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Impaired cardiovascular autonomic function in Parkinson's disease with visual hallucinations.
Authors:Hisayoshi Oka  Masayuki Yoshioka  Kenji Onouchi  Masayo Morita  Soichiro Mochio  Masahiko Suzuki  Toshiaki Hirai  Mitsuyoshi Urashima  Kiyoharu Inoue
Affiliation:Department of Neurology, Jikei University School of Medicine, Tokyo, Japan. h.oka@jikei.ac.jp
Abstract: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.
Keywords:cardiac radioiodinated metaiodobenzylguanidine (123I‐MIBG) scintigraphy  cardiovascular autonomic dysfunction  Parkinson's disease  Valsalva maneuver  visual hallucination
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