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Orthostatic hypotension and REM sleep behaviour disorder: Impact on clinical outcomes in α-synucleinopathies

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dc.contributor.author Pilotto, A.
dc.contributor.author Romagnolo, A.
dc.contributor.author Tuazon, J.A.
dc.contributor.author Vizcarra, J.A.
dc.contributor.author Marsili, L.
dc.contributor.author Zibetti, M.
dc.contributor.author Rosso, M.
dc.contributor.author Rodriguez-Porcel, F.
dc.contributor.author Borroni, B.
dc.contributor.author Rizzetti, M.C.
dc.contributor.author Rossi, C.
dc.contributor.author Vizcarra-Escobar, D.
dc.contributor.author Molano, J.R.
dc.contributor.author Lopiano, L.
dc.contributor.author Ceravolo, R.
dc.contributor.author Masellis, M.
dc.contributor.author Espay, A.J.
dc.contributor.author Padovani, A.
dc.contributor.author Merola, A.
dc.date.accessioned 2019-08-08T15:23:46Z
dc.date.available 2019-08-08T15:23:46Z
dc.date.issued 2019
dc.identifier.uri https://hdl.handle.net/20.500.12866/7147
dc.description.abstract Objective: Review the effect of orthostatic hypotension (OH) and rapid-eye-movement sleep behavioural disorder (RBD) on survival, cognitive impairment and postural stability, and discuss pathogenic mechanisms involved in the association of these two common non-motor features with relevant clinical outcomes in α-synucleinopathies. Methods: We searched PubMed (January 2007-February 2019) for human studies of OH and RBD evaluating cognitive impairment, postural instability, and survival in Parkinson's disease (PD), dementia with Lewy bodies (DLB), multiple system atrophy (MSA) and pure autonomic failure (PAF). Included studies were analysed for design, key results and limitations as per the Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines. Results: OH and RBD showed a positive association with cognitive impairment in PD and DLB, conflicting association in PAF, and no association in MSA. OH was correlated with incident falls and postural instability in PD and DLB but not in MSA. The association between RBD and postural instability was inconclusive; positive in five studies, negative in seven. OH, but not RBD, correlated with reduced survival in PD, DLB and MSA. The combination of OH and RBD was associated with cognitive impairment and more rapid progression of postural instability. Conclusions: OH and RBD yielded individual and combined negative effects on disability in α-synucleinopathies, reflecting a 'malignant' phenotype of PD with early cognitive impairment and postural instability. Underlying mechanisms may include involvement of selected brainstem cholinergic and noradrenergic nuclei. en_US
dc.language.iso eng
dc.publisher BMJ Publishing Group
dc.relation.ispartof urn:issn:1468-330X
dc.rights info:eu-repo/semantics/restrictedAccess
dc.rights.uri https://creativecommons.org/licenses/by-nc-nd/4.0/deed.es
dc.subject sleep disorders en_US
dc.subject cognition en_US
dc.subject Parkinson's disease en_US
dc.subject autonomic en_US
dc.title Orthostatic hypotension and REM sleep behaviour disorder: Impact on clinical outcomes in α-synucleinopathies en_US
dc.type info:eu-repo/semantics/article
dc.identifier.doi https://doi.org/10.1136/jnnp-2019-320846
dc.subject.ocde https://purl.org/pe-repo/ocde/ford#3.02.00 es_PE
dc.subject.ocde https://purl.org/pe-repo/ocde/ford#3.02.25
dc.subject.ocde https://purl.org/pe-repo/ocde/ford#3.02.24
dc.subject.ocde https://purl.org/pe-repo/ocde/ford#3.02.11


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