Cardiovascular autonomic testing performed with a new integrated instrumental approach is useful in differentiating MSA-P from PD at an early stage.
OBJECTIVE
To evaluate whether a battery of cardiovascular autonomic tests (Ewing's battery, EB) performed with a new integrated instrumental approach is useful in differentiating multiple system atrophy with predominant parkinsonism (MSA-P) from Parkinson's disease (PD) at an early stage.


METHODS
We retrospectively analyzed EB tests of all the patients (n = 99) with a parkinsonian syndrome referred to our clinic who performed EB during the first diagnostic workup and were subsequently evaluated at least once a year until a final diagnosis of MSA-P (n = 34) or PD (n = 65). Thirty-eight controls matched for age and sex were included. EB consisted of head-up tilt test (HUTT), Valsalva manoeuvre (VM), deep breathing, and sustained handgrip whose correct execution and results were checked and obtained automatically. Results were compared between groups. Discriminant analysis was performed to identify MSA-P or PD patients.


RESULTS
Orthostatic hypotension was found in 22 MSA-P and 3 PD patients. Cardiovascular reflexes indices were significantly more affected in MSA-P compared to PD and controls. EB presented a 91% sensitivity and 94% specificity in the differentiation of MSA-P and PD. HUTT + VM presented a 91% sensitivity and 92% specificity.


CONCLUSIONS
Our results suggest that EB or HUTT + VM performed with an integrated instrumental approach and analyzed with the discriminant procedure may distinguish MSA-P from PD at an early stage and might improve the accuracy of current diagnostic criteria. However, a validation in separate samples and prospective studies is needed.
Department of Biomedical and Neuromotor Sciences (DIBINEM), University of Bologna, Bologna, Italy. Electronic address: francesca.baschieri@gmail.com.
Francesca
F
Baschieri
Department of Biomedical and Neuromotor Sciences (DIBINEM), University of Bologna, Bologna, Italy; IRCCS, Institute of Neurological Sciences, Bellaria Hospital, Bologna, Italy. Electronic address: giovanna.calandra@unibo.it.
Giovanna
G
Calandra-Buonaura
Department of Biomedical and Neuromotor Sciences (DIBINEM), University of Bologna, Bologna, Italy. Electronic address: andrea.doria3@studio.unibo.it.
Andrea
A
Doria
Department of Neurology, Lewisham and Greenwich NHS Trust, Queen Elizabeth Hospital, London, UK. Electronic address: fmastrolilli@yahoo.it.
Francesca
F
Mastrolilli
Department of Computer Science and Engineering, University of Bologna, Bologna, Italy. Electronic address: aldopaolo.palareti@unibo.it.
Aldopaolo
A
Palareti
Department of Biomedical and Neuromotor Sciences (DIBINEM), University of Bologna, Bologna, Italy; IRCCS, Institute of Neurological Sciences, Bellaria Hospital, Bologna, Italy. Electronic address: giorgio.barletta@unibo.it.
Giorgio
G
Barletta
Department of Biomedical and Neuromotor Sciences (DIBINEM), University of Bologna, Bologna, Italy; IRCCS, Institute of Neurological Sciences, Bellaria Hospital, Bologna, Italy. Electronic address: laura.solieri@unibo.it.
Laura
L
Solieri
Public Local Health Authority of Modena and Bologna, Italy. Electronic address: pietro.guaraldi@unibo.it.
Pietro
P
Guaraldi
Department of Biomedical and Neuromotor Sciences (DIBINEM), University of Bologna, Bologna, Italy. Electronic address: paolo.martinelli@unibo.it.
Paolo
P
Martinelli
Department of Biomedical and Neuromotor Sciences (DIBINEM), University of Bologna, Bologna, Italy; IRCCS, Institute of Neurological Sciences, Bellaria Hospital, Bologna, Italy. Electronic address: pietro.cortelli@unibo.it.
Pietro
P
Cortelli
D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D001342:Autonomic Nervous System Diseases / Q000175:diagnosis / Q000503:physiopathology; D001794:Blood Pressure / Q000502:physiology; D003937:Diagnosis, Differential; D016002:Discriminant Analysis; D042241:Early Diagnosis; D005260:Female; D006339:Heart Rate / Q000502:physiology; D006801:Humans; D008297:Male; D008875:Middle Aged; D019578:Multiple System Atrophy / Q000175:diagnosis* / Q000503:physiopathology*; D010300:Parkinson Disease / Q000175:diagnosis* / Q000503:physiopathology*; D012189:Retrospective Studies; D018667:Tilt-Table Test / Q000379:methods*; D014636:Valsalva Maneuver / Q000502:physiology
Cardiovascular autonomic testing; Disorders of autonomic nervous system; Multiple system atrophy; Orthostatic hypotension; Parkinson's disease