Joo Jae Young, Yoo Dallah, Kim Jae-Myoung, Shin Chaewon, Ahn Tae-Beom
Department of Neurology, Kyung Hee University Hospital, Seoul, Korea.
Department of Neurology, Uijeongbu Eulji Medical Center, Eulji University, Uijeongbu, Korea.
J Mov Disord. 2024 Oct;17(4):408-415. doi: 10.14802/jmd.24104. Epub 2024 Sep 9.
Orthostatic hypotension (OH) is one of the most common autonomic dysfunctions in Parkinson's disease (PD) patients. However, many patients with OH are asymptomatic. Conversely, orthostatic dizziness (OD) is not always associated with OH. We investigated the effects of positional changes on cerebral perfusion in patients with PD and OH.
We enrolled 42 patients, comprising 31 PD patients and 11 healthy controls. All the subjects underwent the following clinical assessments: the OH questionnaire, head-up tilt test (HUTT) with transcranial Doppler (TCD), near-infrared spectroscopy, measurement of the change in oxygenated hemoglobin (ΔHboxy) during the squat-to-stand test (SST), measurement of the time derivative of total hemoglobin (DHbtot), and time taken to reach the peak (peak time [PT]) of DHbtot after restanding.
The mean flow velocity change (ΔMFV) in the TCD during the HUTT failed to differentiate between the PD-OH(+) and PD-OH(-) groups. The change in oxygenated hemoglobin ΔHboxy was greater in the PD-OH(+) group, which persisted for 9 min until the end of the HUTT only in the left hemisphere. During SST, PT was significantly delayed in the left hemisphere in PD-OH(+) patients.
Although TCD demonstrated no significant difference in ΔMFV, the parameters measured by near-infrared spectroscopy, such as ΔHboxy during HUTT and PT during the SST, significantly increased ΔHboxy or delayed PT in the left hemisphere of PD-OH(+). Positional changes have a detrimental effect on cerebral hemodynamics in patients with PD and OH, especially in the left hemisphere.
体位性低血压（OH）是帕金森病（PD）患者中最常见的自主神经功能障碍之一。然而，许多OH患者无症状。相反，体位性头晕（OD）并不总是与OH相关。我们研究了体位变化对PD和OH患者脑灌注的影响。
我们纳入了42名患者，包括31名PD患者和11名健康对照者。所有受试者均接受以下临床评估：OH问卷、经颅多普勒（TCD）的头直立倾斜试验（HUTT）、近红外光谱、深蹲起立试验（SST）期间氧合血红蛋白变化（ΔHboxy）的测量、总血红蛋白时间导数（DHbtot）的测量以及重新站立后达到DHbtot峰值（峰值时间[PT]）所需的时间。
HUTT期间TCD的平均血流速度变化（ΔMFV）未能区分PD-OH（+）组和PD-OH（-）组。PD-OH（+）组的氧合血红蛋白变化ΔHboxy更大，仅在左半球持续9分钟直至HUTT结束。在SST期间，PD-OH（+）患者左半球的PT明显延迟。
尽管TCD显示ΔMFV无显著差异，但近红外光谱测量的参数，如HUTT期间的ΔHboxy和SST期间的PT，在PD-OH（+）患者的左半球显著增加了ΔHboxy或延迟了PT。体位变化对PD和OH患者的脑血流动力学有不利影响，尤其是在左半球。
