Patient-reported autonomic symptoms in Parkinson disease

TLDR

Parkinson disease involves a wide range of autonomic symptoms, yet their full spectrum has not been evaluated with a validated instrument against controls. The study aimed to use the SCOPA‑AUT instrument to assess autonomic symptoms in a large Parkinson disease cohort and controls, and to examine their relationships with demographic, disease, and clinical factors. Researchers evaluated 420 Parkinson disease patients and 150 controls for autonomic, motor, and nonmotor symptoms, demographics, and disease characteristics, and examined associations between autonomic symptoms and these variables. Parkinson disease patients exhibited significantly more autonomic symptoms than controls, especially in gastrointestinal and urinary domains, and higher age, disease severity, and dopaminergic dose were linked to greater autonomic burden, which in turn correlated with motor, cognitive, psychiatric, and sleep disturbances.

Abstract

<b>Objective: </b> There is a wide range of autonomic symptoms (AS) in Parkinson disease (PD), but the full spectrum has never been evaluated with a validated instrument and in comparison with control subjects. In this study a reliable and valid instrument, the SCOPA–AUT, was used to evaluate the occurrence of AS in a large cohort of patients with PD and control subjects and to assess the relations with demographic, disease-related, and clinical variables. <b>Methods: </b> A cohort of 420 patients with PD was evaluated for the occurrence of AS, motor and nonmotor symptoms, as well as for demographic and disease-related characteristics. Results were compared with those of 150 control subjects. Associations between AS and demographic and clinical characteristics were also studied. <b>Results: </b> For all autonomic domains, patients with PD reported more symptoms compared to control subjects, with the greatest differences in the gastrointestinal and urinary domain. Higher age, greater disease severity, and higher doses of dopaminergic medication were related to more autonomic problems. Autonomic symptom severity was associated with more motor dysfunction, depressive symptoms, cognitive dysfunction, psychiatric complications, nighttime sleep disturbances, and excessive daytime sleepiness (all <i>p</i> values &lt; 0.01). <b>Conclusions: </b> Autonomic symptoms (AS) are an important feature of Parkinson disease (PD) and increase with age, disease severity, and medication use. The prominent presence of AS warrants increased clinical awareness and highlights the need for efficacious therapies for the wide spectrum of problems related to this domain of PD.