J Mov Disord.  2024 Oct;17(4):408-415. 10.14802/jmd.24104.

Effect of Positional Changes on Cerebral Perfusion in Parkinson’s Disease Patients With Orthostatic Hypotension

• Joo JY
• Yoo D
• Kim JM
• Shin C
• Ahn TB

• KMID: 2560195
• DOI: http://doi.org/10.14802/jmd.24104

Abstract

Objective
Orthostatic hypotension (OH) is one of the most common autonomic dysfunctions in Parkinson’s disease (PD) patients. However, many patients with OH are asymptomatic. Conversely, orthostatic dizziness (OD) is not always associated with OH. We investigated the effects of positional changes on cerebral perfusion in patients with PD and OH.
Methods
We enrolled 42 patients, comprising 31 PD patients and 11 healthy controls. All the subjects underwent the following clinical assessments: the OH questionnaire, head-up tilt test (HUTT) with transcranial Doppler (TCD), near-infrared spectroscopy, measurement of the change in oxygenated hemoglobin (ΔHb_oxy) during the squat-to-stand test (SST), measurement of the time derivative of total hemoglobin (DHb_tot), and time taken to reach the peak (peak time [PT]) of DHb_tot after restanding.
Results
The mean flow velocity change (ΔMFV) in the TCD during the HUTT failed to differentiate between the PD-OH(+) and PD-OH(-) groups. The change in oxygenated hemoglobin ΔHb_oxy was greater in the PD-OH(+) group, which persisted for 9 min until the end of the HUTT only in the left hemisphere. During SST, PT was significantly delayed in the left hemisphere in PD-OH(+) patients.
Conclusion
Although TCD demonstrated no significant difference in ΔMFV, the parameters measured by near-infrared spectroscopy, such as ΔHb_oxy during HUTT and PT during the SST, significantly increased ΔHb_oxy or delayed PT in the left hemisphere of PD-OH(+). Positional changes have a detrimental effect on cerebral hemodynamics in patients with PD and OH, especially in the left hemisphere.

Keyword

Parkinson’s disease; Orthostatic hypotension; Orthostatic dizziness; Transcranial Doppler; Near-infrared spectroscopy