Modulação autonômica na doença de Parkinson: influência do tempo de diagnóstico e análise por métodos geométricos
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Data
2018-12-17
Autores
Oliveira, Mileide Cristina Stoco de [UNESP]
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Universidade Estadual Paulista (Unesp)
Resumo
A doença de Parkinson (DP) pode promover desordem no sistema nervoso autônomo, contudo estudos que verifiquem a relação entre o tempo de diagnóstico da doença e a modulação autonômica ainda não foram encontrados. Além disso, poucos estudos avaliaram a modulação autonômica na DP por meio da variabilidade da frequência cardíaca (VFC) utilizando métodos geométricos. Objetivos: 1) investigar a relação entre o tempo de diagnóstico e a modulação autonômica em indivíduos com a DP e comparar com indivíduos sem a doença. 2) investigar a modulação autonômica em indivíduos com DP, por meio de índices da VFC obtidos por métodos geométricos. Materiais e métodos: foram avaliados 50 voluntários com idade entre 55 a 83 anos, divididos em 2 grupos: o grupo Parkinson (GP; 26 voluntários) e o grupo controle (GC; 24 voluntários), pareados pelo sexo e idade. Para investigação do tempo de diagnóstico o GP foi subdividido em dois grupos conforme a mediana [mediana = 5,5 anos], sendo: GP1 (abaixo da mediana: menor tempo de diagnóstico; 13 voluntários) e GP2 (acima da mediana: maior tempo de diagnóstico; 13 voluntários). O protocolo experimental foi desenvolvido em duas etapas: na primeira foram coletados dados pessoais, peso, altura, composição corporal, frequência cardíaca, pressão arterial, avaliação pelo Mini-exame do Estado Mental e os voluntários com DP foram avaliados pela Escala de Estágios de Incapacidade de Hoehn e Yahr. Na segunda etapa foi realizada análise da modulação autonômica. Para essa análise, a frequência cardíaca foi captada batimento a batimento com os indivíduos em decúbito dorsal por 30 minutos utilizando um cardiofrequencímetro e índices de VFC foram calculados utilizando métodos lineares nos domínios do tempo e da frequência, e por métodos geométricos; além disso foi considerada para análise. a influência do tempo de diagnóstico da DP. Resultados: não houve diferenças significantes para os índices da VFC entre os grupos GP1 e GP2. Foi observada diminuição significativa dos índices RMSSD, SDNN, pNN50, LFms2 e HFms2 nos grupos GP1 e GP2 em relação ao GC. Já em relação aos índices geométricos, houve diferenças significantes entre GP e GC, demonstradas por diminuição significativa dos índices RRtri, TINN, SD1 e SD2. A análise visual do plot de Poincaré mostrou que indivíduos com DP tem menor dispersão batimento a batimento dos intervalos RR e na distribuição dos intervalos RR a longo prazo observa-se que no GP ocorre maior concentração dos pontos à direita do plot, sugerindo a presença de intervalos RR com maiores valores nesse grupo. Conclusão: o tempo de diagnóstico da DP não influenciou a modulação autonômica, contudo nesses indivíduos redução da modulação parassimpática e da variabilidade global foi observada em relação a indivíduos sem a doença, sugerindo que a presença exclusiva da doença afeta o SNA independente do tempo de diagnóstico. Índices geométricos também detectaram diminuição da modulação autonômica parassimpática e da variabilidade global em indivíduos com a DP, as quais foram independentes de sexo, idade e IMC, sugerindo que esses índices são eficazes para avaliação clínica de manifestações autonômicas da doença e acompanhamento de condutas terapêuticas realizadas nesses pacientes.
Parkinson's disease (PD) can promote disorder in the autonomic nervous system, but studies that verify the relationship between the time of diagnosis of the disease and the autonomic modulation have not yet been found. In addition, few studies have evaluated autonomic PD modulation through heart rate variability (HRV) using geometric methods. Objectives: 1) to investigate the relationship between the time of diagnosis and the autonomic modulation in individuals with PD and to compare with individuals without the disease. 2) to investigate the autonomic modulation in individuals with PD, through HRV indices obtained by geometric methods. Materials and Methods: Fifty volunteers aged 55 to 83 years were divided into two groups: the Parkinson group (GP, 26 volunteers) and the control group (CG, 24 volunteers), matched by sex and age. In order to investigate the time of diagnosis, GP was subdivided into two groups according to the median (median = 5.5 years): GP1 (below median: lower diagnostic time; 13 volunteers) and GP2 (above median: longer time 13 volunteers). The experimental protocol was developed in two stages: the first one was collected personal data, weight, height, body composition, heart rate, blood pressure, Mental State Mini-exam and the volunteers with PD were evaluated by the Disability Stages Scale of Hoehn and Yahr. In the second stage, the analysis of the autonomic modulation was performed. For this analysis, heart rate was recorded beat-to-beat with individuals in dorsal decubitus for 30 minutes using a cardiofrequency meter and HRV indices were calculated using linear methods in time and frequency domains, and by geometric methods; was also considered for analysis. the influence of the time of diagnosis of PD. Results: There were no significant differences for the HRV indices between GP1 and GP2 groups. Significant decrease of the RMSSD, SDNN, pNN50, LFms2 and HFms2 indices was observed in the GP1 and GP2 groups with respect to GC. Regarding the geometric indices, there were significant differences between GP and CG, demonstrated by a significant decrease in RRtri, TINN, SD1 and SD2 indices. The visual analysis of the Poincaré plot showed that individuals with PD have less dispersion beat to beat of RR intervals and in the distribution of RR intervals in the long term it is observed that in the GP there is a higher concentration of points to the right of the plot, suggesting the presence of RR intervals with higher values in this group. Conclusion: the time of diagnosis of PD did not influence autonomic modulation, however, in these individual’s reduction of parasympathetic modulation and global variability was observed in relation to individuals without the disease, suggesting that the exclusive presence of the disease affects the ANS regardless of the time of diagnosis. Geometric indexes also detected a decrease in parasympathetic autonomic modulation and global variability in individuals with PD, which were independent of gender, age and BMI, suggesting that these indices are effective for clinical evaluation of autonomic manifestations of the disease and follow-up of therapeutic conducts performed in these patients.
Parkinson's disease (PD) can promote disorder in the autonomic nervous system, but studies that verify the relationship between the time of diagnosis of the disease and the autonomic modulation have not yet been found. In addition, few studies have evaluated autonomic PD modulation through heart rate variability (HRV) using geometric methods. Objectives: 1) to investigate the relationship between the time of diagnosis and the autonomic modulation in individuals with PD and to compare with individuals without the disease. 2) to investigate the autonomic modulation in individuals with PD, through HRV indices obtained by geometric methods. Materials and Methods: Fifty volunteers aged 55 to 83 years were divided into two groups: the Parkinson group (GP, 26 volunteers) and the control group (CG, 24 volunteers), matched by sex and age. In order to investigate the time of diagnosis, GP was subdivided into two groups according to the median (median = 5.5 years): GP1 (below median: lower diagnostic time; 13 volunteers) and GP2 (above median: longer time 13 volunteers). The experimental protocol was developed in two stages: the first one was collected personal data, weight, height, body composition, heart rate, blood pressure, Mental State Mini-exam and the volunteers with PD were evaluated by the Disability Stages Scale of Hoehn and Yahr. In the second stage, the analysis of the autonomic modulation was performed. For this analysis, heart rate was recorded beat-to-beat with individuals in dorsal decubitus for 30 minutes using a cardiofrequency meter and HRV indices were calculated using linear methods in time and frequency domains, and by geometric methods; was also considered for analysis. the influence of the time of diagnosis of PD. Results: There were no significant differences for the HRV indices between GP1 and GP2 groups. Significant decrease of the RMSSD, SDNN, pNN50, LFms2 and HFms2 indices was observed in the GP1 and GP2 groups with respect to GC. Regarding the geometric indices, there were significant differences between GP and CG, demonstrated by a significant decrease in RRtri, TINN, SD1 and SD2 indices. The visual analysis of the Poincaré plot showed that individuals with PD have less dispersion beat to beat of RR intervals and in the distribution of RR intervals in the long term it is observed that in the GP there is a higher concentration of points to the right of the plot, suggesting the presence of RR intervals with higher values in this group. Conclusion: the time of diagnosis of PD did not influence autonomic modulation, however, in these individual’s reduction of parasympathetic modulation and global variability was observed in relation to individuals without the disease, suggesting that the exclusive presence of the disease affects the ANS regardless of the time of diagnosis. Geometric indexes also detected a decrease in parasympathetic autonomic modulation and global variability in individuals with PD, which were independent of gender, age and BMI, suggesting that these indices are effective for clinical evaluation of autonomic manifestations of the disease and follow-up of therapeutic conducts performed in these patients.
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Palavras-chave
Doença de Parkinson, Sistema nervoso autônomo, Disautonomia, Doenças neurodegenerativas, Parkinson's disease, Autonomic nervous system, Dysautonomia, Neurodegenerative diseases