title: Cerebral autoregulation and white matter lesions in Parkinson's disease and multiple system atrophy.
abstract: Cerebral autoregulation is a complex homeostatic process which ensures constant brain blood supply, despite continuous blood pressure fluctuations. Recent evidence suggests that in Parkinson's disease (PD) and multiple system atrophy (MSA) this process is maintained in a broadened range of blood pressure values, consistent with an adaptive mechanism to increase tolerance to orthostatic hypotension. In PD and MSA orthostatic hypotension may be accompanied by supine hypertension which has been recently linked with cerebral white matter lesions in these conditions. We hypothesize that cerebral autoregulation adaptation to chronic orthostatic hypotension may be directly related with an increase susceptibility to hypertensive peaks. Evaluation of cerebral autoregulatory behavior may thus represent a novel approach to simultaneously target orthostatic symptoms and silent end-organ damage in alpha-synucleinopathies, with a beneficial impact on cerebrovascular and cognitive outcome.
authors.affiliation: Department of Neuroscience, Mental Health and Sensory Organs, "Sapienza" University of Rome, Via di Grottarossa 1035, 00189 Rome, Italy; IRCCS Santa Lucia Foundation, Via Ardeatina 306, 00179 Rome, Italy. Electronic address: indelicato.elisabetta@gmail.it.
authors.forename: Elisabetta
authors.initials: E
authors.lastname: Indelicato
authors.affiliation: Department of Neuroscience, Mental Health and Sensory Organs, "Sapienza" University of Rome, Via di Grottarossa 1035, 00189 Rome, Italy; Department of Neurology, Innsbruck Medical University, Anichstraße 35, 6020 Innsbruck, Austria.
authors.forename: Alessandra
authors.initials: A
authors.lastname: Fanciulli
authors.affiliation: Department of Neurology, Innsbruck Medical University, Anichstraße 35, 6020 Innsbruck, Austria.
authors.forename: Werner
authors.initials: W
authors.lastname: Poewe
authors.affiliation: IRCCS Ospedale San Camillo, Via Alberoni 70, 30126 Venice, Italy.
authors.forename: Angelo
authors.initials: A
authors.lastname: Antonini
authors.affiliation: Department of Neuroscience, Mental Health and Sensory Organs, "Sapienza" University of Rome, Via di Grottarossa 1035, 00189 Rome, Italy; IRCCS Santa Lucia Foundation, Via Ardeatina 306, 00179 Rome, Italy.
authors.forename: Francesco E
authors.initials: FE
authors.lastname: Pontieri
authors.affiliation: Department of Neurology, Innsbruck Medical University, Anichstraße 35, 6020 Innsbruck, Austria.
authors.forename: Gregor K
authors.initials: GK
authors.lastname: Wenning
mesh_terms: D001341:Autonomic Nervous System / Q000503:physiopathology; D001794:Blood Pressure; D002940:Circadian Rhythm / Q000502:physiology; D006706:Homeostasis / Q000502:physiology*; D006801:Humans; D007024:Hypotension, Orthostatic / Q000209:etiology; D008279:Magnetic Resonance Imaging; D008959:Models, Neurological; D019578:Multiple System Atrophy / Q000150:complications / Q000473:pathology / Q000503:physiopathology*; D010300:Parkinson Disease / Q000150:complications / Q000473:pathology / Q000503:physiopathology*; D016683:Supine Position / Q000502:physiology; D066127:White Matter / Q000473:pathology*
keywords: Cerebral autoregulation; Cerebral white matter lesions; Multiple system atrophy; Orthostatic hypotension; Parkinson's disease