Cardiovascular dysautonomia and cognitive impairment in Parkinson's disease (Review)

Khalil,Ibrahim; Sayad,Reem; Kedwany,Ahmed M.; Sayed,Hager Hamdy; Caprara,Ana Letícia Fornari; Rissardo,Jamir Pitton

doi:10.3892/mi.2024.194

Cardiovascular dysautonomia and cognitive impairment in Parkinson's disease (Review)

Authors:
- Ibrahim Khalil
- Reem Sayad
- Ahmed M. Kedwany
- Hager Hamdy Sayed
- Ana Letícia Fornari Caprara
- Jamir Pitton Rissardo
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Affiliations: Faculty of Medicine, Alexandria University, Alexandria 5372066, Egypt, Faculty of Medicine, Assiut University, Assiut 71515, Egypt, Department of Nuclear Medicine, Assuit University, Assuit 71515, Egypt, Department of Neurology, Cooper University Hospital, Camden, NJ 08103, USA
Published online on: September 19, 2024 https://doi.org/10.3892/mi.2024.194
Article Number: 70
Copyright : © Khalil et al. This is an open access article distributed under the terms of Creative Commons Attribution License [CC BY 4.0].

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Abstract

Cognitive impairment is a prevalent non‑motor symptom of Parkinson's disease (PD), which can result in significant disability and distress for patients and caregivers. There is a marked variation in the timing, characteristics and rate at which cognitive decline occurs in patients with PD. This decline can vary from normal cognition to mild cognitive impairment and dementia. Cognitive impairment is associated with several pathophysiological mechanisms, including the accumulation of β‑amyloid and tau in the brain, oxidative stress and neuroinflammation. Cardiovascular autonomic dysfunctions are commonly observed in patients with PD. These dysfunctions play a role in the progression of cognitive impairment, the incidents of falls and even in mortality. The majority of symptoms of dysautonomia arise from changes in the peripheral autonomic nervous system, including both the sympathetic and parasympathetic nervous systems. Cardiovascular changes, including orthostatic hypotension, supine hypertension and abnormal nocturnal blood pressure (BP), can occur in both the early and advanced stages of PD. These changes tend to increase as the disease advances. The present review aimed to describe the cognitive changes in the setting of cardiovascular dysautonomia and to discuss strategies through which these changes can be modified and managed. It is a multifactorial process usually involving decreased blood flow to the brain, resulting in the development of cerebral ischemic lesions, an increased presence of abnormal white matter signals in the brain, and a potential influence on the process of neurodegeneration in PD. Another possible explanation is this association being independent observations of PD progression. Patients with clinical symptoms of dysautonomia should undergo 24‑h ambulatory BP monitoring, as they are frequently subtle and underdiagnosed.

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