Objective: The aim of the study was to determine the relationship between depression, cognitive disorders and autonomic regulation of the cardiovascular system in patients with PD.

Background: Autonomic dysfunction and cognitive disorders are an integral part of the PD, as well as depression is often associated with PD, although the interdependence of these conditions is not well studied.

Methods: 47 patients (mean age 65.8±1.7; 17M/30F) with PD were compared to 28 healthy age and gender-matched controls. Cognition was evaluated using Mini-mental State Examination (MMSE) and Frontal Assessment Battery (FAB). Depression was assessed by Hamilton Depression Rating Scale (HDRS). The heart rate variability (HRV) and blood pressure variability (BPV) was analyzed in time- and frequency-domains. The spectral total power (TP), low frequency (LF) and high frequency (HF) bands and the ratio between LF/HF were calculated. Spontaneous baroreflex sensitivity (BRS) was computed by spectral analysis from R-R time series based on functional testing with slow deep breathing.

Results: The distribution of patients with PD by stages is shown in the Table 1. MMSE (25.3±2.8) and FAB (14.8±3.3) score showed mild cognitive impairment in patients with PD. HDRS score (17.5±4.3) reflects moderate depression in the studied PD group. Resting HR was significantly higher in PD compared to controls. Significant decrease was observed in key HRV parameters (TP, LF, HF, SDNN) and BRS values (Table 2). Statistical analysis revealed no significant differences in indicators of autonomic regulation of the cardiovascular system in patients at different stages of PD by Hoehn and Yahr. It has been found that the higher HDRS score in PD patients was associated with more significant decrease in LF band for HRV (p=0.01) and systolic BPV (p=0.031) reflecting autonomic balance shift towards parasympathetic domination. More significant cognitive impairment was associated with a marked reduction of TP and SDNN and decrease in value of LF and LF/HF (p=0.02, r=0.4; p=0.04, r=0.5; p=0.005, r=0.5; p=0.02, r=0.4, respectively).

Conclusions: These findings support the view that progressive noradrenergic denervation underlies both cardiovascular autonomic dysfunction and cognitive impairment. Depression also might be associated with functional impairment of the autonomic nervous system and both have common pathologic substrate in PD patients.

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MDS Abstracts - https://www.mdsabstracts.org/abstract/cardiovascular-autonomic-dysfunction-depression-and-cognitive-disorders-in-parkinsons-disease-patients/