-
The Journal of Clinical Endocrinology... May 2024In type 2 diabetes mellitus (T2DM), orthostatic hypotension (OH) is associated with cognition, but the mechanisms governing the link between OH and cognition are still...
CONTEXT
In type 2 diabetes mellitus (T2DM), orthostatic hypotension (OH) is associated with cognition, but the mechanisms governing the link between OH and cognition are still unclear.
OBJECTIVE
We sought to analyze Alzheimer's disease (AD) biomarkers and the part of complement proteins in modulating the association of OH with cognitive impairment and examine whether OH could accelerate the clinical progression of mild cognitive impairment (MCI) to dementia in T2DM.
METHODS
We recruited patients with T2DM with MCI and collected general healthy information and blood samples. Complement proteins of astrocyte-derived exosomes were isolated and AD biomarkers of neuronal cell-derived exosomes isolated were quantified by enzyme-linked immunosorbent assay. Cognitive assessments were performed at patient enrollment and follow-up.
RESULTS
Mediation analysis showed that the influence of OH on cognition in T2DM was partly mediated by baseline AD biomarkers and complement proteins. Cox proportional-hazards regression proved the OH group had a higher risk of developing dementia compared to the T2DM without OH group.
CONCLUSION
In T2DM with MCI patients, AD biomarkers and complement proteins mediate the effects of OH on cognitive impairment and OH may be a risk factor of progression from MCI to dementia in T2DM.
Topics: Humans; Diabetes Mellitus, Type 2; Cognitive Dysfunction; Male; Female; Disease Progression; Hypotension, Orthostatic; Aged; Biomarkers; Middle Aged; Dementia; Risk Factors; Alzheimer Disease; Complement System Proteins; Follow-Up Studies
PubMed: 38165720
DOI: 10.1210/clinem/dgad764 -
Frontiers in Medicine 2023Exercise-based treatments can worsen/exacerbate symptoms in people who were SARS-CoV-2 positive and living with post-COVID-19 condition (PL-PCC) and who have...
BACKGROUND
Exercise-based treatments can worsen/exacerbate symptoms in people who were SARS-CoV-2 positive and living with post-COVID-19 condition (PL-PCC) and who have post-exertional malaise (PEM) or orthostatic intolerance (OI). Nevertheless, PEM and OI are not routinely assessed by clinicians. We estimated PEM and OI proportions in PL-PCC, as well as in people not living with PCC (PnL-PCC) and negatives (i.e., never reported a SARS-CoV-2 positive test), and identified associated factors.
METHODS
Participants from the Prevalence, Risk factors, and Impact Evaluation (PRIME) post-COVID-19 condition study were included. PEM and OI were assessed using validated questionnaires. PCC was defined as feeling unrecovered after SARS-CoV-2 infection. Multivariable regression analyses to study PEM and OI were stratified for sex.
RESULTS
Data from 3,783 participants were analyzed. In PL-PCC, the proportion of PEM was 48.1% and 41.2%, and the proportion of OI was 29.3% and 27.9% in women and men, respectively. Proportions were higher in PL-PCC than negatives, for PEM in women OR=4.38 [95%CI:3.01-6.38]; in men OR = 4.78 [95%CI:3.13-7.29]; for OI in women 3.06 [95%CI:1.97-4.76]; in men 2.71 [95%CI:1.75-4.21]. Associated factors were age ≤ 60 years, ≥1 comorbidities, and living alone.
CONCLUSION
High proportions of PEM and OI are observed in PL-PCC. Standard screening for PEM and OI is recommended in PL-PCC to promote appropriate therapies.
PubMed: 38162880
DOI: 10.3389/fmed.2023.1292446 -
Journal of Parkinson's Disease 2023Multiple system atrophy (MSA) is a rare neurodegenerative disease characterized by Parkinsonism, ataxia, and autonomic nervous failure. Orthostatic hypotension (OH) is...
BACKGROUND
Multiple system atrophy (MSA) is a rare neurodegenerative disease characterized by Parkinsonism, ataxia, and autonomic nervous failure. Orthostatic hypotension (OH) is the main feature of central vascular autonomic failure in MSA.
OBJECTIVE
The study aimed elucidate the effects of OH on cognitive function, disease milestones, and survival.
METHODS
A total of 444 patients with clinically established MSA were enrolled. Mild and severe OH were defined as a decrease in systolic blood pressure (SBP)/diastolic blood pressure (DBP) >20/10 mmHg and SBP/DBP ≥30/15 mmHg, respectively.
RESULTS
In this study, 215 MSA patients presented without OH, 88 had mild OH, and 141 had severe OH. The proportion of MSA-C in the severe OH subgroup was significantly higher than that in the subgroup without OH (95/46 vs. 113/102, p = 0.021). The UMSARS I score and the frequency of supine hypertension (SH) in patients with OH were significantly higher than those in patients without OH (16.22 vs. 16.89 vs. 14.60, p < 0.001; 77/64 vs. 29/59 vs. 32/183, p < 0.001). Factors related to the severity of OH included sex (OR, 0.65; p = 0.031), onset age (OR, 0.98; p = 0.029), and SH (OR, 0.21; p < 0.001). The median survival time of patients with severe OH was significantly lower than that of patients without OH (6.79 vs. 8.13 years, p = 0.001). Consistently, Cox survival analysis found that compared with patients without OH, patients with severe OH had a significantly increased risk of death (OR, 2.22; p < 0.001).
CONCLUSION
Our large cohort study of MSA provides additional evidence for the negative impact of severe OH on survival.
Topics: Humans; Hypotension, Orthostatic; Multiple System Atrophy; Cohort Studies; Parkinson Disease; Hypertension; Prognosis
PubMed: 38143372
DOI: 10.3233/JPD-230095 -
Medicina (Kaunas, Lithuania) Dec 2023: During tilt testing, myalgic encephalomyelitis/chronic fatigue syndrome (ME/CFS) patients experience an abnormal reduction in cerebral blood flow (CBF). The...
: During tilt testing, myalgic encephalomyelitis/chronic fatigue syndrome (ME/CFS) patients experience an abnormal reduction in cerebral blood flow (CBF). The relationship between this CBF reduction and symptom severity has not been examined in detail. Our hypothesis was that ME/CFS severity is related to the degree of the CBF reduction during tilt testing. : First, from our database, we selected ME/CFS patients who had undergone assessments of ME/CFS symptomatology and tilt tests on the same day, one at the first visit and the second during a follow-up. The change in symptomatology was related to the change in CBF during the tilt test. Second, we combined the data of two previously published studies (n = 219), where disease severity as defined by the 2011 international consensus criteria (ICC) was available but not published. : 71 patients were retested because of worsening symptoms. The ICC disease severity distribution (mild-moderate-severe) changed from 51/45/4% at visit-1 to 1/72/27% at follow-up ( < 0.0001). The %CBF reduction changed from initially 19% to 31% at follow-up ( < 0.0001). Of 39 patients with stable disease, the severity distribution was similar at visit-1 (36/51/13%) and at follow-up (33/49/18%), = ns. The %CBF reduction remained unchanged: both 24%, = ns. The combined data of the two previously published studies showed that patients with mild, moderate, and severe disease had %CBF reductions of 25, 29, and 33%, respectively ( < 0.0001). : Disease severity and %CBF reduction during tilt testing are highly associated in ME/CFS: a more severe disease is related to a larger %CBF reduction. The data suggest a causal relationship where a larger CBF reduction leads to worsening symptoms.
Topics: Humans; Fatigue Syndrome, Chronic; Patient Acuity; Cerebrovascular Circulation
PubMed: 38138257
DOI: 10.3390/medicina59122153 -
Physiological Reports Dec 2023Whether high-intensity exercise training and detraining combined with skeletal muscle pump (MP) could alter the magnitude of postexercise hypotension has not been...
Whether high-intensity exercise training and detraining combined with skeletal muscle pump (MP) could alter the magnitude of postexercise hypotension has not been investigated. We therefore sought to determine whether the combination of MP (unloaded back-pedaling) with 4 weeks of high-intensity exercise training and detraining could alter the magnitude of postexercise hypotension. Fourteen healthy men underwent 4 weeks of high-intensity exercise training (5 consecutive days per week for 15 min per session at 40% of the difference between the gas exchange threshold and maximal oxygen uptake [i.e., Δ40%]) followed by detraining for 4 weeks. Assessments were conducted at Pre-training (Pre), Post-training (Post) and after Detraining with (MP) and without MP (Con). The exercise test in the Pre, Post and the Detraining consisted of 15 min exercise at Δ40% followed by 1 h of recovery. At all time-points, the postexercise reduction in mean arterial pressure (MAP) was reduced in MP compared to Con (all p < 0.01). Four weeks of high-intensity exercise training resulted in a reduction in the magnitude of postexercise hypotension (i.e., the change in MAP from baseline was mitigated) across both trials (All p < 0.01) when compared to Pre and Detraining. Following Detraining, the reduction of MAP from baseline was reduced compared to Pre, but was not different from Post. We conclude that high-intensity exercise training combined with skeletal MP reduces the magnitude of postexercise hypotension, and this effect is partially retained for 4 weeks following the complete cessation of high-intensity exercise training.
Topics: Male; Humans; Post-Exercise Hypotension; Exercise; Exercise Test
PubMed: 38129108
DOI: 10.14814/phy2.15862 -
Scientific Reports Dec 2023This research proposed to retrospectively analyze 20 years of clinical data and investigate the relationship between demographic factors and syncopal symptom in...
This research proposed to retrospectively analyze 20 years of clinical data and investigate the relationship between demographic factors and syncopal symptom in pediatric vasovagal syncope. A total of 2513 children, 1124 males and 1389 females, age range 3-18 years, who presented to Department of Pediatric Cardiovasology, Children's Medical Center, The Second Xiangya Hospital, Central South University with unexplained syncope or pre-syncope and were diagnosed with vasovagal syncope were retrospectively collected and divided into syncope group (n = 1262) and pre-syncope group (n = 1251). (1) Females had a 36% increased risk of syncope compared to males, a 27% increased risk of syncope for every 1-year increase in age, and a 2% decreased risk of syncope for every 1 cm increase in height. (2) A non-linear relationship between age, height, weight and syncope was observed. When age > 10.67 years, the risk of syncope increases by 45% for each 1-year increase in age; when height < 146 cm, the risk of syncope decreases by 4% for each 1 cm increase in height; when weight < 28.5 kg, the risk of syncope decreases by 10% for each 1 kg increase in weight. Demographic factors are strongly associated with syncopal symptom in pediatric vasovagal syncope and can help to predict the risk.
Topics: Male; Female; Humans; Child; Child, Preschool; Adolescent; Syncope, Vasovagal; Retrospective Studies; Syncope; Tilt-Table Test; Demography
PubMed: 38123593
DOI: 10.1038/s41598-023-49722-w -
Frontiers in Neurology 2023Myalgic encephalomyelitis/chronic fatigue syndrome (ME/CFS) is a complex, chronic, multi-system disorder that is characterized by a substantial impairment in the...
INTRODUCTION
Myalgic encephalomyelitis/chronic fatigue syndrome (ME/CFS) is a complex, chronic, multi-system disorder that is characterized by a substantial impairment in the activities that were well tolerated before the illness. In an earlier report, we had described three adult women who met criteria for ME/CFS and orthostatic intolerance, and had congenital or acquired cervical spinal stenosis. All three experienced substantial global improvements in their ME/CFS and orthostatic intolerance symptoms after recognition and surgical treatment of the cervical stenosis. After a several year period of improvement, one of the individuals in that series experienced a return of ME/CFS and orthostatic intolerance symptoms.
MAIN SYMPTOMS AND CLINICAL FINDINGS
Radiologic investigation confirmed a recurrence of the ventral compression of the spinal cord due to a shift of the disc replacement implant at the involved cervical spinal level.
THERAPEUTIC INTERVENTION
Decompression of the spinal cord with removal of the implant and fusion at the original C5-C6 level was once again followed by a similar degree of improvement in function as had been observed after the first operation.
CONCLUSION
This recapitulation of the outcomes after surgical management of cervical stenosis provides further evidence in support of the hypothesis that cervical spinal stenosis can exacerbate pre-existing or cause new orthostatic intolerance and ME/CFS. Especially for those with refractory symptoms and neurological signs, surgical interventions may offer relief for selected patients with this complex condition.
PubMed: 38099073
DOI: 10.3389/fneur.2023.1284062 -
Journal of Family Medicine and Primary... Oct 2023The reason for autonomic dysfunction in COVID-19 is yet to get clear, though we tend to notice a few dysautonomia cases during post-COVID-19 manifested most commonly in...
BACKGROUND
The reason for autonomic dysfunction in COVID-19 is yet to get clear, though we tend to notice a few dysautonomia cases during post-COVID-19 manifested most commonly in the form of postural orthostatic tachycardia syndrome (POTS).
CASE PRESENTATION
A case of autonomic dysregulation is presented in a COVID-19 patient as a post-COVID-19 sequelae. On doing an active stand test and two basic autonomic function tests, dysautonomia was diagnosed in the patient, after going through all routine investigations for six months. Cardiac parasympathetic integrity was assessed by measuring the heart rate response to standing by continuous electrocardiographic tracing. The management of these patients is usually conservative.
CONCLUSION
Family physicians must be aware of such cases in future for early diagnosis and management of the patients.
PubMed: 38074226
DOI: 10.4103/jfmpc.jfmpc_74_23 -
Gerontology 2024Peripheral neuropathy (PN) becomes more common with increasing life expectancy, but general population prevalence estimates are lacking. We investigated an...
INTRODUCTION
Peripheral neuropathy (PN) becomes more common with increasing life expectancy, but general population prevalence estimates are lacking. We investigated an epidemiological distribution of signs of PN among 2,996 community-dwelling participants in Good Aging in Skåne Study, age 60-97, and their impact on physical and autonomic function.
METHODS
Signs of PN were measured with Utah Early Neuropathy Scale (UENS). Associations between UENS and physical tests, pain, and dysautonomic phenomena were calculated for each sex, adjusted for age, with estimated marginal means (EMM) and odds ratios (ORs) in four UENS quantiles (Q1-Q4).
RESULTS
Participants in Q4 had worse EMM for: time to complete Timed Up and Go test (Q4-Q1: male 10.8-9.6 s; female 11.7-10.2 s), 15 m Walk test (Q4-Q1: male 11.1-9.9 s; female 11.2-10.4 s), and fewer repetitions in Step test (Q4-Q1: male 15.2-17.0 steps; female 14.5-15.8 steps). Higher OR of failing one-leg balance 60 s test {male 2.5 (confidence interval [CI] 95%: 1.7-3.8); female 2.1 (1.1-3.2)}, Foam Pad Balance test (male 4.6 [CI 95%: 3.2-6.7]; female 1.8 [1.3-2.6]), and lower physical quality of life were seen in Q4 compared to Q1. Participants in Q4 had higher OR for walking aid usage, falls, fear of falling, pain, and urinary incontinence, while in males, higher OR for orthostatic intolerance, fecal incontinence, and constipation.
CONCLUSIONS
In a general population, 20-25% of older adults who have highest UENS scores, a sensitive measure of early PN, express slower gait, worse balance, lower quality of life, pain, falls and fear of falling, and autonomic symptoms.
Topics: Humans; Male; Female; Aged; Aged, 80 and over; Postural Balance; Quality of Life; Fear; Time and Motion Studies; Peripheral Nervous System Diseases; Pain
PubMed: 38043521
DOI: 10.1159/000535620 -
Cureus Oct 2023Background Dysautonomia denotes an alteration in the autonomic nervous system that can significantly lead to multiorgan failure. Conversely, depression not only affects...
Background Dysautonomia denotes an alteration in the autonomic nervous system that can significantly lead to multiorgan failure. Conversely, depression not only affects cognitive functions but also poses a risk factor for sudden cardiac death. In our study, the Composite Autonomic Scoring-31 (COMPASS-31) is used to quantify the autonomic symptoms present if any in patients with depression. Materials and methods Forty-two patients with major depressive disorder (MDD) were recruited using a PHQ-9 questionnaire followed by a COMPASS-31 scale to quantify dysautonomia symptoms, and they were compared with healthy controls. Further regression analysis was conducted to establish any relationship between independent variables and COMPASS-31 scores. Results The average COMPASS-31 score in patients with MDD was 22.56±8.42, which was significantly increased compared to healthy controls (p=0.001). Furthermore, the differences persisted across various subdomains of the COMPASS-31 scale relative to severity of depression. Conclusion The study observations could provide a relevant perception regarding the association between depression and autonomic dysfunction with the use of a simple and brief yet validated instrument COMPASS-31, which can be utilized for screening at the primary care level.
PubMed: 38034226
DOI: 10.7759/cureus.48008