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Autonomic dysfunction in elderly bedfast patients
M Kihara1, M Takahashi, K Nishimoto
1Department of Neurology, Kinki University School of Medicine, 377-2 Ohno-Higashi, Osaka-Sayama, Osaka, 589, Japan.
Objective:
to quantify autonomic function in bedfast elderly patients.
Patients And Methods:
we analysed orthostatic blood pressure, heart rate response to tilt, heart rate response to deep breathing, quantitative sudomotor axon reflex test (QSART) and beat-to-beat blood pressure during phases II and IV of the Valsalva manoeuvre (VM) in 15 patients with (OH+) and without orthostatic hypotension (OH-) and 12 age-matched controls.
Results:
all bedfast patients had a poor response in the late phase II of beat-to-beat blood pressure, while OH+ patients had an additional abnormality in phase IV. QSARTs in the distal leg and foot were decreased in both OH+ and OH- groups. There was no difference between the two groups in duration of being bedfast or in activities of daily living.
Conclusions:
(i) being bedfast results in postganglionic sympathetic dysfunction in the lower extremities; (ii) some patients who have beta-adrenergic dysfunction have OH and (iii) preventing patients from becoming being bedfast may be important for the maintenance of normal autonomic functions.