{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,22]],"date-time":"2026-10-22T22:36:05Z","timestamp":1792708565545,"version":"4.5.0"},"reference-count":30,"publisher":"Wiley","issue":"11","license":[{"start":{"date-parts":[[2025,10,30]],"date-time":"2025-10-30T00:00:00Z","timestamp":1761782400000},"content-version":"vor","delay-in-days":0,"URL":"http:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":["onlinelibrary.wiley.com"],"crossmark-restriction":true},"short-container-title":["Euro J of Neurology"],"published-print":{"date-parts":[[2025,11]]},"abstract":"ABSTRACT<\/jats:title>\n \n Background<\/jats:title>\n \n Degenerative parkinsonian syndromes, including the alpha\u2010synucleinopathies (\n aSYN<\/jats:styled-content>\n ) Parkinson's disease (\n PD<\/jats:styled-content>\n ), and multiple system atrophy (\n MSA<\/jats:styled-content>\n ), and the tauopathy progressive supranuclear palsy (\n PSP<\/jats:styled-content>\n ), are characterized by motor and non\u2010motor symptoms. The later subsume autonomic dysfunction, which may appear early or progress with the disease. Cardiac dysfunction varies by syndrome and can also occur in isolated\n REM<\/jats:styled-content>\n sleep behavior disorder (\n iRBD<\/jats:styled-content>\n ), a prodromal stage of\n aSYN<\/jats:styled-content>\n . Overlapping motor features make early differentiation challenging. Heart rate variability (\n HRV<\/jats:styled-content>\n ) analysis is a noninvasive tool for evaluating cardiac autonomic function, with deceleration capacity (\n DC<\/jats:styled-content>\n ) as a sensitive parasympathetic marker. This study compares\n HRV<\/jats:styled-content>\n and\n DC<\/jats:styled-content>\n across parkinsonian syndromes to assess their potential in early diagnosis and differentiation.\n <\/jats:p>\n <\/jats:sec>\n \n Methods<\/jats:title>\n \n Using standardized 30\u2010min resting ECG recordings in the early morning, we analyzed\n HRV<\/jats:styled-content>\n parameters in five groups:\n iRBD<\/jats:styled-content>\n (\n n<\/jats:italic>\n \u2009=\u200910),\n PD<\/jats:styled-content>\n (\n n<\/jats:italic>\n \u2009=\u200910),\n MSA<\/jats:styled-content>\n (\n n<\/jats:italic>\n \u2009=\u200910),\n PSP<\/jats:styled-content>\n (\n n<\/jats:italic>\n \u2009=\u20099), and healthy controls (\n HC<\/jats:styled-content>\n ,\n n<\/jats:italic>\n \u2009=\u200910). Evaluated\n HRV<\/jats:styled-content>\n parameters included\n HRV<\/jats:styled-content>\n index (\n HRVI<\/jats:styled-content>\n ), reflecting overall variability, and\n DC.<\/jats:styled-content>\n <\/jats:p>\n <\/jats:sec>\n \n Results<\/jats:title>\n \n As expected,\n DC<\/jats:styled-content>\n was significantly lower in\n MSA<\/jats:styled-content>\n (3.82\u2009\u00b1\u20091.38) and unexpectedly even lower in\n PSP<\/jats:styled-content>\n (3.19\u2009\u00b1\u20092.77), compared to\n HC<\/jats:styled-content>\n (9.66\u2009\u00b1\u20094.67) and\n PD<\/jats:styled-content>\n (7.55\u2009\u00b1\u20092.48). These findings are novel for\n PSP<\/jats:styled-content>\n .\n HRVI<\/jats:styled-content>\n was significantly reduced in\n PSP<\/jats:styled-content>\n , while other\n HRV<\/jats:styled-content>\n parameters showed no significant differences.\n <\/jats:p>\n <\/jats:sec>\n \n Conclusions<\/jats:title>\n \n Deceleration\n capacity (DC)<\/jats:styled-content>\n reduction in\n MSA<\/jats:styled-content>\n and\n PSP<\/jats:styled-content>\n suggests pronounced cardiac parasympathetic dysfunction.\n DC<\/jats:styled-content>\n may support differentiation between\n PD<\/jats:styled-content>\n and atypical syndromes, but larger studies are needed for validation. Given the impact of autonomic dysfunction on quality of life and mortality, comprehensive autonomic testing should be included in the diagnostic workup.\n <\/jats:p>\n <\/jats:sec>","DOI":"10.1111\/ene.70395","type":"journal-article","created":{"date-parts":[[2025,10,30]],"date-time":"2025-10-30T10:32:08Z","timestamp":1761820328000},"update-policy":"https:\/\/doi.org\/10.1002\/crossmark_policy","source":"Crossref","is-referenced-by-count":3,"title":["Deceleration Capacity as a Marker of Autonomic Cardiac Modulation in Prodromal and Manifest Parkinson's Disease, Multiple System Atrophy, and Progressive Supranuclear Palsy"],"prefix":"10.1111","volume":"32","author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-0361-0985","authenticated-orcid":false,"given":"Elisabeth","family":"Ruppert","sequence":"first","affiliation":[{"name":"Department of Neurology Philipps University of Marburg Marburg Germany"},{"name":"Department of Neurology, CIRCSom (International Research Center for ChronoSomnology) & Sleep Disorders Center University Hospital of Strasbourg, University of Strasbourg Paris France"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Nuria","family":"Mix","sequence":"additional","affiliation":[{"name":"Department of Neurology Philipps University of Marburg Marburg Germany"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Karl","family":"Kesper","sequence":"additional","affiliation":[{"name":"Department of Pulmonology University of Marburg Marburg Germany"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Axel","family":"Bauer","sequence":"additional","affiliation":[{"name":"Department of Cardiology and Angiology, Clinic of Internal Medicine University Hospital Innsbruck Innsbruck Austria"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"David","family":"Vadasz","sequence":"additional","affiliation":[{"name":"Department of Neurology Philipps University of Marburg Marburg Germany"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Vincent","family":"Ries","sequence":"additional","affiliation":[{"name":"Department of Neurology Philipps University of Marburg Marburg Germany"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Elisabeth","family":"Sittig","sequence":"additional","affiliation":[{"name":"Department of Neurology Philipps University of Marburg Marburg Germany"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Ulrich","family":"Koehler","sequence":"additional","affiliation":[{"name":"Department of Pulmonology University of Marburg Marburg Germany"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Annette","family":"Janzen","sequence":"additional","affiliation":[{"name":"Department of Neurology Philipps University of Marburg Marburg Germany"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Wolfgang H.","family":"Oertel","sequence":"additional","affiliation":[{"name":"Department of Neurology Philipps University of Marburg Marburg Germany"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"311","published-online":{"date-parts":[[2025,10,30]]},"reference":[{"key":"e_1_2_10_2_1","doi-asserted-by":"publisher","DOI":"10.1016\/S0140\u20106736(21)00218\u2010X"},{"key":"e_1_2_10_3_1","doi-asserted-by":"publisher","DOI":"10.1002\/mds.26987"},{"key":"e_1_2_10_4_1","doi-asserted-by":"publisher","DOI":"10.1212\/01.wnl.0000324625.00404.15"},{"key":"e_1_2_10_5_1","doi-asserted-by":"publisher","DOI":"10.14802\/jmd.09019"},{"key":"e_1_2_10_6_1","doi-asserted-by":"publisher","DOI":"10.3233\/JPD\u2010223201"},{"key":"e_1_2_10_7_1","volume-title":"The International Classification of Sleep Disorders, Diagnostic and Coding Manual","author":"American Academy of Sleep Medicine (AASM)","year":"2014"},{"key":"e_1_2_10_8_1","doi-asserted-by":"publisher","DOI":"10.1007\/s00441\u2010018\u20102851\u20109"},{"key":"e_1_2_10_9_1","doi-asserted-by":"publisher","DOI":"10.1136\/jnnp.2004.037028"},{"key":"e_1_2_10_10_1","doi-asserted-by":"publisher","DOI":"10.1002\/mds.23347"},{"key":"e_1_2_10_11_1","doi-asserted-by":"publisher","DOI":"10.3389\/fneur.2019.00363"},{"key":"e_1_2_10_12_1","doi-asserted-by":"publisher","DOI":"10.1007\/s00415\u2010022\u201011347\u2010w"},{"key":"e_1_2_10_13_1","doi-asserted-by":"publisher","DOI":"10.1093\/oxfordjournals.eurheartj.a014868"},{"key":"e_1_2_10_14_1","doi-asserted-by":"publisher","DOI":"10.1016\/S0140\u20106736(06)68735\u20107"},{"key":"e_1_2_10_15_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.physa.2005.08.080"},{"key":"e_1_2_10_16_1","doi-asserted-by":"publisher","DOI":"10.1161\/JAHA.120.016075"},{"key":"e_1_2_10_17_1","doi-asserted-by":"publisher","DOI":"10.1007\/s00392\u2010023\u201002248\u20107"},{"key":"e_1_2_10_18_1","doi-asserted-by":"publisher","DOI":"10.3389\/fneur.2023.1323454"},{"key":"e_1_2_10_19_1","doi-asserted-by":"publisher","DOI":"10.3390\/brainsci11080959"},{"key":"e_1_2_10_20_1","doi-asserted-by":"publisher","DOI":"10.1007\/s10286\u2010024\u201001104\u20106"},{"key":"e_1_2_10_21_1","doi-asserted-by":"publisher","DOI":"10.1007\/s10286\u2010021\u201000815\u20104"},{"key":"e_1_2_10_22_1","doi-asserted-by":"publisher","DOI":"10.3389\/fphys.2012.00034"},{"key":"e_1_2_10_23_1","doi-asserted-by":"publisher","DOI":"10.1001\/archneur.56.1.33"},{"key":"e_1_2_10_24_1","doi-asserted-by":"publisher","DOI":"10.1212\/wnl.47.1.1"},{"key":"e_1_2_10_25_1","volume-title":"R Foundation for Statistical Computing"},{"key":"e_1_2_10_26_1","doi-asserted-by":"publisher","DOI":"10.1016\/S0735\u20101097(97)00554\u20108"},{"key":"e_1_2_10_27_1","doi-asserted-by":"publisher","DOI":"10.1042\/CS20070137"},{"key":"e_1_2_10_28_1","doi-asserted-by":"publisher","DOI":"10.5603\/PJNNS.a2019.0005"},{"key":"e_1_2_10_29_1","doi-asserted-by":"publisher","DOI":"10.1136\/jnnp.70.3.305"},{"key":"e_1_2_10_30_1","doi-asserted-by":"publisher","DOI":"10.1002\/mds.23677"},{"key":"e_1_2_10_31_1","doi-asserted-by":"publisher","DOI":"10.1007\/s10286\u2010018\u20100557\u20104"}],"container-title":["European Journal of Neurology"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/onlinelibrary.wiley.com\/doi\/pdf\/10.1111\/ene.70395","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2025,11,28]],"date-time":"2025-11-28T07:01:44Z","timestamp":1764313304000},"score":1,"resource":{"primary":{"URL":"https:\/\/onlinelibrary.wiley.com\/doi\/10.1111\/ene.70395"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2025,10,30]]},"references-count":30,"journal-issue":{"issue":"11","published-print":{"date-parts":[[2025,11]]}},"alternative-id":["10.1111\/ene.70395"],"URL":"https:\/\/doi.org\/10.1111\/ene.70395","archive":["Portico"],"relation":{},"ISSN":["1351-5101","1468-1331"],"issn-type":[{"value":"1351-5101","type":"print"},{"value":"1468-1331","type":"electronic"}],"subject":[],"published":{"date-parts":[[2025,10,30]]},"assertion":[{"value":"2025-06-18","order":0,"name":"received","label":"Received","group":{"name":"publication_history","label":"Publication History"}},{"value":"2025-09-29","order":2,"name":"accepted","label":"Accepted","group":{"name":"publication_history","label":"Publication History"}},{"value":"2025-10-30","order":3,"name":"published","label":"Published","group":{"name":"publication_history","label":"Publication History"}}],"article-number":"e70395"}}