Objective: The aim of this study was to determine the relationship between 24 h ambulatory blood pressure measurements (ABPM), i.e., absence or presence of nocturnal dipping, and psychosis scores and non-motor symptoms on quality of life in early stages of HD patients.

Background: Huntington disease (HD) is characterized by the triad of motor abnormalities, cognitive dysfunction, and behavioral changes. A psychological condition that has been well studied in HD is psychosis. Cardiovascular autonomic dysfunction in HD can include a reversed or loss of blood pressure (BP) circadian rhythm, referred to as nocturnal non-dipping.

Method: Sixty patients with HD (30male, 30 female) underwent 24 h ABPM using an autonomic protocol and self report diary. A decrease in nocturnal  mean arterial blood pressure (MAP) of less than 10% was defined as non-dipping. Patients were interviewed (including the Brief Psychiatric Rating Scale; BPRS) for the assessment of psychosis. We used Hoehn and Yahr scale modified by Lindvall to assess HD severity and non-motor symptoms.

Results: 34 patients were dippers and 26 were non-dippers. BPRS scores were higher in non-dippers vs dippers and non-dippers on average met the criteria for psychosis. There was a correlation between BPRS scores and non-dipping (percentage of day/awake and at night/asleep MAP difference) indicating that those patients who had a blunted nocturnal fall in BP were more prone to psychotic symptoms. Non-motor disturbances were observed in 82%. Hyposmia was observed in 26%; constipation in 61.6% of patients; violation of urination in 71% of patients; 28% of patients reported increased sweating. Sleep disorders were observed in 78% of patients: insomnia disorders in 47% of patients, excessive daytime sleepiness 32%. . There was a positive correlation of the quality of life with non-motor symptoms, affective and sleep disorders.

Conclusion: These results suggest that HD patients who show a blunted circadian BP rhythm are more likely to develop psychosis than those whose BP decreases normally at night. Non-motor symptoms in the early stages of the disease significantly deteriorate the quality of life and daily activities of patients with PD.

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MDS Abstracts - https://www.mdsabstracts.org/abstract/nocturnal-blood-pressure-non-dipping-psychosis-and-non-motor-symptoms-in-early-stages-of-huntingtons-disease-patients/