Sex-differences in autonomic and cardiovascular responses to multimodal therapy in Parkinson's disease: a pilot study

Parkinson's Disease (PD) bears a variety of sex differences and is associated with cardiovascular dysregulation (CDR). Variation in the routinely assessed standard parameters heart rate (HR) and blood pressure (BP) seem not well understood within the frame of sex-specific developments under therapy. Parameters of heart rate variability (RMSSD) and electrodermal activity (meanEDA) may assist the understanding of underlying autonomic developments. This pilot study aims to describe sex-specific cardiovascular and autonomic responses to a multimodal inpatient rehabilitation program in patients with PD.

Forty-one PD patients (24 male, 17 female) participated in a stationary, multimodal therapy intervention (MTI). Before and after MTI, HR, BP, RMSSD, and meanEDA were assessed in supine baseline (5 min of rest before orthostasis) and during supine adaption to rest (5 min of rest after orthostasis). Differences between baseline and adaption to rest as well as differences over time of MTI were calculated using Wilcoxon test; sex differences using Mann-Whitney-U test.

Before MTI, women's supine HR (p = .034*; d = .17) and BP (p = .015*, d = 0.4) were significantly higher during adaption to rest than during baseline. After MTI, women's supine HR (p = .020*; d = .84) and BP (p = .022*, d = 0.5) during adaption to rest had decreased significantly. Men's HR and BP remained constant and without differences between the supine conditions. RMSSD and meanEDA remained steady in both sexes.

The sex-specific responsiveness to MTI supports the concept of sex-sensitive therapeutic management for cardiovascular symptoms in PD. In both sexes, peripheral cardiovascular outcomes appeared not attributable to corresponding outcomes in autonomic regulation. Further examination of autonomic parameters could provide a foundation for developing therapeutic approaches that address central nervous system mechanisms. The study was officially registered (08/2020). The data supporting the findings of this study are available under http://apps.who.int/trialsearch/ under trial number DRKS00022773.