Akaogi Y, Asahina M, Yamanaka Y, Koyama Y, Hattori T
Department of Neurology, Chiba University School of Medicine, Chiba, Japan.
Neurology. 2009 Jul 7;73(1):59-65. doi: 10.1212/WNL.0b013e3181aae83c.
To elucidate the differences among dementia with Lewy bodies (DLB), Parkinson disease with dementia (PDD), and Parkinson disease without dementia (PD), with respect to the involvement of the autonomic nervous system, we clinically investigated the cutaneous and cardiovascular autonomic functions in patients with Lewy body disease.
We studied 36 patients with Lewy body disorders, including 12 patients with DLB (age, 75.4 +/- 5.9 years), 12 patients with PDD (71.0 +/- 6.8 years), and 12 patients with PD (70.9 +/- 4.2 years), and 12 healthy control subjects (69.9 +/- 5.3 years). Sympathetic sweat response (SSwR) and skin vasomotor reflex (SkVR) on the palm were recorded to estimate the cutaneous sympathetic function, and the head-up tilt test was performed and coefficient of variation of R-R intervals (CV(R-R)) was studied to estimate the cardiovascular function.
The patients with DLB, patients with PDD, and patients with PD showed severely reduced SSwR amplitudes, significantly lower than that in the controls. The mean SkVR amplitudes in the patients with DLB and patients with PDD were significantly lower than that in the controls, but not in the patients with PD. The mean decreases in the systolic blood pressure during the head-up tilt test in the patients with DLB and patients with PDD were less than that in the controls. The mean CV(R-R) value was significantly lower in the patients with DLB.
Sudomotor function on the palm may be severely affected in Lewy body disorders, while skin vasomotor function and the cardiovascular system may be more severely affected in dementia with Lewy bodies and Parkinson disease with dementia than in Parkinson disease.
为阐明路易体痴呆（DLB）、帕金森病痴呆（PDD）和非痴呆型帕金森病（PD）在自主神经系统受累方面的差异，我们对路易体病患者的皮肤和心血管自主神经功能进行了临床研究。
我们研究了36例路易体疾病患者，包括12例DLB患者（年龄75.4±5.9岁）、12例PDD患者（71.0±6.8岁）和12例PD患者（70.9±4.2岁），以及12名健康对照者（69.9±5.3岁）。记录手掌的交感神经发汗反应（SSwR）和皮肤血管运动反射（SkVR）以评估皮肤交感神经功能，并进行头高位倾斜试验，研究R-R间期变异系数（CV(R-R)）以评估心血管功能。
DLB患者、PDD患者和PD患者的SSwR振幅严重降低，显著低于对照组。DLB患者和PDD患者的平均SkVR振幅显著低于对照组，但PD患者并非如此。DLB患者和PDD患者在头高位倾斜试验期间收缩压的平均下降幅度小于对照组。DLB患者的平均CV(R-R)值显著更低。
路易体疾病可能严重影响手掌的汗腺运动功能，而皮肤血管运动功能和心血管系统在路易体痴呆和帕金森病痴呆中可能比在帕金森病中受到更严重的影响。
