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1.
Yhojan Rodríguez Manuel Rojas Carolina Ramírez-Santana Yeny Acosta-Ampudia Diana M. Monsalve Juan-Manuel Anaya 《Clinical autonomic research》2018,28(2):211-214
Purpose
To determine if autonomic symptoms are associated with previous Zika virus infection.Methods
Case–control study including 35 patients with Zika virus infection without evidence of neurological disease and 105 controls. Symptoms of autonomic dysfunction were assessed with the composite autonomic symptom scale 31 (COMPASS-31).Results
Patients with previous Zika virus infection had significantly higher COMPASS-31 score than controls regardless of age and sex (p = 0.007). The main drivers for the higher scores where orthostatic intolerance (p = 0.003), secretomotor (p = 0.04) and bladder symptoms (p < 0.001).Conclusion
Zika virus infection is associated with autonomic dysfunction. The mechanisms remain to be elucidated.2.
Paul N. Pfeiffer Marcia Valenstein Dara Ganoczy Jennifer Henry Steven K. Dobscha John D. Piette 《Social psychiatry and psychiatric epidemiology》2017,52(2):183-191
Background
Following discharge, patients hospitalized for depression are at high risk for poor retention in outpatient care and adverse outcomes.Aims
Pilot tests a post-hospital monitoring and enhanced support program for depression.Method
48 patients at a Veterans Affairs Medical Center discharged following a depression-related inpatient stay received weekly visits or phone calls for 6 months from their choice of either a family member/friend (n = 19) or a certified peer support specialist (n = 29). Participants also completed weekly automated telephone monitoring calls assessing depressive symptoms and antidepressant medication adherence.Results
Over 90% of participants were more satisfied with their care due to the service. The mean change from baseline to 6 months in depression symptoms was ?7.9 (p < 0.05) according to the Patient Health Questionnaire and ?11.2 (p < 0.05) according to the Beck Depression Inventory-II for those supported by a family member/friend, whereas those supported by a peer specialist had mean changes of ?3.5 (p < 0.05) and ?1.7 (p > 0.10), respectively.Conclusions
Increased contact with a chosen support person coupled with automated telephone monitoring after psychiatric hospitalization is an acceptable service for patients with depression. Those who received the service, and particularly those supported by a family member/friend, experienced reductions in symptoms of depression.3.
Alessandra Fanciulli Georg Göbel Jean Pierre Ndayisaba Roberta Granata Susanne Duerr Stefano Strano Carlo Colosimo Werner Poewe Francesco E. Pontieri Gregor K. Wenning 《Clinical autonomic research》2016,26(2):97-105
Objective
Supine hypertension (SH) is a feature of cardiovascular autonomic failure that often accompanies orthostatic hypotension and may represent a negative prognostic factor in parkinsonian syndromes. Here we investigated the frequency rate as well as the clinical and tilt test correlates of SH in Parkinson’s disease (PD) and multiple system atrophy (MSA).Methods
197 PD (33 demented) and 78 MSA (24 MSA-Cerebellar, 54 MSA-Parkinsonian) patients who had undergone a tilt test examination were retrospectively included. Clinical-demographic characteristics were collected from clinical records at the time of the tilt test examination.Results
SH (>140 mmHg systolic, >90 mmHg diastolic) occurred in 34 % of PD patients (n = 66, mild in 71 % of patients, moderate in 27 %, severe in 2 %) and 37 % of MSA ones (n = 29, mild in 55 % of patients, moderate in 17 %, severe in 28 %). No difference was observed in SH frequency between demented versus gender-, age- and disease duration-matched non-demented PD patients, or between patients with the parkinsonian (MSA-P) versus the cerebellar (MSA-C) variant of MSA. In PD, SH was associated with presence of cardiovascular comorbidities (p = 0.002) and greater systolic (p = 0.007) and diastolic (p = 0.002) orthostatic blood pressure fall. Orthostatic hypotension (p = 0.002), and to a lesser degree, lower daily dopaminergic intake (p = 0.01) and use of anti-hypertensive medications (p = 0.04) were associated with SH in MSA.Interpretation
One-third of PD and MSA patients suffer from mild to severe SH, independently of age, disease duration or stage. In PD, cardiovascular comorbidities significantly contribute to the development of SH, while in MSA, SH appears to reflect cardiovascular autonomic failure.4.
Tuba Özcan Erdal Benli Feriha Özer Esra Yancar Demir Yasemin Kaya Ali Ayyıldız 《Clinical autonomic research》2016,26(3):205-209
Objective
Age at onset in Parkinson’s disease (PD) seems to be related nonmotor symptoms. In this study we investigated the effect of the age at onset on symptoms of sexual dysfunction (SSD) in patients with PD.Methods
This prospective study comprised 22 consecutive outpatients with early onset PD (EOPD—onset of the disease before 55 years), and 66 outpatients with late onset PD (LOPD—onset of PD over 55 years). They were all recruited from the Department of Movement Disorders, Clinic of Neurology. The diagnosis was established according to the UK PD Brain Bank Criteria by a movement disorders specialist. The Unified PD Rating Scale (UPDRS) motor was used to assess motor disability and Hoehn and Yahr (H&Y) stage was used to establish disease severity. The sexual functions of the patients were rated by applying the Arizona Sexual Experiences Scale (ASEX).Results
Thirteen EOPD patients (59.09 %) and 53 of the LOPD patients (80.3 %) (p 0.047) reported dissatisfaction with at least one item of ASEX. There were no differences between H&Y stages (p 0.205) UPDRS total (p 0.267) and motor scores (p 0.100) between groups. LOPD patients had significantly higher ASEX scores than EOPD patients (p 0.001).Interpretation
Sexual dysfunciton occurs more frequently and more severely in LOPD than EOPD patients. PD patients with different ages at onset clinically present differently in terms of SSD.5.
Background
The BRadykinesia Akinesia INcordination (BRAIN) test is an online keyboard-tapping test previously validated as a sensitive tool for detecting signs of Parkinson’s disease.Objectives
To determine whether the BRAIN test can measure disability in MS and identify the presence of pyramidal or cerebellar dysfunction.Methods
Kinesia scores (KS, number of key taps in 30 s), akinesia times (AT, mean dwell time on each key) and incoordination scores (IS, variance of travelling time between keys) were calculated in 39 MS patients. These were correlated against the Expanded Disability Status Scale (EDSS) scores, pyramidal and cerebellar functional system scores and 9-hole peg test scores.Results
EDSS correlated with KS (r = ? 0.594, p < 0.001), AT (r = 0.464, p = 0.003) and IS (r = 0.423, p = 0.007). 9-HPT scores strongly correlated with KS (r = 0.926, p < 0.001). Pyramidal scores correlated with KS (r = ? 0.517, p < 0.001). Cerebellar scores correlated with KS (r = ? 0.665, p < 0.001), AT (r = 0.567, p < 0.001) and IS (r = 0.546, p = 0.007). Receiver operating characteristic curves demonstrate that KS can distinguish between the presence or absence of pyramidal and cerebellar dysfunction with area under curve 0.840 (p < 0.001) and 0.829 (p < 0.001), respectively.Conclusions
The BRAIN test can remotely measure disability in MS. Specific scores differ according to the presence and severity of pyramidal or extrapyramidal dysfunction. It demonstrates huge potential in monitoring disease progression in clinical trials.6.
Kirsten Hauber Albert Eduard Boon Robert Vermeiren 《Child and adolescent psychiatry and mental health》2017,11(1):58
Objective
To examine changes in personality disorders and symptomology and the relation between personality disorder variables and treatment outcomes in an adolescent sample during partial residential mentalization based treatment.Methods
In a sample of 62 (out of 115) adolescents treated for personality disorders, assessment was done pre- and post-treatment using the Structured Clinical Interview for DSM personality disorders and the Symptom Check List 90.Results
Significant reductions in personality disorder traits (t = 8.36, p = .000) and symptoms (t = 5.95, p = .000) were found. During pre-treatment, 91.8% (n = 56) of the patients had one or more personality disorders, compared to 35.4% (n = 22) at post-treatment. Symptom reduction was not related to pre-treatment personality disorder variables.Conclusion
During intensive psychotherapy, personality disorders and symptoms may diminish. Future studies should evaluate whether the outcomes obtained are the result of the treatment given or other factors.7.
8.
Purpose
Postural tachycardia syndrome (POTS) is a disorder featured by orthostatic intolerance. The purpose of this study was to investigate the severity of quality of life issues in POTS patients.Methods
Online surveys for health related quality of life, sleep quality, fatigue, pain, and suicidal ideation were completed by 624 POTS patients and 139 controls.Results
People with POTS have significantly more days of poor physical health (p < 0.001), fewer days with good energy (p < 0.001), and significantly more days with activity limitations (p < 0.001) than controls. Pain severity was significantly higher for those with POTS (p < 0.001) while feelings of control over life was lower than controls (p < 0.001). Sleep quality and daytime fatigue were also significantly worse for those with POTS than controls (p < 0.001). Finally, those with POTS have a significantly higher risk of suicide compared with controls (p < 0.001).Interpretation
The myriad of symptoms from which many POTS patients suffer is associated with a decreased quality of life. Nearly half of our sample with POTS was at high risk for suicide. More work needs to be done to determine the underlying issues surrounding suicide in POTS so that an appropriate treatment regimen can be developed.9.
Objective
To assess the effects of PR-fampridine on cognitive functioning, fatigue and depression in patients with multiple sclerosis (PwMS).Methods
Thirty-two PwMS were included in this trial. Cognitive performance was assessed in an open-label and randomized double-blind, placebo-controlled study design using a comprehensive neuropsychological test battery as well as questionnaires examining depression and fatigue.Results
We found significant improvements in cognitive measures assessing alertness (tonic alertness, p = 0.0244 and phasic alertness, p = 0.0428), psychomotor speed (p = 0.0140) as well as verbal fluency (p = 0.0002) during open-label treatment with PR-fampridine. These effects of performance were paralleled by patients’ perception of reduced fatigue (physical, p = 0.0131; cognitive, p = 0.0225; total, p = 0.0126). Fampridine-induced improvements in phasic alertness (p = 0.0010) and measures of fatigue (physical, p = 0.0014; cognitive, p = 0.0003; total, p = 0.0005) were confirmed during randomized, double-blind, placebo-controlled assessment in the second year. In addition, we found positive effects of PR-fampridine on depressive symptoms (p = 0.0049). We demonstrated persisting beneficial effects of PR-fampridine on fatigue in PwMS over a period of more than 2 years. Drug responsiveness regarding cognitive performance and fatigue was not limited to walking responders.Conclusions
Our data demonstrate significant positive effects of treatment with PR-fampridine over 2 years on different cognitive domains as well as fatigue and depression in a cohort of PwMS. These findings imply that PR-fampridine should be considered as symptomatic treatment improving aspects of cognition, fatigue and depression in PwMS.10.
Jamie M. Jacobs Kelly M. Shaffer Ryan D. Nipp Joel N. Fishbein James MacDonald Areej El-Jawahri William F. Pirl Vicki A. Jackson Elyse R. Park Jennifer S. Temel Joseph A. Greer 《Annals of behavioral medicine》2017,51(4):519-531
Background
Individuals with advanced, incurable cancer often experience high physical and psychological symptom burden. Family and friend caregivers are at risk for emotional distress.Purpose
The aim of the study is to investigate the interrelationship of distress in patient-caregiver dyads at the time of newly diagnosed incurable cancer.Methods
From May 2011 to July 2015, within 8 weeks of diagnosis of advanced lung or noncolorectal gastrointestinal cancer, 350 patients and 275 family caregivers were enrolled in a randomized controlled trial of early palliative care. Actor–partner interdependence modeling was used to examine relationships between dyad’s self-reported anxiety and depressive symptoms on the Hospital Anxiety and Depression Scale at baseline.Results
Comparing patients with caregivers, patients reported more depressive symptoms (M diff = .84; t[274] = 3.17, p = .002, d = .22) and caregivers reported more anxiety symptoms (M diff =1.62, t[274] = 4.91, p < .001, d = .39). Dyads’ anxiety symptoms were positively associated, as were depressive symptoms (rs = .21, ps ≤ .001). Actor–partner interdependence modeling showed that patients’ anxiety symptoms were positively associated with their own depressive symptoms, with an equal effect for caregivers (actor effect βs = 0.52, ps < .001). Patients’ own anxiety was concurrently positively associated with their caregivers’ depressive symptoms, with an equal effect for caregivers to patients (partner effect βs=0.08, ps=.008).Conclusions
In the context of newly diagnosed incurable cancer, caregivers experience more pronounced anxiety, while patients report greater depressive symptoms. Findings indicate that anxiety and depressive symptoms are interrelated among dyads facing newly diagnosed incurable disease. Results emphasize the importance of addressing distress in both patients and caregivers. Future research should discern when dyadic versus individual psychosocial interventions would be optimal.Trial Registration Number
The trial was registered with the ClinicalTrials.gov database (NCT02349412) https://clinicaltrials.gov/ct2/show/NCT02349412.11.
Hailey W. Bulls Mary K. Lynch Megan E. Petrov Ethan W. Gossett Michael A. Owens Sarah C. Terry Kate M. Wesson-Sides Burel R. Goodin 《Annals of behavioral medicine》2017,51(5):673-682
Background
Racial differences in endogenous pain facilitatory processes have been previously reported. Evidence suggests that psychological and behavioral factors, including depressive symptoms and sleep, can alter endogenous pain facilitatory processes. Whether depressive symptoms and sleep might help explain racial differences in endogenous pain facilitatory processes has yet to be determined.Purpose
This observational, microlongitudinal study examined whether depressive symptoms and sleep were sequential mediators of racial differences in endogenous pain facilitatory processes.Methods
A total of 50 (26 African American and 24 non-Hispanic white) community-dwelling adults without chronic pain (mean 49.04 years; range 21–77) completed the Center for Epidemiological Studies Depression Scale prior to seven consecutive nights of sleep monitoring with actigraphy in the home environment. Participants subsequently returned to the laboratory for assessment of endogenous pain facilitation using a mechanical temporal summation protocol.Results
Findings revealed greater depressive symptoms, poorer sleep efficiency, and greater temporal summation of mechanical pain in African Americans compared to non-Hispanic whites. In a sequential mediation model, greater depressive symptoms predicted poorer sleep efficiency (t = ?2.55, p = .014), and poorer sleep efficiency predicted enhanced temporal summation of mechanical pain (t = ?4.11, p < .001), particularly for African Americans.Conclusions
This study underscores the importance of examining the contribution of psychological and behavioral factors when addressing racial differences in pain processing. Additionally, it lends support for the deleterious impact of depressive symptoms on sleep efficiency, suggesting that both sequentially mediate racial differences in endogenous pain facilitation.12.
Ari J. Elliot Nicholas A. Turiano Benjamin P. Chapman 《Annals of behavioral medicine》2017,51(2):240-250
Background
Socioeconomic health disparities research may benefit from further consideration of dispositional factors potentially modifying risk associated with low socioeconomic status, including that indexed by systemic inflammation.Purpose
This study was conducted to investigate interactions of SES and the Five-Factor Model (FFM) personality traits in predicting circulating concentrations of the inflammatory markers interleukin-6 (IL-6) and C-reactive protein (CRP).Method
Using a sample of middle-aged and older adults from the Midlife in the United States Survey (MIDUS) biomarker project (N = 978), linear regression models tested interactions of each FFM trait with a composite measure of SES in predicting IL-6 and CRP, as well as the explanatory role of medical morbidity, measures of adiposity, and health behaviors.Results
SES interacted with conscientiousness to predict levels of IL-6 (interaction b = .03, p = .002) and CRP (interaction b = .04, p = .014) and with neuroticism to predict IL-6 (interaction b = ?.03, p = .004). Socioeconomic gradients in both markers were smaller at higher levels of conscientiousness. Conversely, the socioeconomic gradient in IL-6 was larger at higher levels of neuroticism. Viewed from the perspective of SES as the moderator, neuroticism was positively related to IL-6 at low levels of SES but negatively related at high SES. Interactions of SES with both conscientiousness and neuroticism were attenuated upon adjustment for measures of adiposity.Conclusions
Conscientiousness may buffer, and neuroticism amplify, excess inflammatory risk associated with low SES, in part through relationships with adiposity. Neuroticism may be associated with lower levels of inflammation at high levels of SES.13.
Francis Vergunst Jorun Rugkåsa Constantinos Koshiaris Judit Simon Tom Burns 《Social psychiatry and psychiatric epidemiology》2017,52(11):1375-1384
Purpose
Community treatment orders (CTOs) are widely used internationally despite a lack of evidence supporting their effectiveness. Most effectiveness studies are relatively short (12-months or less) and focus on clinical symptoms and service data, while a little attention is given to patients’ social outcomes and broader welfare. We tested the association between the duration of CTO intervention and patients’ long-term social outcomes.Methods
A sub-sample (n = 114) of community-based patients from the Oxford Community Treatment Order Evaluation Trial (OCTET) were interviewed 48 months after randomisation. Multivariate regression models were used to examine the association between the duration of the CTO intervention and social outcomes as measured by the social network schedule, Objective Social Outcomes Index, Euro-Qol EQ-5D-3L (EQ-5D), and Oxford Capabilities Questionnaire for Mental Health.Results
No significant association was found between the duration of CTO intervention and social network size (IRR = 0.996, p = .63), objective social outcomes (B = ?0.003, p = .77), health-related quality of life (B = 0.001, p = .77), and capabilities (B = 0.046, p = .41). There were no between-group differences in social outcomes when outcomes were stratified by original arm of randomisation. Patients had a mean of 10.2 (SD = 5.9) contacts in their social networks, 42% of whom were relatives.Conclusions
CTO duration was not associated with improvements in patients’ social outcomes even over the long term. This study adds to growing concerns about CTO effectiveness and the justification for their continued use.14.
Barbara H. Brumbach Wendy C. Birmingham Watcharaporn Boonyasiriwat Scott Walters Anita Y. Kinney 《Annals of behavioral medicine》2017,51(5):694-706
Background
Understanding the pathways by which interventions achieve behavioral change is important for optimizing intervention strategies.Purpose
We examined mediators of behavior change in a tailored-risk communication intervention that increased guideline-based colorectal cancer screening among individuals at increased familial risk.Methods
Participants at increased familial risk for colorectal cancer (N = 481) were randomized to one of two arms: (1) a remote, tailored-risk communication intervention (Tele-Cancer Risk Assessment and Evaluation (TeleCARE)) or (2) a mailed educational brochure intervention.Results
Structural equation modeling showed that participants in TeleCARE were more likely to get a colonoscopy. The effect was partially mediated through perceived threat (β = 0.12, p < 0.05), efficacy beliefs (β = 0.12, p < 0.05), emotions (β = 0.22, p < 0.001), and behavioral intentions (β = 0.24, p < 0.001). Model fit was very good: comparative fit index = 0.95, root-mean-square error of approximation = 0.05, and standardized root-mean-square residual = 0.08.Conclusion
Evaluating mediating variables between an intervention (TeleCARE) and a primary outcome (colonoscopy) contributes to our understanding of underlying mechanisms that lead to health behavior change, thus leading to better informed and designed future interventions.Trial Registration Number
ClinicalTrials.gov, NCT01274143.15.
Background
Inpatient video-EEG monitoring (VEM) can contribute to the diagnosis and treatment in many of the monitored patients. Most admissions to VEM are elective and are scheduled ahead before the monitoring session.Purpose
To retrospectively evaluate the yield of non-elective VEM sessions.Methods
We retrospectively reviewed the VEM recordings and medical records of all the patients admitted to our one-bed VEM unit from June 2007 to June 2015. A VEM session was diagnostic when a seizure, an event or previously unreported interictal epileptiform discharges were recorded.Results
The study group included 304 adults aged 18–92 years (mean 40.4 ± 17.4 years), 181 (59%) women. The diagnostic yield of non-elective and elective VEM session was similar (66 and 69%, respectively). In non-elective VEM, fewer patients had known epilepsy (p = 0.0001), session duration was shorter (p = 0.0001), and seizures and interictal epileptiform discharges were recorded less frequently compared to elective VEM (p = 0.005 and p = 0.0001, respectively).Conclusion
Non-elective VEM can provide useful information in patients admitted to the neurology department with recent neurological or behavioral events. A timely and correct diagnosis in these patients can potentially reduce unnecessary use of antiepileptic drugs in patients with psychogenic nonepileptic seizures and the morbidity and mortality associated with undiagnosed seizures.16.
Stephanie M. Wolahan Mayumi L. Prins David L. McArthur Courtney R. Real David A. Hovda Neil A. Martin Paul M. Vespa Thomas C. Glenn 《Neurocritical care》2017,26(2):239-246
Background
The objective was to investigate the impact of targeting tight glycemic control (4.4–6.1 mM) on endogenous ketogenesis in severely head-injured adults.Methods
The data were prospectively collected during a randomized, within-patient crossover study comparing tight to loose glycemic control, defined as 6.7–8.3 mM. Blood was collected periodically during both tight and loose glycemic control epochs. Post hoc analysis of insulin dose and total nutritional provision was performed.Results
Fifteen patients completed the crossover study. Total ketones were increased 81 μM ([38 135], p < 0.001) when blood glucose was targeted to tight (4.4–6.1 mM) compared with loose glycemic control (6.7–8.3 mM), corresponding to a 60 % increase. There was a significant decrease in total nutritional provisions (p = 0.006) and a significant increase in insulin dose (p = 0.008).Conclusions
Permissive underfeeding was tolerated when targeting tight glycemic control, but total nutritional support is an important factor when treating hyperglycemia.17.
Purpose
The initial symptoms of multiple system atrophy (MSA) and, in particular, early autonomic symptoms, have received less attention than motor symptoms. Whereas pathognomonic motor signs are essential to diagnostic specificity, early symptoms important to recognition of a neurodegenerative disorder may be less apparent or diagnostically ambiguous. This observational study sought to identify the very earliest symptoms in the natural history of MSA.Methods
Detailed clinical histories focusing on early symptoms were obtained from 30 subjects recently diagnosed with MSA. Historical data were correlated with neurological examinations and laboratory autonomic testing.Results
Subjects’ mean age was 63.9 years. Ten were classified as having MSA-P and 20 MSA-C. The evaluations occurred 2.9 ± 0.4 months after diagnosis. The first symptom of MSA was autonomic in 22 (73%) and motor in 3 (10%) subjects (p < 0.0001). The most frequent first symptom was erectile failure, which occurred in all men beginning 4.2 ± 2.6 years prior to diagnosis. After erectile failure, postural lightheadness or fatigue following exercise, urinary urgency or hesitancy, and violent dream enactment behavior consistent with REM behavioral sleep disorder were the most frequent initial symptoms. Neither the order of symptom progression, which was highly variable, nor autonomic severity scores differentiated between MSA-P and MSA-C.Conclusions
The first symptoms of MSA are frequently autonomic and may predate recognition of motor manifestations. Orthostatic hypotension and, in men, erectile failure are among the first symptoms that, when evaluated in the context of associated clinical findings, may facilitate accurate and earlier diagnosis.18.
Jennifer Fillo Stephanie Brooks Holliday Amy DeSantis Anne Germain Daniel J. Buysse Karen A. Matthews Wendy M. Troxel 《Annals of behavioral medicine》2017,51(6):879-889
Background
Emerging research has begun to examine associations between relationship functioning and sleep. However, these studies have largely relied on self-reported evaluations of relationships and/or of sleep, which may be vulnerable to bias.Purpose
The purpose of the study was to examine associations between relationship functioning and sleep in military couples. This is the first research to examine associations between observed relationship behaviors and subjective and polysomnographically measured sleep in a sample at-risk for both sleep and relationship problems.Methods
The sample included 35 military veterans and their spouses/partners. Marital functioning was coded from a videotaped conflict interaction. Analyses focused on behavioral codes of hostility and relationship-enhancing attributions. Sleep was assessed via self-report and in-home polysomnography.Results
Greater hostility was associated with poorer sleep efficiency for oneself (b = ?0.195, p = .013). In contrast, greater relationship-enhancing attributions were associated with higher percentages of stage N3 sleep (b = 0.239, p = .028). Partners’ hostility was also positively associated with higher percentages of stage N3 sleep (b = 0.272, p = .010). Neither hostility nor relationship-enhancing attributions was associated with self-reported sleep quality, percentage of REM sleep, or total sleep time.Conclusions
Both partners’ positive and negative behaviors during conflict interactions were related to sleep quality. These findings highlight the role that effective communication and conflict resolution skills may play in shaping not only the marital health of veterans and their spouses but also the physical health of both partners as well. Understanding the links between relationship functioning and sleep may be important targets of intervention in the aftermath of war.19.
Philipp Moog O. Eren S. Kossegg K. Valda A. Straube M. Grünke H. Schulze-Koops M. Witt 《Clinical autonomic research》2017,27(6):385-392
Objective
To assess autonomic function by infrared dynamic pupillometry in patients with ANCA-vasculitis (AAV) in correlation to autonomic symptoms, disease specific clinical parameters and cardiovascular reflex tests.Methods
Patients with AAV and healthy controls underwent pupillometry at rest and after sympathetic stimulation (cold pressor test). Three parasympathetic parameters (amplitude, relative amplitude, maximum constriction velocity) and one sympathetic parameter (late dilatation velocity) were assessed. Results were correlated with clinical parameters, symptoms of autonomic dysfunction (COMPASS31 questionnaire), heart rate variability during deep breathing test and blood pressure response to pain.Results
23 patients and 18 age-matched controls were enrolled. Patients had a smaller amplitude (1.44 vs. 1.70 mm; p = 0.009) and a slower constriction velocity (4.15 vs. 4.71 mm/s; p = 0.028) at baseline and after sympathetic stimulation (1.47 vs. 1.81 mm, p = 0.001; 4.38 vs. 5.19 mm/s, p = 0.006, respectively). Relative amplitude was significantly smaller in patients after sympathetic stimulation (28.6 vs. 32.5%; p = 0.043), but not at baseline. There was no difference in sympathetic pupillary response between the groups. In patients, parasympathetic pupil response was correlated negatively with age and positively with parasympathetic cardiac response. After adjusting for age, no significant correlation was observed with clinical parameters. However, there was a trend towards a negative correlation with disease duration, vasculitis damage index and CRP.Conclusion
Patients with AAV exhibit parasympathetic pupillary autonomic dysfunction. Although correlations were weak and not significant, pupillary autonomic dysfunction is rather linked to chronic damage than to active inflammation or symptoms of autonomic dysfunction.20.
Kelly M. Shaffer Jamie M. Jacobs Jessica N. Coleman Jennifer S. Temel Jonathan Rosand Joseph A. Greer Ana-Maria Vranceanu 《Neurocritical care》2017,27(2):180-186