Cardiovascular autonomic dysfunction in dementia with Lewy bodies and Parkinson's disease
Hisayoshi Oka1, Masayo Morita, Kenji Onouchi
1Department of Neurology, Jikei University School of Medicine, 3-25-8, Nishi-shinbashi, Tokyo, 105-8461, Japan. h.oka@jikei.ac.jp
Insights
Cardiovascular autonomic dysfunction is more severe in dementia with Lewy bodies (DLB) than in Parkinson's disease (PD). This dysfunction in DLB is often due to postganglionic sympathetic nerve loss.
Area of Science:
- Neurology
- Cardiology
Background:
- Cardiovascular autonomic dysfunction is a known complication in neurodegenerative diseases.
- Dementia with Lewy bodies (DLB) and Parkinson's disease (PD) share overlapping features, necessitating differentiation of their autonomic profiles.
Purpose of the Study:
- To compare the extent and pattern of cardiovascular autonomic dysfunction between DLB and PD.
- To investigate the underlying mechanisms of autonomic dysfunction in DLB.
Main Methods:
- Utilized meta-iodobenzylguanidine ((123)I-MIBG) scintigraphy and hemodynamic autonomic function testing (Valsalva maneuver).
- Included 27 patients with DLB, 46 with PD, and 20 healthy controls.
Main Results:
- Reduced (123)I-MIBG uptake in DLB compared to PD and controls.
- DLB exhibited decreased baroreceptor reflex and blunted SBP responses.
- DLB showed significantly lower SBP responses and plasma norepinephrine levels than PD and controls, suggesting more severe sympathetic denervation.
Conclusions:
- Cardiovascular autonomic dysfunction is more pronounced in DLB than in PD.
- The primary cause in DLB is typically postganglionic sympathetic nervous dysfunction.
- A subset of DLB patients may experience dysautonomia due to preganglionic dysfunction.
Objective:
We estimated the extent and pattern of cardiovascular autonomic dysfunction in dementia with Lewy bodies (DLB) as compared with that in Parkinson's disease (PD).
Methods:
We performed meta-iodobenzylguanidine ((123)I-MIBG) scintigraphy of the heart and hemodynamic autonomic function testing using the Valsalva maneuver in 27 patients with DLB, 46 with PD, and 20 controls.
Results:
(123)I-MIBG uptakes in DLB were reduced as compared with those in control and PD. Hemodynamic studies revealed that DLB had decreased baroreceptor reflex and reduced responses of SBP in phases II and IV as compared with PD and control. SBP responses on standing and the difference in plasma norepinephrine (NE) concentrations between supine and standing positions were reduced in PD as compared with those in control. Furthermore, SBP responses on standing, plasma NE concentrations in supine and standing positions, and the difference in plasma NE concentrations between these positions were significantly lower in DLB than in PD and control. Plasma NE concentrations in DLB with orthostatic hypotension (OH) were lower than that in DLB without OH, although some patients who had DLB with orthostatic hypotension had relatively normal plasma NE levels.
Conclusion:
Cardiovascular autonomic dysfunction is more severe in DLB than in PD and is usually caused by the loss of postganglionic sympathetic nervous function, although dysautonomia in some patients with DLB may result from preganglionic dysfunction.
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