The ?WR Testworks Autonomic Nervous System Integrated Evaluation Laboratory? provides a unique resource to assess autonomic and peripheral nerve function. The turn-key system is linked to a central computer and accesses a common database. The system is in use in some major clinical and research centers in the United States and has been developed, tested, validated, and upgraded. The system consists only of high quality equipment components, excellent technical support from the company, and an extensive normative database. There is currently no system to test autonomic function at the VA Maryland Health Care System (VAMHCS) in Baltimore or any surrounding VA hospital. Drs. Russell and Zilliox have many years of expertise with assessing autonomic function and are supported by two fully trained technicians. Thus, the combination of the equipment and the expertise will ensure that high quality, reproducible research recordings are obtained. The WR Testworks Full Autonomic Lab will be mainly utilized by six Major Users funded by VA awards; and one minor user who works closely with several VA investigators. All these projects are linked by a common theme in that they assess macro and micro vascular disease and neuropathy. As many of the funded VA clinical or translational projects at the VAMHCS in Baltimore are linked to autonomic nervous system dysfunction, the system will potentially offer other VA investigators a new powerful tool for their research projects, and provide a platform to develop new research strategies. The autonomic laboratory will be primarily utilized in these VA funded projects: Project I (James Russell, MD): Autonomic testing will be performed in Veterans with impaired glucose regulation as part of a lifestyle intervention study. A measure of autonomic function, the cardiovagal function will be the primary outcome measure. Subjects will be randomized to either an intense intervention group or standard care group. The laboratory will be Important in measuring cardiovagal autonomic function in this study. Project II (Dr. Lindsay Zilliox, MD): In this project the association between falls and orthostatic hypotension in metabolic syndrome will be determined. Subjects will undergo an intervention program to determine if the balance and lifestyle change will improve autonomic function, as measured by the autonomic laboratory, and reduce risk of falls. Project III (Brajesh Lal, MD): The project will determine the association between symptomatic carotid stenosis, cerebral hypoperfusion, and cognitive impairment. As impaired autonomic function and autonomic neuropathy impacts cerebral blood flow; testing research subjects for impaired autonomic function would help to identify factors that might impair cerebral blood flow and thereby affect cognitive performance. Project IV (Odessa Addison, PhD): Autonomic dysfunction increases the development of peripheral arterial disease and this in turn is associated with both autonomic and neuropathic changes. The autonomic laboratory would allow examination of the autonomic nervous system?s role in altered muscle perfusion in peripheral arterial disease and the effect of weight loss and exercise interventions. Project V (Steven Prior, PhD): This study will determine (1) the association between circulating angiogenic cell mobilization; and improved autonomic function and reduced small fiber neuropathy and (2) the effect of exercise training and neuromuscular electrical stimulation on autonomic neuropathy, and in turn the effect on peripheral arterial disease. Project VI (Alice Ryan, PhD): This study will examine the effect of a resistive training intervention on autonomic function with an intention to improve stroke outcomes and falls risk.
The WR Testworks Full Autonomic Lab allows clinician scientists to perform a broad range of tests in the search for autonomic neuropathies and dysfunction. The Integrated Autonomic Laboratory will be used to determine the impact of autonomic dysfunction in Veterans with: Type 2 diabetes mellitus, metabolic syndrome, diabetic neuropathy, peripheral arterial disease, stroke and other vascular disorders. All tests are non-invasive, standardized, quantitative, and easy to perform. The disorders mentioned are an increasing problem among older adults, particularly Veterans and disproportionately affect several minority Veteran populations. Autonomic dysfunction significantly increases the risk of stroke, large vessel vascular disease, and falls. Consequently, recognizing the presence of abnormal autonomic function or autonomic neuropathy and intervening to improve function will have a significant impact on clinical outcomes in Veterans.
