Evaluation of cerebral autoregulation by multimodality monitoring during tilt table test and Valsalva maneuver in Parkinson's disease

Xiao Dong Yuan, Szirmai Imre, Debreczeni Robert

Research output: Contribution to journalArticle


Objective: To analyze clinical characteristic of static and dynamic cerebral autoregulation (CA) in patients with Parkinson disease (PD), mean cerebral blood flow velocities (MCBFV) in both middle cerebral artery (MCA), mean arterial blood pressure (MABP), end tidal CO 2 (EtCO 2) and some other index are measured simultaneously and continuously during the Valsalva maneuver (VM) and tilt table testing (TTT). Methods: Seventeen patients with PD and eight age-matched control subjects were measured continuously and simultaneously of heart rate (HR), CBFV in both MCA by transcranial Doppler, MABP, MABP adjusted to brain level (MABP brain) by Finapress 2300 Ohmeda and end-tidal CO 2 (EtCO 2). TIT was performed firstly during graded tilt (in the rest supine position as baseline, 10°, 30°, 70° head-up tilt, and supine recovery). Secondly, VM was carried out. Gosling's pulsatility index of MABP brain and both MCA (PI BP, PIMCBFV L, PIMCBFV R), ratio of PIMCBFV L/PI BP, PIMCBFV R/PIB P (PI L/PI BP, PI R/PI BP) were calculated for all phases. Cerebrovascular resistance (CVR) and static CA (sCA) were also calculated. The autoregulatory indices, as authoregulatory slope indice (ASI), A I-II and A I-IV, side-to-side differences of indices (SSD), were also calculated during VM. Results: The results in TTT showed that MABP brain was decreased significantly in control and patients with Head-up tilt, but there was a significant decrease from baseline only at 70° head-up position (77.1 ± 12.3, 59.9 ± 10.2, P = 0.03;79.2 ± 11.8, 61.8 ± 15.1, P = 0.02), but it was not significant between patients and controls at any tilt level (P > 0.05). MCBFV in MCA in the patients was significantly lower than that in the controls ((34.1 ± 7.5)-(44.1 ± 13.8), (61.4 ± 15.9)-(65.4 ± 19.2), P < 0.05), and CVR in the patients were significantly higher than that in the controls at all test positions ((2.0 ± 1.1)-(2.3 ± 1.0), (1.0 ± 0.2)-(1.2 ± 0.4), P < 0.05). sCA MCAL and sCA MCAR were significantly decreased in the patient group (by 15.0%, 6.8%) than those in the control group (by 73.4%, 75.7%) (P < 0.01). During VM, MCBFV was significantly lower in the patients than in the controls in all phases ((35.7 ± 12.7)-(54.2 ± 16.1), (47.1 ± 11.3)-(80.2 ± 25.5), P < 0.05). MCBFV in the patients was not different between phase II a and II b (P = 0.33). PI BP in the controls was markedly lower in phase II b than on the baseline (P < 0.05), and PI L/PI BP was markedly higher in phase II a, II b than on the baseline (P < 0.05). PI BP in patients was markedly decreased in phase I, II a, II b, III than on the baseline ((0.6 ± 0.1)-(0.5 ± 0.2), 0.7 ± 0.1, P < 0.05) respectively, but PI L/PI BP and PI R/PI BP rose significantly in phase II a to III((2.1 ± 1.0)-(2.9 ± 1.5), 1.5 ± 0.5, P < 0.05). Conclusions: Patients with PD are in a baseline condition of higher CVR, lower MCBFV. The results in TTT showed that the patients with PD presented a special type of dysfunction of sCA resulting from dysfunction of dilatation of the downstream resistance vessels. Dynamic CA during VM shows characteristic phase-delayed changes in healthy controls. The clinical threshold of CA markedly rises and the intensity of CA. Decreases in PD, which makes CA further delayed to phase III. PI L/PI BP and PI R/PI BP were better parameters for testing dynamic CA in PD.

Original languageEnglish
Pages (from-to)92-97
Number of pages6
JournalChinese Journal of Neurology
Issue number2
Publication statusPublished - Feb 1 2007


  • Blood flow velocity
  • Middle cerebral artery
  • Parkinson's disease
  • Tilt-table test
  • Valsalva maneuver

ASJC Scopus subject areas

  • Neurology
  • Clinical Neurology

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