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© 1998 Oxford University Press

other

Autonomic dysfunction in elderly bedfast patients

MIKIHIRO KIHARA, MITSUO TAKAHASHI, KAZUHIRO NISHIMOTO, KAZUTO OKUDA, TAKA-AKI MATSUI, TOMOYUKI YAMAKAWA1 and AKIHIKO OKUMURA1

Department of Neurology, Kinki University School of Medicine 377–2 Ohno-Higashi, Osaka-Sayama, Osaka, 589, Japan
1Department of Rehabilitation, Takahashi Hospital Osaka, Japan

M. Kihara. Fax: (+81) 723 68 4846

Objective: to quantify autonomic function in bedfast elderly patients.

Patients and methods: we analysed orthostatic blood pressure, heart rate response to tilt, heart rate response to deep breathing, quantitative sudomotor axon reflex test (QSART) and beat-to-beat blood pressure during phases II and IV of the Valsalva manoeuvre (VM) in 15 patients with (OH+) and without orthostatic hypotension (OH–) and 12 age-matched controls.

Results: all bedfast patients had a poor response in the late phase II of beat-to-beat blood pressure, while OH+ patients had an additional abnormality in phase IV. QSARTs in the distal leg and foot were decreased in both OH+ and OH– groups. There was no difference between the two groups in duration of being bedfast or in activities of daily living.

Conclusions: (i) being bedfast results in postganglionic sympathetic dysfunction in the lower extremities; (ii) some patients who have ß-adrenergic dysfunction have OH and (iii) preventing patients from becoming being bedfast may be important for the maintenance of normal autonomic functions.

Keywords: autonomic dysfunctions, bedfast orthostatic hypotension, quantitative sudomotor axon reflex test Valsalva manoeuvre

Received February 19, 1997; accepted in revised form September 29, 1997.


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