Impairment of cerebral hemodynamic response to the cold pressor test in patients with Parkinson's disease

Shih Jei Tsai, Shiuan Chih Chen, Tsong Ming Leu, Chiu Mei Chen, Hsi Hsien Chou, Hsien Yu Peng, Jiuan Miaw Liao, Tzer-Bin Lin

Research output: Contribution to journalArticlepeer-review

15 Citations (Scopus)


Background and purpose: Disturbance of the autonomic nervous system (ANS) is frequently encountered in Parkinson's disease (PD). In this study, we examined changes in systemic and cerebral hemodynamics during the cold pressor test (CPT) to determine whether cerebrovascular reactivity, controlled by the sympathetic nervous system, is intact or impaired in patients with PD. Methods: Forty-nine patients with PD and 49 sex- and age-matched non-PD subjects were evaluated. Measurements were performed in the resting state and over a period of 1 min of CPT. The cerebral blood flow velocity (CBFV) and pulsatility index (PI) of the middle cerebral artery (MCA) were recorded by transcranial color-coded Doppler ultrasonography (TCCS). Mean arterial blood pressure (MAP), heart rate (HR), and end-tidal CO2 (Et-CO2) were investigated simultaneously. The resistance of the cerebrovascular bed (CVR) was calculated as the ratio of mean arterial blood pressure to mean cerebral blood flow velocity (Vm). Changes of Vm, PI and CVR in response to the cold pressor test were evaluated. Results: Baseline values for control and PD subjects showed no statistical difference. CPT induced a significant increase in MAP, HR, and Vm in both groups. Pulsatility index (PI) and CVR were decreased in both groups during CPT. Percent increases of Vm (P <0.001) and MAP (P = 0.011) were significantly higher while the percent decreases of PI (P = 0.002) and CVR (P = 0.007) were significantly decreased more in the non-PD group. Conclusions: This study indirectly shows that ANS-mediated cerebrovascular reactivity is impaired in patients with PD. Further investigations are needed to confirm the hypothesis that using the cold pressor test to evaluate cerebrovascular reactivity might be beneficial in early diagnosis of impairment of ANS-mediated cerebrovascular autoregulation in patients with PD.

Original languageEnglish
Pages (from-to)94-100
Number of pages7
JournalParkinsonism and Related Disorders
Issue number2
Publication statusPublished - Feb 2009
Externally publishedYes


  • Cerebral blood flow velocity
  • Cerebral hemodynamics
  • Cold pressor test
  • Parkinson's disease
  • Sympathetic nervous system
  • Transcranial color-coded duplex sonography (TCCS)

ASJC Scopus subject areas

  • Geriatrics and Gerontology
  • Clinical Neurology
  • Neurology


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