Autonomic dysfunction in elderly bedfast patients.
OBJECTIVE
to quantify autonomic function in bedfast elderly patients.


METHODS
we analysed orthostatic blood pressure, heart rate response to tilt, heart rate response to deep breathing, quantitative sudomotor axon reflex test (QSART) and beat-to-beat blood pressure during phases II and IV of the Valsalva manoeuvre (VM) in 15 patients with (OH+) and without orthostatic hypotension (OH-) and 12 age-matched controls.


RESULTS
all bedfast patients had a poor response in the late phase II of beat-to-beat blood pressure, while OH+ patients had an additional abnormality in phase IV. QSARTs in the distal leg and foot were decreased in both OH+ and OH- groups. There was no difference between the two groups in duration of being bedfast or in activities of daily living.


CONCLUSIONS
(i) being bedfast results in postganglionic sympathetic dysfunction in the lower extremities; (ii) some patients who have beta-adrenergic dysfunction have OH and (iii) preventing patients from becoming being bedfast may be important for the maintenance of normal autonomic functions.
Kihara
M
M
Department of Neurology, Kinki University School of Medicine, 377-2 Ohno-Higashi, Osaka-Sayama, Osaka, 589, Japan.
Takahashi
M
M
Nishimoto
K
K
Okuda
K
K
Matsui
T
T
Yamakawai
T
T
Okumura
A
A
D000368:Aged; D000369:Aged, 80 and over; D001341:Autonomic Nervous System / Q000503:physiopathology; D001342:Autonomic Nervous System Diseases / Q000175:diagnosis* / Q000503:physiopathology; D001369:Axons / Q000502:physiology; D001510:Bed Rest; D001794:Blood Pressure / Q000502:physiology; D005260:Female; D016330:Frail Elderly; D006339:Heart Rate / Q000502:physiology; D006801:Humans; D007024:Hypotension, Orthostatic / Q000175:diagnosis* / Q000503:physiopathology; D008297:Male; D012021:Reflex, Abnormal / Q000502:physiology; D018667:Tilt-Table Test; D014636:Valsalva Maneuver / Q000502:physiology