Unraveling the stride: exploring the influence of neurogenic orthostatic hypotension on gait and balance in Parkinson's disease.

IF 3.9 3区医学 Q1 CLINICAL NEUROLOGY

Clinical Autonomic Research Pub Date : 2024-12-01 Epub Date: 2024-10-02 DOI:10.1007/s10286-024-01071-y

Gabriele Imbalzano, Claudia Ledda, Marta Maria Tangari, Carlo Alberto Artusi, Elisa Montanaro, Mario Giorgio Rizzone, Maurizio Zibetti, Leonardo Lopiano, Alberto Romagnolo

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引用次数: 0

Abstract

Purpose: Neurogenic orthostatic hypotension (nOH) and gait impairment are frequent sources of disability in Parkinson's disease (PD). However, the impact of nOH on balance and gait features remains unclear. This cross-sectional study aimed to assess the influence of nOH on postural and gait parameters in a cohort of patients with PD by means of wearable inertial sensors.

Methods: Gait and balance were assessed using Opal inertial sensors. nOH was defined as sustained systolic blood pressure (BP) drop ≥ 20 mmHg or diastolic BP drop ≥ 10 mmHg within 3 min of standing, with a ΔHR/ΔSBP ratio ≤ 0.5 bpm/mmHg. Analysis of covariance was performed to evaluate differences in gait/balance features between patients with and without nOH, adjusting for age, cognitive status, and motor disability. Moreover, we performed the same analysis considering the presence of hemodynamically relevant nOH (orthostatic mean BP ≤ 75 mmHg).

Results: A total of 82 patients were enrolled, 26 with nOH (31.7%), of which 13 presented with hemodynamically relevant nOH. After correcting for confounders, nOH was independently associated with lower gait speed (p = 0.027), shorter stride length (p = 0.033), longer time for postural transitions (p = 0.004), and increased postural sway (p = 0.019). These differences were even more pronounced in patients with hemodynamically relevant nOH. Higher postural sway was associated with a 7.9-fold higher odds of falls (p = 0.040).

Conclusions: Our study presents an objective demonstration of the independent negative impact of nOH on gait and balance in PD, emphasizing the need for careful detection and management of nOH to mitigate gait and balance disturbances in PD.

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揭开步伐的神秘面纱：探索神经源性正张力低血压对帕金森病患者步态和平衡的影响。

目的：神经源性正张力性低血压（nOH）和步态障碍是帕金森病（PD）致残的常见原因。然而，nOH 对平衡和步态特征的影响仍不清楚。这项横断面研究旨在通过可穿戴惯性传感器，评估nOH对一组帕金森病患者姿势和步态参数的影响：nOH定义为站立3分钟内收缩压（BP）持续下降≥20 mmHg或舒张压下降≥10 mmHg，且ΔHR/ΔSBP比值≤0.5 bpm/mmHg。在对年龄、认知状况和运动障碍进行调整后，我们进行了协方差分析，以评估有 nOH 和无 nOH 患者在步态/平衡特征方面的差异。此外，我们还进行了同样的分析，以考虑是否存在与血液动力学相关的nOH（正压平均血压≤75 mmHg）：共有 82 名患者入选，其中 26 人患有 nOH（31.7%），13 人出现了与血流动力学相关的 nOH。校正混杂因素后，nOH 与步速降低（p = 0.027）、步幅缩短（p = 0.033）、姿势转换时间延长（p = 0.004）和姿势摇摆增加（p = 0.019）独立相关。这些差异在血流动力学相关的 nOH 患者中更为明显。姿势摇摆增加与跌倒几率增加 7.9 倍相关（p = 0.040）：我们的研究客观地证明了nOH对帕金森病患者步态和平衡的独立负面影响，强调了仔细检测和管理nOH以减轻帕金森病步态和平衡障碍的必要性。

本文章由计算机程序翻译，如有差异，请以英文原文为准。

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来源期刊

Clinical Autonomic Research 医学-临床神经学

CiteScore

7.40

自引率

6.90%

发文量

审稿时长

>12 weeks

期刊介绍： Clinical Autonomic Research aims to draw together and disseminate research work from various disciplines and specialties dealing with clinical problems resulting from autonomic dysfunction. Areas to be covered include: cardiovascular system, neurology, diabetes, endocrinology, urology, pain disorders, ophthalmology, gastroenterology, toxicology and clinical pharmacology, skin infectious diseases, renal disease. This journal is an essential source of new information for everyone working in areas involving the autonomic nervous system. A major feature of Clinical Autonomic Research is its speed of publication coupled with the highest refereeing standards.