Conclusion

Neurodegeneration does not occur in isolation but is believed to result from various chronic insults such as neurotoxic material, mitochondrial dysfunction, and accumulation of abnormal proteins that interact over time leading to selective neuronal loss.

Cardiac autonomic dysfunction occurs early in Lewy body disorders, including PD, DLB, and RBD, reflecting the early accumulation of Lewy bodies in cardiac sympathetic postganglionic nerves. HRV was significantly lower in early PD and DLB, and higher HRV was associated with better cognitive function. In addition, a reduction in cardiac MIBG uptake was associated with subsequent risk of dementia, suggesting reduced uptake may reflect wider extension of alpha-synuclein pathology in PD Traditional vascular risk factors and brain white matter changes contribute to the neurodegenerative process in PD. Vascular endothelial dysfunction occurs during early stages of atherosclerosis, and plays an important role in selective permeability of molecules entering the brain from the bloodstream.

FMD was significantly lower in PD patients, which was associated with levodopa treatment. STN-DBS could reduce levodopa dosage and improve FMD with significant motor improvement. The

４０

modification of these parameters represents a promising therapeutic approach to treat PD.

Figure 8. Proposed mechanism of the relationship between cardiac autonomic and vascular endothelial dysfunction in PD.

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-국문요약-파킨슨병의 심장자율신경계와 혈관 내피기능의 역할

(지도교수: 홍지만)

파킨슨병 환자에서는 심장 자율신경계의 이상 (심박 변이도, 심장 신티그래피)이 흔히 관찰된다. 또한 신경퇴행성 질환에서 혈관 내피 기능이 병의 발병 기전이나 진행에 영향을 준다는 보고가 되고 있다. 하지만 초기 파킨슨병에서 심장자율신경계나 혈관 내피기능의 이상이 얼마나 감소되어 있는지, 또한 병의 진행에 어떠한 영향을 끼치는 지는 잘 알려져 있지 않다. 따라서 본 연구에서는 심장 자율 신경계나 혈관 내피기능애 대한 임상적 의의 (진단 및 예후) 와 가능한 기전을 조사하였다. 그 결과, 심박 변이도가 초기 파킨슨병에서 현저히 감소되어 있어 조기 감별 진단에 유용하며, 파킨슨병의 렘 수면 장애와 인지기능 저하와 연관성이 있었다. 또한 심장 신티그라피는 파킨슨 환자가 치매로의 전환 위험도를 예측할 수 있었다. 초기 파킨슨병에서 혈관 내피기능은 떨어져 있었으며, 이것은 파킨슨병의 대표적인 약물 치료제인 레보도파와 관련이 있었다. 또한 파킨슨병의 뇌 심부 자극술 수술적 치료 후 레보도파를 현저히 줄인 후 운동기능의 개선과 함께 혈관 내피기능의 상승이 있었다.

결론적으로, 파킨슨 환자에서 심장 자율 신경계의 이상은 초기부터 관찰되고 있으며, 이는 병의 조기진단 뿐 아니라 인지기능과 추후 치매로의 위험도와 연관 있음을 보여주었다. 혈관 내피기능 또한 파킨슨병 초기에서부터 보이고 있으며, 레보도파 약물 치료와 관련이 있고 수술적 치료로 약물을 줄인다면 호전될 수 있음을 보여주었다.

Keywords: 파킨슨병, 심박변이도, 심장 신티그래피, 혈관내피기능, 심장자율신경계