Dynamic cerebral autoregulation impairment in patients with Parkinson’s disease correlates with autonomic disfunction

The aim of this study was to investigate dynamic cerebral autoregulation (dCA) function in patients with Parkinson’s disease (PD) and explore the relevant influencing factors by improved detection and evaluation methods. This study included 100 idiopathic patients with PD and 100 age- and sex-matched healthy controls. All participants provided informed consent. Patients with PD were comprehensively assessed using the following standardized scales: The Movement Disorder Society-Sponsored Revision of the Unified Parkinson’s Disease Rating Scale (MDS-UPDRS) and the Modified Hoehn and Yahr (mHY) Scale for motor symptom severity; the Non-Motor Symptoms Scale for nonmotor symptoms; and the Scales for Outcomes in Parkinson’s Disease-Autonomic (SCOPA-AUT) for autonomic disfunction. dCA was evaluated by simultaneously monitoring bilateral middle cerebral artery systolic blood flow velocities and finger arterial blood pressure. Transfer function analysis (TFA) was then applied to these continuous recordings to derive key parameters, including the phase, gain, and coherence functions. Group differences in these parameters between patients with PD and healthy controls were analyzed. Furthermore, we examined the correlations between the autoregulation parameters and clinical scores using Spearman’s rank correlation and partial correlation analyses, with age and sex as covariates. Compared with the control group, the PD group exhibited significantly slower bilateral middle cerebral artery peak flow velocities (t =-14.768, p < 0.01, Cohen’s d = -2.08, 95% CI (-2.43, -1.74); t =-11.554, p < 0.001, Cohen’s d = -1.63, 95% CI (-1.95, -1.31); importantly, the dCA was impaired in patients with PD, as evidenced by a bilaterally reduced phase difference (t =-2.517, p = 0.013, Cohen’s d = -0.35, 95% CI (-0.63, -0.07); t =-2.395, p = 0.018, Cohen’s d = -0.33, 95% CI (-0.62, -0.05) and increased gain (t = 2.751, p = 0.006, Cohen’s d = 0.38, 95% CI (0.11, 0.67); t = 3.433, p = 0.001, Cohen’s d = 0.48, 95% CI (0.20, 0.76). The severity of this dCA impairment demonstrated significant, albeit varying, correlations with clinical subtypes defined by the MDS-UPDRS Part III. The impairment of dynamic cerebral blood flow autoregulation was correlated to different degrees with different subtypes of patients with PD, classified by the MDS-UPDRSIII score (r = 0.198, p = 0.049), PD-NMSS score(r = 0.276, p = 0.0.05), and SCOPA-AUT score(r = 0.207, p = 0.039). After adjusting for the SCOPA-AUT score, there was no correlation between abnormal dCA parameters or subtypes and the MDS-UPDRSIII score or PD-NMSS score. dCA function is impaired in patients with PD, and there is a weak correlation between impaired dCA function and higher motor symptom scores and nonmotor symptom scores. After the evaluation score is adjusted, impaired dCA function is related mainly to autonomic disfunction.