Blood pressure and heart rate responses to orthostatic challenge and Valsalva manoeuvre in mild cognitive impairment with Lewy bodies.
Blood pressure and heart rate responses to orthostatic challenge and Valsalva manoeuvre in mild cognitive impairment with Lewy bodies.
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DOI：
10.1002/gps.5709
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发表时间：
2022-05
影响因子：
4
通讯作者：
Thomas, Alan J.
中科院分区：
文献类型：
--
作者：
Hamilton, Calum A.;Frith, James;Donaghy, Paul C.;Barker, Sally A. H.;Durcan, Rory;Lawley, Sarah;Barnett, Nicola;Firbank, Michael;Roberts, Gemma;Taylor, John-Paul;Allan, Louise M.;O'Brien, John;Yarnall, Alison J.;Thomas, Alan J.
直立性低血压是正常衰老和年龄相关神经退行性疾病的常见特征，特别是突触核蛋白病，包括路易体痴呆。直立性低血压和其他异常心血管反应可能是路易体病的早期标志。我们的目的是评估直立位挑战和Valsalva动作的异常血压和心率反应是否在轻度认知功能障碍伴路易体（MCI-LB）中比阿尔茨海默病（MCI-AD）引起的MCI更常见。MCI患者（n = 89）接受了纵向临床评估，分类为可能的MCI-LB、可能的MCI-LB或MCI-AD，并在基线时进行了客观自主神经功能测试。根据心血管逐搏数据计算对主动站立和Valsalva动作的血压和心率反应，根据当前标准定义异常，并使用logistic模型估计经年龄调整的组间差异。直立性低血压和对直立性激发的异常心率反应在可能的MCI‐LB中并不比MCI‐AD更常见。在可能的MCI-LB中，Valsalva动作的心率异常同样不常见。对Valsalva的异常血压反应（延迟恢复至基线/应变释放后无超调）在可能的MCI‐LB中比MCI‐AD更常见。在次要分析中，主动站立后和Valsalva应变释放后10 s的血压下降幅度与心脏交感神经去神经支配弱相关。可能的MCI-LB可能具有对Valsalva的异常血压反应，但直立性低血压不是MCI-AD的明确区别特征。路易体痴呆前驱期早期自主神经功能异常的证据有限。这可能表明，在早期路易体病的症状发作有一个可变的分期，而不是确定性的“身体第一”分期以前的理论。
Orthostatic hypotension is a common feature of normal ageing, and age‐related neurodegenerative diseases, in particular the synucleinopathies including dementia with Lewy bodies. Orthostatic hypotension and other abnormal cardiovascular responses may be early markers of Lewy body disease. We aimed to assess whether abnormal blood pressure and heart rate responses to orthostatic challenge and Valsalva manoeuvre would be more common in mild cognitive impairment with Lewy bodies (MCI‐LB) than MCI due to Alzheimer's disease (MCI‐AD). MCI patients (n = 89) underwent longitudinal clinical assessment with differential classification of probable MCI‐LB, possible MCI‐LB, or MCI‐AD, with objective autonomic function testing at baseline. Blood pressure and heart rate responses to active stand and Valsalva manoeuvre were calculated from beat‐to‐beat cardiovascular data, with abnormalities defined by current criteria, and age‐adjusted group differences estimated with logistic models. Orthostatic hypotension and abnormal heart rate response to orthostatic challenge were not more common in probable MCI‐LB than MCI‐AD. Heart rate abnormalities were likewise not more common in response to Valsalva manoeuvre in probable MCI‐LB. An abnormal blood pressure response to Valsalva (delayed return to baseline/absence of overshoot after release of strain) was more common in probable MCI‐LB than MCI‐AD. In secondary analyses, magnitude of blood pressure drop after active stand and 10‐s after release of Valsalva strain were weakly correlated with cardiac sympathetic denervation. Probable MCI‐LB may feature abnormal blood pressure response to Valsalva, but orthostatic hypotension is not a clear distinguishing feature from MCI‐AD. There is limited evidence of early autonomic function abnormalities in prodromal dementia with Lewy bodies. This may suggest that there is a variable staging of symptom onset in early Lewy body disease, rather than the deterministic ‘body first’ staging previously theorised.
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DOI：
10.1007/s12350-019-01977-5
发表时间：
2021-10
期刊：
Journal of nuclear cardiology : official publication of the American Society of Nuclear Cardiology
影响因子：
--
作者：
Roberts G;Lloyd JJ;Jefferson E;Kane JPM;Durcan R;Lawley S;Petrides GS;Howe K;Haq I;O'Brien JT;Thomas AJ
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影响因子：
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DOI：
10.1016/j.jalz.2011.03.005
发表时间：
2011-05
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Alzheimer's & dementia : the journal of the Alzheimer's Association
影响因子：
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