp, JG van Dijk, BR Bloem, RT Koopmans
    Journal of Parkinson's Disease.2016; 6(4): 805.     CrossRef
Orthostatic Hypotension in Drug-Naïve Patients with Parkinson’s Disease
Hyo-Jin Bae, Sang-Myung Cheon, Jae Woo Kim
J Mov Disord. 2011;4(1):33-37.
DOI: https://doi.org/10.14802/jmd.11005
  • 8,504 View
  • 57 Download
  • 10 Citations
AbstractAbstract PDF
Background and Purpose

Orthostatic hypotension (OH) is known to be present even in patients with early Parkinson’s disease (PD). To affirm the presence of OH and find correlation between OH and other dysautonomic symptoms in PD, this study has done in newly-diagnosed PD patients.

Methods

Forty-five non-demented patients with no prior history of treatment for PD were recruited (17 men, 63.8 ± 10.1 years of age). All the patients were evaluated for OH before starting medications. Autonomic symptoms were evaluated with structured questionnaires. Clinical characteristics of PD were evaluated (median Hoehn and Yahr stage 2.0 (1–3), 1.3 ± 1.1 years of disease duration), and comorbid medical conditions that could affect blood pressure were also recorded.

Results

OH was prevalent, and eighteen patients (40%) showed orthostatic hypotension, and twenty-seven (60%) did not (normotensive group). There was no significant difference in demographic and clinical characteristics between groups. The presence or severity of symptoms of autonomic dysfunction in the OH group also not differed from those of the normotensive group.

Conclusions

OH was prevalent even in the early stage of PD, and was not related to presence or severity of any other symptoms of autonomic dysfunction. Our findings suggest that clinicians should pay attention to OH from the early stage of disease.

Citations

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  • Pronounced Orthostatic Hypotension in GBA-Related Parkinson’s Disease
    Tatiana Usnich, Henrike Hanssen, Katja Lohmann, Christina Lohse, Christine Klein, Meike Kasten, Norbert Brüggemann
    Journal of Parkinson's Disease.2022; 12(5): 1539.     CrossRef
  • Could Small Heat Shock Protein HSP27 Be a First-Line Target for Preventing Protein Aggregation in Parkinson’s Disease?
    Javier Navarro-Zaragoza, Lorena Cuenca-Bermejo, Pilar Almela, María-Luisa Laorden, María-Trinidad Herrero
    International Journal of Molecular Sciences.2021; 22(6): 3038.     CrossRef
  • Delayed orthostatic hypotension in Parkinson’s disease
    Sang-Won Yoo, Joong-Seok Kim, Ji-Yeon Yoo, Eunkyeong Yun, Uicheul Yoon, Na-Young Shin, Kwang-Soo Lee
    npj Parkinson's Disease.2021;[Epub]     CrossRef
  • Neurogenic orthostatic hypotension in early stage Parkinson's disease: New insights from the first 105 patients of the BoProPark study
    Francesca Baschieri, Luisa Sambati, Pietro Guaraldi, Giorgio Barletta, Pietro Cortelli, Giovanna Calandra-Buonaura
    Parkinsonism & Related Disorders.2021; 93: 12.     CrossRef
  • Trajectory Analysis of Orthostatic Hypotension in Parkinson’s Disease: Results From Parkinson’s Progression Markers Initiative Cohort
    Kui Chen, Kangshuai Du, Yichen Zhao, Yongzhe Gu, Yanxin Zhao
    Frontiers in Aging Neuroscience.2021;[Epub]     CrossRef
  • Autonomic dysfunction in Parkinson’s disease: Implications for pathophysiology, diagnosis, and treatment
    Zhichun Chen, Guanglu Li, Jun Liu
    Neurobiology of Disease.2020; 134: 104700.     CrossRef
  • Prevalence and factors related to orthostatic syndromes in recently diagnosed, drug-naïve patients with Parkinson disease
    Cecilia Quarracino, Matilde Otero-Losada, Francisco Capani, Santiago Pérez-Lloret
    Clinical Autonomic Research.2020; 30(3): 265.     CrossRef
  • Orthostatic hypotension in Parkinson disease
    Ylva Hivand Hiorth, Kenn Freddy Pedersen, Ingvild Dalen, Ole-Bjørn Tysnes, Guido Alves
    Neurology.2019; 93(16): e1526.     CrossRef
  • The range and nature of non-motor symptoms in drug-naive Parkinson’s disease patients: a state-of-the-art systematic review
    Panagiotis Zis, Roberto Erro, Courtney C Walton, Anna Sauerbier, Kallol Ray Chaudhuri
    npj Parkinson's Disease.2015;[Epub]     CrossRef
  • Orthostatic Hypotension and Cognitive Impairment in <i>De Novo</i> Patients with Parkinson’s Disease
    Hyo-Jin Bae, Jun-Ho Lim, Sang-Myung Cheon
    Journal of Movement Disorders.2014; 7(2): 102.     CrossRef
Autonomic Dysfunctions in Parkinsonian Disorders
Hyo-Jin Bae, Sang-Myung Cheon, Jae Woo Kim
J Mov Disord. 2009;2(2):72-77.
DOI: https://doi.org/10.14802/jmd.09019
  • 31,555 View
  • 84 Download
  • 4 Citations
AbstractAbstract PDF
Background and Purpose:

Symptoms of autonomic dysfunctions are common in the patients with parkinsonian disorders. Because clinical features of autonomic dysfunctions are diverse, the comprehensive evaluation is essential for the appropriate management. For the appreciation of autonomic dysfunctions and the identification of differences, patients with degenerative parkinsonisms are evaluated using structured questionnaire for autonomic dysfunction (ADQ).

Methods:

Total 259 patients, including 192 patients with [idiopathic Parkinson’s disease (IPD, age 64.6 ± 9.6 years)], 37 with [multiple system atrophy (MSA, 62.8 ± 9.1)], 9 with [dementia with Lewy body (DLB, 73.9 ± 4.3)], and 21 with [progressive supranuclear palsy (PSP, 69.4 ± 9.6)]. The ADQ was structured for evaluation of the presence of symptoms and its severity due to autonomic dysfunction, covering gastrointestinal, urinary, sexual, cardiovascular and thermoregulatory domains. Patients were also evaluated for the orthostatic hypotension.

Results:

Although dementia with Lewy body (DLB) patients were oldest and duration of disease was longest in IPD, total ADQ scores of MSA and PSP (23.9 ± 12.6 and 21.1 ± 7.8) were significantly increased than that of IPD (15.1 ± 10.6). Urinary and cardiovascular symptom scores of MSA and gastrointestinal symptom score of PSP were significantly worse than those of IPD. The ratio of patient with orthostatic hypotension in IPD was 31.2% and not differed between groups (35.1% in MSA, 33.3% in DLB and 33.3% in PSP). But the systolic blood pressure dropped drastically after standing in patients with MSA and DLB than in patients with IPD and PSP.

Conclusions:

Patients with degenerative parkinsonism showed widespread symptoms of autonomic dysfunctions. The severity of those symptoms in patients with PSP were comparing to that of MSA patients and worse than that of IPD.

Citations

Citations to this article as recorded by  
  • Autonomic dysfunction in progressive supranuclear palsy
    Francesca Baschieri, Maria Vitiello, Pietro Cortelli, Giovanna Calandra-Buonaura, Francesca Morgante
    Journal of Neurology.2022;[Epub]     CrossRef
  • The Non-Motor Symptom Profile of Progressive Supranuclear Palsy
    Sudhakar Pushpa Chaithra, Shweta Prasad, Vikram Venkappayya Holla, Albert Stezin, Nitish Kamble, Ravi Yadav, Pramod Kumar Pal
    Journal of Movement Disorders.2020; 13(2): 118.     CrossRef
  • Subtypes of Parkinson’s Disease: What Do They Tell Us About Disease Progression?
    Seyed-Mohammad Fereshtehnejad, Ronald B. Postuma
    Current Neurology and Neuroscience Reports.2017;[Epub]     CrossRef
  • Characteristics of Nonmotor Symptoms in Progressive Supranuclear Palsy
    Ruwei Ou, Wei Song, Qianqian Wei, Ke Chen, Bei Cao, Yanbing Hou, Bi Zhao, Huifang Shang
    Parkinson's Disease.2016; 2016: 1.     CrossRef
Comparison of Cerebral Glucose Metabolism between Possible and Probable Multiple System Atrophy
Kyum-Yil Kwon, Jae Seung Kim, Ki Chun Im, Myoung Chong Lee, Sun Ju Chung
J Mov Disord. 2009;2(1):22-28.
DOI: https://doi.org/10.14802/jmd.09006
  • 8,866 View
  • 82 Download
  • 2 Citations
AbstractAbstract PDF
Background:

To investigate the relationship between presenting clinical manifestations and imaging features of multisystem neuronal dysfunction in MSA patients, using 18F-fluorodeoxyglucose positron emission tomography (18F-FDG PET).

Methods:

We studied 50 consecutive MSA patients with characteristic brain MRI findings of MSA, including 34 patients with early MSA-parkinsonian (MSA-P) and 16 with early MSA-cerebellar (MSA-C). The cerebral glucose metabolism of all MSA patients was evaluated in comparison with 25 age-matched controls. 18F-FDG PET results were assessed by the Statistic Parametric Mapping (SPM) analysis and the regions of interest (ROI) method.

Results:

The mean time from disease onset to 18F-FDG PET was 25.9±13.0 months in 34 MSA-P patients and 20.1±11.1 months in 16 MSA-C patients. Glucose metabolism of the putamen showed a greater decrease in possible MSA-P than in probable MSA-P (p=0.031). Although the Unified Multiple System Atrophy Rating Scale (UMSARS) score did not differ between possible MSA-P and probable MSA-P, the subscores of rigidity (p=0.04) and bradykinesia (p= 0.008) were significantly higher in possible MSA-P than in probable MSA-P. Possible MSA-C showed a greater decrease in glucose metabolism of the cerebellum than probable MSA-C (p=0.016).

Conclusions:

Our results may suggest that the early neuropathological pattern of possible MSA with a predilection for the striatonigral or olivopontocerebellar system differs from that of probable MSA, which has prominent involvement of the autonomic nervous system in addition to the striatonigral or olivopontocerebellar system.

Citations

Citations to this article as recorded by  
  • F-18 FP-CIT PET in Multiple System Atrophy of the Cerebellar Type: Additional Role in Treatment
    Young Jin Jeong, Sang-Myung Cheon, Do-Young Kang, Jae Woo Kim
    Contrast Media & Molecular Imaging.2017; 2017: 1.     CrossRef
  • A systematic review of lessons learned from PET molecular imaging research in atypical parkinsonism
    Flavia Niccolini, Marios Politis
    European Journal of Nuclear Medicine and Molecular Imaging.2016; 43(12): 2244.     CrossRef

JMD : Journal of Movement Disorders