Background and Purpose Impulse-control disorder is an important nonmotor symptom of Parkinson's disease (PD) that can lead to financial and social problems, and be related to a poor quality of life. A nationwide multicenter prospective study was performed with the aim of validating the Korean Version of the Questionnaire for Impulsive-Compulsive Disorders in Parkinson's Disease Rating Scale (K-QUIP-RS). Methods The K-QUIP-RS was constructed using forward and backward translation, and pretesting of the prefinal version. PD patients on stable medical condition were recruited from 27 movement-disorder clinics. Participants were assessed using the K-QUIP-RS and evaluated for parkinsonian motor and nonmotor statuses and for PD-related quality of life using a predefined evaluation battery. The test retest reliability of the K-QUIP-RS was assessed over an interval of 10-14 days, and correlations between the KQUIP-RS and other clinical scales were analyzed. Results This study enrolled 136 patients. The internal consistency of the K-QUIP-RS was indicated by a Cronbach's a coefficient of 0.846, as was the test retest reliability by a Guttman split-half coefficient of 0.808. The total K-QUIP-RS score was positively correlated with the scores for depression and motivation items on the Unified PD Rating Scale (UPDRS), Montgomery-Asberg Depression Scale, and Rapid-Eye-Movement Sleep-Behavior-Disorders Questionnaire. The total K-QUIP-RS score was also correlated with the scores on part II of the UPDRS and the PD Quality of Life-39 questionnaire, and the dopaminergic medication dose. Conclusions The K-QUIP-RS appears to be a reliable assessment tool for impulse-control and related behavioral disturbances in the Korean PD population.

Background and Purpose This study aimed to determine the clinimetric properties of the Korean version of Parkinson's Disease Sleep Scale-2 (K-PDSS-2) and whether distinct subtypes of sleep disturbance can be empirically identified in patients with Parkinson's disease (PD) using the cross-culturally validated K-PDSS-2. Methods The internal consistency, test-retest reliability, scale precision, and convergent validity of K-PDSS-2 were assessed in a nationwide, multicenter study of 122 patients with PD. Latent class analysis (LCA) was used to derive subgroups of patients who experienced similar patterns of sleep-related problems and nocturnal disabilities. Results The total K-PDSS-2 score was 11.67 +/- 9.87 (mean +/- standard deviation) at baseline and 12.61 +/- 11.17 at the retest. Cronbach's a coefficients of the total K-PDSS-2 scores at baseline and follow-up were 0.851 and 0.880, respectively. The intraclass correlation coefficients over the 2-week study period ranged from 0.672 to 0.848. The total K-PDSS-2 score was strongly correlated with health-related quality of life measures and other corresponding nonmotor scales. LCA revealed three distinct subtypes of sleep disturbance in the study patients: "less-troubled sleepers:," "PD-related nocturnal difficulties," and "disturbed sleepers". Conclusions K-PDSS-2 showed good clinimetric attributes in accordance with previous studies that employed the original version of the PDSS-2, therefore confirming the cross-cultural usefulness of the scale. This study has further documented the first application of an LCA approach for identifying subtypes of sleep disturbance in patients with PD.

Background: Sleep-related problems in Parkinson’s disease (PD) have received greater attention in recent years due to their clinical influence on morbidity, disability, and the health-related quality of life (HRQoL) of patients. This study aimed to evaluate the clinimetric properties of the Korean version of the Parkinson’s Disease Sleep Scale-2 (K-PDSS-2), and to analyze whether distinct sleep disturbance subtypes could be empirically identified in patients with PD based on the cross-culturally validated K-PDSS-2. Methods: The internal consistency, test-retest reliability, scale precision, and convergent validity of the K-PDSS-2 were assessed in a nationwide, multicenter study of 122 patients with PD. Latent class analysis (LCA) was used to derive subgroups of patients who experienced similar patterns of sleep-related problems and nocturnal disabilities. Results: The mean total K-PDSS-2 scores were 11.67 ± 9.87 (mean ± standard deviation) at baseline, and 12.61 ± 11.17 upon follow up testing. The Cronbach’s α coefficients of the total K-PDSS-2 score at baseline and at follow up testing were 0.851 and 0.880 respectively. Intraclass correlation coefficient over the 2-week period ranged from 0.672 to 0.848. The total K-PDSS-2 score was strongly correlated to HRQoL measures and other corresponding nonmotor scales. LCA indicated three distinct sleep disturbance classes in the study patients, namely “less troubled sleepers”, “PD-related nocturnal difficulties”, and “disturbed sleepers”. Conclusions: The K-PDSS-2 showed good clinimetric attributes in accordance with prior studies that were using the original version of the PDSS-2, therefore confirming the cross-cultural usefulness of the scale. Further, this study documents the first application of an LCA approach for identifying sleep disturbance subtypes in patients with PD. Keywords: Parkinson’s disease; sleep; PDSS-2; validity; reliability; Korean version; latent class analysis.

Objective Autonomic symptoms are commonly observed in patients with Parkinson's disease (PD) and often limit the activities of daily living. The Scale for Outcomes in Parkinson's disease-Autonomic (SCOPA-AUT) was developed to evaluate and quantify autonomic symptoms in PD. The goal of this study was to translate the original SCOPA-AUT, which was written in English, into Korean and to evaluate its reliability and validity for Korean PD patients. Methodsaa For the translation, the following processes were performed: forward translation, backward translation, expert review, pretest of the pre-final version and development of the final Korean version of SCOPA-AUT (K-SCOPA-AUT). In total, 127 patients with PD from 31 movement disorder clinics of university-affiliated hospitals in Korea were enrolled in this study. All patients were assessed using the K-SCOPA-AUT and other motor, non-motor, and quality of life scores. Test-retest reliability for the K-SCOPA-AUT was assessed over a time interval of 10-14 days. Results The internal consistency and reliability of the K-SCOPA-AUT was 0.727 as measured by the mean Cronbach's a-coefficient. The test-retest correlation reliability was 0.859 by the Guttman split-half coefficient. The total K-SCOPA-AUT score showed a positive correlation with other non-motor symptoms [ the Korean version of non-motor symptom scale (KNMSS)], activities of daily living (Unified Parkinson's Disease Rating Scale part II) and quality of life [ the Korean version of Parkinson's Disease Quality of Life 39 (K-PDQ39)]. Conclusion The K-SCOPA-AUT had good reliability and validity for the assessment of autonomic dysfunction in Korean PD patients. Autonomic symptom severities were associated with many other motor and non-motor impairments and influenced quality of life.

OBJECTIVE:We aimed to investigate the effect of ropinirole on excessive daytime sleepiness (EDS) and depression in Parkinson's disease (PD) with a large population.METHODS:We conducted a cross-sectional observational study at nine hospitals in Korea between April 24, 2013, and April 22, 2015. We analyzed the demographic and clinical features, other medical history, history of antiparkinsonian medication within 6 months, Hoehn and Yahr stage (HY stage), Unified Parkinson's Disease Rating Scale (UPDRS) part II and III, Epworth Sleepiness Scale (ESS), and 30-item Geriatric Depression Scale (GDS-30).RESULTS:Four-hundred-thirteen patients with PD (mean age: 65.2 ± 9.0 years; men: 227 patients) were analyzed. Multivariate logistic regression analysis showed that age at examination, UPDRS II, and GDS-30 were independent risk factors for EDS and that sex, UPDRS II, and ESS were independent risk factors for depression.CONCLUSION:Our large group study did not find any significant associations of ropinirole with EDS and depression in Korean PD patients.

Background Sleep problems commonly occur in patients with Parkinson's disease (PD), and are associated with a lower quality of life. The aim of the current study was to translate the English version of the Scales for Outcomes in Parkinson's Disease-Sleep (SCOPA-S) into the Korean version of SCOPA-S (K-SCOPA-S), and to evaluate its reliability and validity for use by Korean-speaking patients with PD. Methods In total, 136 patients with PD from 27 movement disorder centres of university-affiliated hospitals in Korea were enrolled in this study. They were assessed using SCOPA, Hoehn and Yahr Scale (HYS), Unified Parkinson's Disease Rating Scale (UPDRS), Parkinson's Disease Sleep Scale 2nd version (PDSS-2), Non-motor Symptoms Scale (NMSS), Montgomery Asberg Depression Scale (MADS), 39-item Parkinson's Disease Questionnaire (PDQ39), Neurogenic Orthostatic Hypotension Questionnaire (NOHQ), and Rapid Eye Movement Sleep Behaviour Disorder Questionnaire (RBDQ). The test-retest reliability was assessed over a time interval of 10–14 days. Results The internal consistency (Cronbach's α-coefficients) of K-SCOPA-S was 0.88 for nighttime sleep (NS) and 0.75 for daytime sleepiness (DS). Test-retest reliability was 0.88 and 0.85 for the NS and DS, respectively. There was a moderate correlation between the NS sub-score and PDSS-2 total score. The NS and DS sub-scores of K-SCOPA-S were correlated with motor scale such as HYS, and non-motor scales such as UPDRS I, UPDRS II, MADS, NMSS, PDQ39, and NOHQ while the DS sub-score was with RBDQ. Conclusion The K-SCOPA-S exhibited good reliability and validity for the assessment of sleep problems in the Korean patients with PD.

Extranigral non-motor signs precede the first motor manifestations of Parkinson’s disease by many years in some patients. The presence of α-synuclein deposition within colon tissues in patients with Parkinson’s disease can aid in identifying early neuropathological changes prior to disease onset. In the present study, we evaluated the roles of non-motor symptoms and signs and imaging biomarkers of nigral neuronal changes and α-synuclein accumulation in the colon. Twelve subjects undergoing colectomy for primary colon cancer were recruited for this study. Immunohistochemical staining for α-synuclein in normal and phosphorylated forms was performed in normally appearing colonic tissue. We evaluated 16 candidate premotor risk factors in this study cohort. Among them, ten subjects showed positive immunostaining with normal- and phosphorylated-α-synuclein. An accumulation of premotor markers in each subject was accompanied with positive normal- and phosphorylated-α-synuclein immunostaining, ranging from 2 to 7 markers per subject, whereas the absence of Lewy bodies in the colon was associated with relative low numbers of premotor signs. A principal component analysis and a cluster analysis of these premotor markers suggest that urinary symptoms were commonly clustered with deposition of peripheral phosphorylated-α-synuclein. Among other premotor marker, color vision abnormalities were related to non-smoking. This mathematical approach confirmed the clustering of premotor markers in preclinical stage of Parkinson’s disease. This is the first report showing that α-synuclein in the colon and other premotor markers are related to each other in neurologically normal subjects.

Questionnaire-based analyses show that patients with essential tremor (ET) may have several autonomic dysfunctions, especially in the cardiovascular and genitourinary domains; yet the laboratory correlates of autonomic dysfunction in ET are unknown and have not been studied. Herein, we explored whether sympathetic and parasympathetic functions differed between control subjects and patients with ET. Seventy-five elderly patients with ET were enrolled in this study, along with 25 age-matched controls. Orthostatic vital signs, ambulatory 24-h blood pressure monitoring and 24-h Holter monitoring values were recorded and metaiodobenzylguanidine (MIBG) uptake was assessed using the heart-to-mediastinum ratio (H/M ratio). The frequencies of orthostatic hypotension, supine hypertension, nocturnal hypertension and non-dipping were not different between the ET patients and the controls, although ET patients had more episodes of orthostatic intolerance. The ET group also had similar heart rate variations as the control group for all the time-domains. The mean H/M ratios for the ET group were not statistically different from that of the control group. This result proves that the autonomic control of the cardiovascular system is normal in ET.

Background: Rapid eye movement (REM) sleep behavioral disorder (RBD), orthostatic hypotension (OH), and cardiac sympathetic denervation were commonly observed in PD and are related in both the premotor and motor periods. This study is intended to evaluate if the OH and cardiac sympathetic denervation found in PD are associated with RBD.Methods: Among 94 non-medicated and mild PD patients, 53 had RBD. Orthostatic vital signs and ambulatory 24-hour blood pressure values were recorded. I-123-metaiodobenzylguanidine (MIBG) cardiac scintigraphy as obtained in all patients. The association between orthostatic hypotension, supine hypertension, nocturnal hypertension, non-dipping, myocardial MIBG uptake, and RBD was analyzed.Results: RBD was associated with orthostatic hypotension. Patients with RBD had higher systolic blood pressure changes during orthostasis and lower myocardial MIBG uptake than patients without RBD and controls. Patients with OH also had lower mean H/M ratios those in the non-OH group.Conclusion: This study showed that RBD was closely associated with OH and cardiac sympathetic denervation in patients with early and mild PD. The result also suggests that impaired cardiac sympathetic innervation could be the mechanism behind OH in PD. This association may be closely correlated with Braak alpha-synuclein pathogenetic sequences, which would account for the clinical spectrum of PD. (C) 2016 Elsevier B.V. All rights reserved.

Background Impaired renal function and proteinuria have been associated with cognitive impairment and dementia. Chronic kidney disease is considered to be an independent risk factor for Lewy body spectrum disorders (LBD). However, few studies have mentioned an association between proteinuria and cognition in LBD. We investigated the relationship between proteinuria and cognitive dysfunction in patients with Parkinson's disease (PD) and dementia with Lewy bodies (DLB). Methods Among 186 patients with LBD, 53 had PD-normal cognition (PD-NC), 76 had PD-mild cognitive impairment (PD-MCI), 43 had PD-dementia (PDD) and 14 had DLB. The urine protein/creatinine ratio was calculated using the spot urine test and brain magnetic resonance scans was obtained in all patients. Results The urine protein/creatinine ratio was significantly higher in patients with PDD and DLB than in those with PD-MCI, PD-NC patients and healthy controls, and was correlated with white matter hyperintensities on magnetic resonance imaging. All abnormal neuropsychological test results were associated with increased urine protein/creatinine ratio. After controlling for age, education, symptom duration, diabetes mellitus, hypertension, and parkinsonian motor severity, the urine protein/creatinine ratio was significantly associated with decreased cognition. Conclusion The urine protein/creatinine ratio was associated with cognitive status in LBD. These finding suggests that increased protein excretion is associated with cognitive dysfunction in patients with LBD.

Dear Sirs, Moyamoya disease is characterized by a progressive narrowing or occlusion of the terminal portion of the internal carotid arteries and the proximal part of the anterior and middle cerebral arteries, with a concomitant development of abnormal collateral vessels [1]. Common clinical presentations in childhood are ischemic stroke or transient ischemic attack, headache and convulsion [1]. Involuntary movements in patients with moyamoya disease are uncommon, occur in only 3 to 6% of patients [2], and mostly in children. These involuntary movements include chorea, hemidystonia, hemichoreoathetosis, and paroxysmal dyskinesia [2], and are attributed to ischemic changes in the basal ganglia-thalamocortical circuits. Here, we report on a 17-year-old female patient who had an involuntary choreiform movement in her right hand that was associated with moyamoya disease. This symptom, along with hyperventilation, developed immediately after eating hot noodles. The symptom was usually aggravated under stressful conditions such as student assessments and regressed when at rest. The patient had no familial history of chorea or other movement disorders, and she denied the use of any drugs. There was no family history of neurological diseases. On examination, the patient presented with choreic movements involving the right arm. The involuntary movement was a jerky and irregular athetoid movement (Supplementary Video in the online-only Data Supplement). In addition, there was mild slowness with a decremental response observed in the both arms. Neither rigidity nor a rest tremor was observed. The choreoathetoid movement was not present during sleep. The patient’s mental status was normal, and the cranial, motor and sensory nerve examinations showed no other abnormality. The routine laboratory tests, including a complete blood count, fasting glucose and glycosylated hemoglobin A1c, liver enzymes, blood urea nitrogen, creatinine, electrolytes, the erythrocyte sedimentation rate, thyroid functions, serum ceruloplasmin, urine and serum copper, vitamin B1, vitamin B6, and niacin were within the normal limits. The antinuclear antibody and antiphospholipid antibody tests were negative. Genetic tests for Huntington’s disease and spinocerebellar ataxia type 17 were normal. Magnetic resonance imaging (MRI) of the brain showed a low signal intensity on the right parieto-occipital area and multiple flow-voids in both basal ganglia on T2-, T1-, and fluid attenuation inversion recovery-weighted images (Figure 1A, ​,B,B, and ​andC).C). Contrast-enhanced MRI showed diffuse leptomeningeal enhancement along the cortical sulci and a strong enhancement of perforating arteries in the basal ganglia and deep white matter (“ivy sign”) (Figure 1D and ​andE).E). Magnetic resonance cerebral angiography demonstrated severe stenosis of both internal carotid arteries at the supraclinoid portion with numerous collateral vessels (Figure 1F). A 99mTc-hexamethylpropylene amieoxime brain single photon emission computed tomography showed decreased perfusions in the right temporo-occipital cortex, bilateral fronto-temporal areas, and in both basal ganglia (Figure 1G). Digital subtraction cerebral angiography confirmed the moyamoya disease Suzuki grade IV (Figure 1H, ​,I,I, and ​andJJ). Figure 1. A, B, and C: Magnetic resonance imaging (MRI) of the brain showed a low signal intensity on the right parieto-occipital area and multiple flow-voids in both basal ganglia on T2-, T1-, and fluid attenuation inversion recovery-weighted images. D and E: ... The clinical presentations of pediatric moyamoya disease are associated with cerebral ischemia, which causes migraine-like headaches, epileptic seizures, and cerebral infarction [1]. The symptoms are characteristically induced by hyperventilation or breath holding, such as that during crying or playing an instrument [3]. These neurological events appear to have a vasoactive mechanism that is responsive to an acid-base imbalance, but not simply thrombogenic mechanisms [4]. In addition, some patients may experience an ischemic attack after eating hot and spicy noodles. Chorea complicated by moyamoya disease as the first manifestation is extremely rare. In addition, the occurrence of chorea during a specific daily activity such as eating hot noodles is of particular interest. This case suggests that chorea relates directly to hyperventilation and the associated hypocarbia, which could result in profound vasoconstriction and vasospasm [4-6]. In the present patient, an ischemic lesion was found only in the right parieto-occipital area, which was on the ipsilateral side of the hemichorea. The occurrence of a right hemichorea in the present patient is difficult to explain. Some studies have reported ipsilateral ischemic lesions in moyamoya disease and chorea [6]. However, these studies did not provide any association between hemichorea and an ipsilateral ischemic lesion. We also cannot suggest any association between hemichorea and an ipsilateral parenchymal lesion. The patient’s symptom has not disappeared, but has been fluctuating. The chorea is usually aggravated in stressful conditions and is regressed when at rest. We speculate that the hypoperfusion of the left basal ganglia and frontal cortex is associated with a transient aggravation of the right hemichorea. An interruption of the basal ganglia-thalamocortical circuits could have caused the involuntary movements presented in the present patient. Although hyperventilation-related hypoperfusionischemia is the main pathology for chorea in patients with moyamoya disease, to the best of our knowledge, the occurrence of chorea immediately after eating hot foods is rare. This case represents another example of chorea in moyamoya disease that is associated with vasospasm and ischemia.

Dear Editor, Many conditions have been shown to provoke migraines and most patients have one or more typical precipitating factors. Odours are one of the trigger factors known to provoke migraines with relative ease and frequency (1). Osmophobia is more common in patients with migraine than in other headache disorders, and its presence can help distinguish migraine from other primary headaches (2). Previous studies have suggested that the relationship between odour and migraine involves the peripheral trigemino-nociceptive system or neuronal hyperexcitability of central trigeminal structures (1). However, the exact mechanism through which odour precipitates migraine attacks and the importance of this mechanism are unclear. We report a 52-year-old woman suffering from migraines triggered by noxious odours, who became migraine-free after she lost her olfactory function following an episode of severe rhinitis. The patient has suffered from headaches since her twenties. Her typical headaches were a seven out of 10 in severity, pulsating in nature, involved her right temporal area and were associated with nausea. Most attacks were triggered by chemical odours including car exhaust, perfumes and tobacco smoke, among others. Her migraines typically lasted for 24– 36 hours and occurred two to three times per month. Four months before her visit to our neurology clinic, the patient had an upper respiratory infection (URI) with runny nose and coughing. After recovery from the URI, she reported that she could not smell anything. Three months later, her anosmia had not improved. She underwent rhinoscopic examination that revealed atrophic mucosae in the nasal cavity; the patient scored zero points in smell detection and identification tests. Her neurological examination and the brain magnetic resonance imaging were normal. Surprisingly, after the patient became anosmic, the migraines ceased. Initially, she was treated for anosmia only with a nasal steroid spray. After 2 weeks of nasal spray treatment, the patient reported no improvement. The patient received stellate ganglion blocks 12 times, which are known to be effective in treating anosmia. However, her sense of smell did not recover, the results of follow-up tests did not vary from baseline and she did not experience any migraines for the following 12 months. This case illustrates how odour can be an important migraine trigger factor. The injury of olfactory nerve terminals along with atrophy of the nasal mucosa can reduce or prevent migraine attacks. This case adds to clinical examples explaining the pathophysiology of olfactory-induced migraine attacks via transient receptor potential ankyrin 1 (TRPA1) pathways (1). Irritants into the nasal mucosa can produce meningeal vasodilatation by a TRPA1and Calcitonin generelated peptide (CGRP) -dependent mechanism. It is possible that the disappearance of migraine was unrelated to anosmia; thus, other factors cannot be ruled out as the cause of this condition. In particular, the possibility that anosmia-treatment regimens could influence migraine frequencies should also be considered (3). In summary, we experienced a patient with migraine apparently triggered by odours who became migrainefree after she lost her olfactory function. We hypothesize that sensory factors can be important triggers in migraines, as were proven experimentally.

Background and Aim: Both depression and cardiovascular autonomic dysfunctions, such as orthostatic hypotension, supine hypertension, and the absence of normal nocturnal blood pressure (BP) fall (“nondipping”), occur relatively commonly in Parkinson disease (PD); however, the relationship between depression and cardiovascular autonomic abnormalities has not been established. In this study, we sought to determine whether the cardiovascular autonomic abnormalities found in PD are associated with depression. Methods: Among 129 nondemented, levodopa-naive patients with mild PD, 44 had depression. Orthostatic vital signs and ambulatory 24-hour BP monitoring were recorded, and geriatric depressive scales were obtained in all patients. Associations between orthostatic hypotension, supine hypertension, nocturnal hypertension, nondipping, and depression were analyzed. The ratio of the standard deviation of 24-hour heart rate to that of systolic BP (SBP) was utilized as an index of baroreflex–cardiovagal function. Results: Depression was associated with orthostatic hypotension, and patients with depression had higher SBP change during orthostasis and attenuated cardiovagal dysfunction as observed during ambulatory BP monitoring. Across individuals, values for orthostatic changes in BP were correlated with values for geriatric depressive scale. Conclusion: Depression is associated with neurocirculatory abnormalities—especially orthostatic hypotension—in early PD. Although the association does not imply causation, this result suggests that depression in PD might be associated with functional impairment of the autonomic nervous system and its pathologic substrate.

BACKGROUND AND PURPOSE:White matter hyperintensities (WMHs) in the cholinergic pathways are associated with cognitive performance in Alzheimer's disease (AD) and Parkinson disease dementia (PDD). This study aimed to evaluate the relationship between loss of white matter cholinergic pathways and cognitive function in patients with AD, diffuse Lewy body disease (DLB), and PDD. METHODS:The subjects included 20 patients with AD, 17 with DLB, 21 with PDD, and 20 healthy controls. The extent of WMHs within cholinergic pathways was assessed using the Cholinergic Pathways Hyperintensities Scale (CHIPS) and was compared among the different diseases. RESULTS:The mean CHIPS scores were similar among the three dementia groups (AD vs. DLB vs. PDD = 34.6 ± 17.9 vs. 32.4 ± 14.1 vs. 31.8 ± 14.5, p = 0.781 by ANCOVA) and higher than those of controls (11.5 ± 7.6, p = 0.001 by ANCOVA). CONCLUSIONS:Losses of cholinergic pathways were similar among AD, DLB, and PDD groups, and more severe cognitive dysfunction was associated with elevated WMHs. These findings suggest that interruption of acetylcholine pathways may be related to cognitive dysfunction in these three diseases, even though they have different pathological mechanisms.

Task-specific dystonia and occupational cramps present as focal excessive muscle contractions that develop after long-term repetitive practice of highly skilled and overlearned tasks. It commonly affects the upper extremities and includes writer's cramp, tailor's dystonia, and shoemaker's dystonia [ [1] Torres-Russotto D. Perlmutter J.S. Task-specific dystonias: a review. Ann. N. Y. Acad. Sci. 2008; 1142: 179-199 Crossref PubMed Scopus (115) Google Scholar ]. Recently, a peculiar form of dystonia was observed in a hairdresser [ 2 Roberts K. Mahon B. O'Rourke K. Lynch T. “Club-cutting” dystonic tremor: a case report. Tremor Other Hyperkinet. Mov. 2013; 3 (http://tremorjournal.org/article/view/158) Google Scholar , 3 Giorelli M. Zimatore G.B. Hairdresser's dystonia: an unusual occupational dystonia. Tremor Other Hyperkinet. Mov. 2013; 3 (http://tremorjournal.org/article/view/204) Google Scholar ].

Background and Purpose Altered blood pressure (BP) and heart rate variations (HRVs) have been reported in Alzheimer’s disease (AD). However, it is unclear how these two manifestations are associated with AD. Therefore, the objective of this study was to investigate BP and heart rate variability in AD compared to that in normal controls, patients with subjective memory impairment (SMI), and patients with mild cognitive impairment (MCI). Methods Case-control comparisons were made among AD (n=37), MCI (n=24), SMI (n=17), and controls (n=25). All patients underwent clinical and neuropsychological assessments with 24-h ambulatory BP and Holter monitoring. Results Patients with AD had higher pulse pressures than those in other groups. In addition, AD patients experienced blunted nocturnal BP dipping associated with declining cognitive status. AD patients also had larger ranges of HRV in parasympathetic domains compared to other groups, especially at night. Conclusions Our results suggest that diurnal sympathetic and parasympathetic cardiac variability were significantly disturbed in mild cholinesterase-naive AD patients. This may be an indirect sign of disturbed integrity to the sleep-wake cycle in mild AD.