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a Department of
Neurology, University of Oulu, PO Box 5000, 90014 University of Oulu,
Finland, b Department of Medicine, Division of Cardiology,
University of Oulu, PO Box 5000, 90014 University of Oulu, Finland
Correspondence to: Dr T Haapaniemi Tarja.Haapaniemi{at}oulu.fi
Received 3 July 2000 and in revised form 5 October 2000;
Accepted 26 October
2000
OBJECTIVES
Cardiovascular
reflex tests have shown both sympathetic and parasympathetic failure in
Parkinson's disease. These tests, however, describe the autonomic
responses during a restricted time period and have great individual
variability, providing a limited view of the autonomic cardiac control
mechanisms. Thus, they do not reflect tonic autonomic regulation. The
aim was to examine tonic autonomic cardiovascular regulation in
untreated patients with Parkinson's disease.
METHODS24 Hour
ambulatory ECG was recorded in 54 untreated patients with Parkinson's
disease and 47 age matched healthy subjects. In addition to the
traditional spectral (very low frequency, VLF; low frequency, LF; high
frequency, HF) and non-spectral components of heart rate variability,
instantaneous beat to beat variability (SD1) and long term continuous
variability (SD2) derived from Poincaré plots, and the slope of the
power law relation were analysed.
RESULTSAll spectral
components (p<0.01) and the slope of the power-law relation (p<0.01)
were lower in the patients with Parkinson's disease than in the
control subjects. The Unified Parkinson's disease rating scale total
and motor scores had a negative correlation with VLF and LF power
spectrum values and the power law relation slopes. Patients with mild
hypokinesia had higher HF values than patients with more severe
hypokinesia. Tremor and rigidity were not associated with the HR
variability parameters.
CONCLUSIONSParkinson's
disease causes dysfunction of the diurnal autonomic cardiovascular
regulation as demonstrated by the spectral measures of
heart rate variability and the slope of the power law relation. This dysfunction seems to be more profound in patients with more severe Parkinson's disease.
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