Association of depressive symptoms with circadian blood pressure alterations in Parkinson's disease.
To assess whether among patients with Parkinson's disease (PD) depression, a common non-motor symptom associated with reduced survival, is associated with cardiovascular dysautonomia. We enrolled 125 subjects with PD consecutively admitted to a geriatric day hospital. All participants underwent comprehensive evaluation, fasting blood sampling, and 24-h ambulatory blood pressure monitoring. The percent reduction in nocturnal blood pressure (dipping) was calculated. Depressive symptoms were assessed through the 15-item Geriatric Depression Scale (GDS); a score ≥5 identified moderate to severe symptoms. Among participants (mean age 72.7 ± 7.8 years, 32 % women) 61 subjects (49 %) presented with a GDS score ≥ 5. When compared with other participants, subjects with a GDS score ≥ 5 had reduced adjusted levels of percent systolic (-2.6 ± 2.7 vs. 4.7 ± 2.5; p = 0.003), diastolic (0.6 ± 2.8 vs. 7.4 ± 2.6; p = 0.007), and mean blood pressure dipping (-0.7 ± 2.6 vs. 6.8 ± 2.5; p = 0.002). In separate logistic regression models, depressive symptoms were associated with reduced systolic (OR 0.94; 95 % CI 0.89; 0.98), diastolic (OR 0.94; 95 % CI 0.90; 0.99), and mean blood pressure dipping (OR 0.93; 95 % CI 0.89; 0.98), after adjusting for potential confounders. Depressive symptoms are prevalent, and independently associated with cardiovascular dysautonomia among patients with Parkinson's disease. This might explain the remarkable incidence of sudden death, as well as the association of depressive symptoms with reduced survival reported in these patients. The finding of depressive symptoms in subjects with Parkinson's disease should therefore prompt assessment of cardiovascular autonomic function.
Centro Medicina dell'Invecchiamento, Dipartimento di Geriatria, Ortopedia e Neuroscienze, Università Cattolica del Sacro Cuore, Largo F. Vito 1, 00168, Rome, Italy. davidevetrano@gmail.com.
Davide L
DL
Vetrano
Centro Medicina dell'Invecchiamento, Dipartimento di Geriatria, Ortopedia e Neuroscienze, Università Cattolica del Sacro Cuore, Largo F. Vito 1, 00168, Rome, Italy.
Maria S
MS
Pisciotta
Centro Medicina dell'Invecchiamento, Dipartimento di Geriatria, Ortopedia e Neuroscienze, Università Cattolica del Sacro Cuore, Largo F. Vito 1, 00168, Rome, Italy.
Maria R
MR
Lo Monaco
Centro Medicina dell'Invecchiamento, Dipartimento di Geriatria, Ortopedia e Neuroscienze, Università Cattolica del Sacro Cuore, Largo F. Vito 1, 00168, Rome, Italy.
Graziano
G
Onder
Department of Geriatrics, Campus Bio-Medico University, Rome, Italy.
Alice
A
Laudisio
Centro Medicina dell'Invecchiamento, Dipartimento di Geriatria, Ortopedia e Neuroscienze, Università Cattolica del Sacro Cuore, Largo F. Vito 1, 00168, Rome, Italy.
Vincenzo
V
Brandi
Centro Medicina dell'Invecchiamento, Dipartimento di Geriatria, Ortopedia e Neuroscienze, Università Cattolica del Sacro Cuore, Largo F. Vito 1, 00168, Rome, Italy.
Domenico
D
La Carpia
Centro Medicina dell'Invecchiamento, Dipartimento di Geriatria, Ortopedia e Neuroscienze, Università Cattolica del Sacro Cuore, Largo F. Vito 1, 00168, Rome, Italy.
Mauro
M
Guglielmo
Centro Medicina dell'Invecchiamento, Dipartimento di Geriatria, Ortopedia e Neuroscienze, Università Cattolica del Sacro Cuore, Largo F. Vito 1, 00168, Rome, Italy.
Antonio
A
Nacchia
Centro Medicina dell'Invecchiamento, Dipartimento di Geriatria, Ortopedia e Neuroscienze, Università Cattolica del Sacro Cuore, Largo F. Vito 1, 00168, Rome, Italy.
Domenico
D
Fusco
Centro Medicina dell'Invecchiamento, Dipartimento di Geriatria, Ortopedia e Neuroscienze, Università Cattolica del Sacro Cuore, Largo F. Vito 1, 00168, Rome, Italy.
Diego
D
Ricciardi
Institute of Neurology, Università Cattolica del Sacro Cuore, Rome, Italy.
Anna R
AR
Bentivoglio
Centro Medicina dell'Invecchiamento, Dipartimento di Geriatria, Ortopedia e Neuroscienze, Università Cattolica del Sacro Cuore, Largo F. Vito 1, 00168, Rome, Italy.
Roberto
R
Bernabei
Centro Medicina dell'Invecchiamento, Dipartimento di Geriatria, Ortopedia e Neuroscienze, Università Cattolica del Sacro Cuore, Largo F. Vito 1, 00168, Rome, Italy.
Giuseppe
G
Zuccalà
D000368:Aged; D000369:Aged, 80 and over; D001794:Blood Pressure / Q000502:physiology*; D002940:Circadian Rhythm / Q000502:physiology*; D015897:Comorbidity; D003863:Depression / Q000453:epidemiology / Q000503:physiopathology*; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D010300:Parkinson Disease / Q000453:epidemiology / Q000503:physiopathology*; D054969:Primary Dysautonomias / Q000453:epidemiology / Q000503:physiopathology*
Ambulatory blood pressure monitoring; Depression; Dysautonomia; Non-motor symptoms; Parkinson’s disease