Potential conflict of interest: Drs. Langston and Azhu Valappil received support for this study by a Rapid Response Innovation Award from the Michael J Fox Foundation for Parkinson's disease. As for financial disclosures, a patent has been filed by the Parkinson's Institute and Clinical Center (a nonprofit 501c3 organization) on the techniques described in this research article. All other authors: None.
Exploring the electrocardiogram as a potential tool to screen for premotor Parkinson's disease†
Version of Record online: 25 OCT 2010
Copyright © 2010 Movement Disorder Society
Volume 25, Issue 14, pages 2296–2303, 30 October 2010
How to Cite
Valappil, R. A., Black, J. E., Broderick, M. J., Carrillo, O., Frenette, E., Sullivan, S. S., Goldman, S. M., Tanner, C. M. and Langston, J. W. (2010), Exploring the electrocardiogram as a potential tool to screen for premotor Parkinson's disease. Mov. Disord., 25: 2296–2303. doi: 10.1002/mds.23348
- Issue online: 25 OCT 2010
- Version of Record online: 25 OCT 2010
- Manuscript Accepted: 21 JUN 2010
- Manuscript Revised: 2 MAR 2010
- Manuscript Received: 19 JAN 2010
- heart rate variability;
- cardiac autonomic dysfunction;
- Parkinson's disease;
- pre-motor Parkinson's disease.
The aim of this study was to test the hypothesis that patients with REM sleep behavior disorder, many of whom will develop Parkinson's disease (PD) or a related synucleinopathy, will demonstrate decreased heart rate variability (HRV) compared with a group of age-matched controls as measured by an electrocardiogram during wakefulness. We compared HRV in 11 untreated idiopathic REM sleep behavior disorder patients (9 men and 2 women; mean age, 63.3 years; SD, 7.5 years) and 11 control subjects with idiopathic insomnia without REM sleep behavior disorder (7 men and 4 women; mean age, 59.5 years; SD, 8.7 years). Subjects with other causes of reduced HRV were excluded. HRV was determined from 5-minute presleep segments of a single channel electrocardiogram recorded during polysomnographic evaluations, using R-R intervals during wakefulness. Time domain, geometric measures, and spectral analysis of the R-R intervals were significantly different between cases and controls. A discriminant function analysis correctly classified 95.5% of subjects (overall model fit, P = 0.016). Leave-one-out cross-validation correctly classified 77.3% of subjects. HRV during wakefulness is significantly decreased in patients with idiopathic REM sleep behavior disorder compared with control subjects, suggesting abnormalities of both sympathetic and parasympathetic function. Patients with RBD may later develop motor and cognitive features of a Lewy body disorder, such as PD. Cardiac autonomic dysfunction is also impaired in PD, suggesting that impaired HRV may be an early sign of PD. HRV measured by routine electrocardiograms could be used to screen for Lewy body disorders such as PD. © 2010 Movement Disorder Society.