Oka Hisayoshi, Yoshioka Masayuki, Onouchi Kenji, Morita Masayo, Mochio Soichiro, Suzuki Masahiko, Hirai Toshiaki, Urashima Mitsuyoshi, Inoue Kiyoharu
Department of Neurology, Jikei University School of Medicine, Tokyo, Japan.
Department of Neurology, Aoto Hospital, Jikei University School of Medicine, Tokyo, Japan.
Mov Disord. 2007 Jul 30;22(10):1510-1514. doi: 10.1002/mds.21581.
We assessed the relations of visual hallucinations (VH) to cardiovascular autonomic dysfunction in patients with Parkinson's disease (PD). The subjects were 37 patients without VH (VH(-)) and 31 with VH (VH(+)). Autonomic function was evaluated on the basis of cardiac 123-radioiodinated metaiodobenzylguanidine (123I-MIBG) uptake and hemodynamic testing with Valsalva maneuver. Systolic blood pressure (SBP) and plasma norepinephrine concentrations (NE) were measured by tilt-table testing. 123I-MIBG uptake was lower in VH(+) than VH(-). Hemodynamic studies showed that VH(-) had only cardiac sympathetic and parasympathetic dysfunction, while VH(+) additionally had reduced vasomotor sympathetic functions. The fall in SBP during tilt-table testing was greater in VH(+) than VH(-). NE and its difference in the supine and upright positions were decreased in VH(+). We conclude that cardiac and vasomotor sympathetic dysfunction is more severe in VH(+) than in VH(-). Severe dysfunction in PD with VH is probably attributed to Lewy-body lesions or neuronal loss in sympathetic ganglia, the central autonomic system, or both.
我们评估了帕金森病（PD）患者视幻觉（VH）与心血管自主神经功能障碍之间的关系。研究对象为37例无视幻觉的患者（VH(-)）和31例有视幻觉的患者（VH(+)）。基于心脏123 - 放射性碘间碘苄胍（123I - MIBG）摄取以及采用瓦尔萨尔瓦动作进行的血流动力学测试来评估自主神经功能。通过倾斜试验测量收缩压（SBP）和血浆去甲肾上腺素浓度（NE）。VH(+)组的123I - MIBG摄取低于VH(-)组。血流动力学研究表明，VH(-)组仅存在心脏交感和副交感神经功能障碍，而VH(+)组还存在血管运动交感神经功能减退。倾斜试验期间VH(+)组的SBP下降幅度大于VH(-)组。VH(+)组中NE及其在仰卧位和直立位的差值均降低。我们得出结论，VH(+)组的心脏和血管运动交感神经功能障碍比VH(-)组更严重。PD伴VH患者的严重功能障碍可能归因于路易体病变或交感神经节、中枢自主神经系统或两者的神经元丢失。
