Impaired cardiovascular autonomic function in Parkinson's disease with visual hallucinations.
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.
Oka
Hisayoshi
H
Department of Neurology, Jikei University School of Medicine, Tokyo, Japan.
Yoshioka
Masayuki
M
Department of Neurology, Jikei University School of Medicine, Tokyo, Japan.
Onouchi
Kenji
K
Department of Neurology, Aoto Hospital, Jikei University School of Medicine, Tokyo, Japan.
Morita
Masayo
M
Department of Neurology, Fuji Civilian Central Hospital, Shizuoka, Japan.
Mochio
Soichiro
S
Department of Neurology, Third Hospital, Jikei University School of Medicine, Tokyo, Japan.
Suzuki
Masahiko
M
Department of Neurology, Jikei University School of Medicine, Tokyo, Japan.
Hirai
Toshiaki
T
Department of Neurology, Jikei University School of Medicine, Tokyo, Japan.
Urashima
Mitsuyoshi
M
Division of Clinical Research and Development, Jikei University School of Medicine, Tokyo, Japan.
Inoue
Kiyoharu
K
Department of Neurology, Jikei University School of Medicine, Tokyo, Japan.
D019797:3-Iodobenzylguanidine; D000368:Aged; D000369:Aged, 80 and over; D000704:Analysis of Variance; D001342:Autonomic Nervous System Diseases / Q000000981:diagnostic imaging / Q000209:etiology*; D001794:Blood Pressure / Q000502:physiology; D002318:Cardiovascular Diseases / Q000000981:diagnostic imaging / Q000209:etiology*; D005260:Female; D006212:Hallucinations / Q000150:complications*; D006801:Humans; D008297:Male; D008875:Middle Aged; D009638:Norepinephrine / Q000097:blood; D010300:Parkinson Disease / Q000150:complications*; D011877:Radionuclide Imaging; D019275:Radiopharmaceuticals; D018667:Tilt-Table Test
D019275:Radiopharmaceuticals; D019797:3-Iodobenzylguanidine; D009638:Norepinephrine