Are dysautonomic and sensory symptoms present in early Parkinson’s disease?

Abstract

Parkinson's disease (PD) occurs with an annual incidence of 13/100.000, is slightly more frequent in men and is characterized by the motor symptoms tremor, rigidity, bradykinesia and postural instability. In addition, non-motor symptoms have been increasingly connected to the disease although already described in James Parkinson's 'Essay on the shaking palsy' from 1817. The motor symptoms in PD are related to the degeneration of dopaminergic cells in the substantia nigra (SN). These symptoms respond well to dopaminergic substitution. It is much more unclear whether non-motor symptoms like dysautonomia, insomnia, day-time sleepiness, fatigue, pain and neuropsychiatric symptoms respond to levodopa. Autonomic symptoms include dizziness because of orthostatic hypotension, constipation, nausea, voiding symptoms and increased sweating. Such symptoms as well as sensory symptoms like hyposmia and pain are very frequently reported in PD and seem to occur early in the disease process. Braak proposed a sequential model of neuropathology in PD starting with affection of the olfactory bulb and the autonomic innervation of the heart and gut. Affection of SN is seen from Braak stage 3, and limbic and cortical structures are affected in the later stages of the disease. Currently, the evidence for sensory and autonomic involvement in PD is reviewed with special focus on the early phase of the disease.

Neurite Aggregation and Calcium Dysfunction in iPSC-Derived Sensory Neurons with Parkinson’s Disease-Related LRRK2 G2019S Mutation

“…Evidence of pathological changes in the dorsal root ganglia and the vagus, glossopharyngeal, and internal superior laryngeal peripheral nerves is rapidly accumulating ( Mu et al., 2013a , Mu et al., 2013b ). Lewy body pathology has also been observed in the dorsal vagus ganglion and parasympathetic nuclei, enteric nervous system, and cardiac and pelvic plexus ( Wakabayashi and Takahashi, 1997 , Orimo et al., 2008 , Beach et al., 2010 , Tysnes et al., 2010 , Cersosimo and Benarroch, 2012 ). It remains to be determined whether peripheral neuron damage precipitates the development of non-motor symptoms in PD, but focused analysis on the peripheral nervous system may ultimately provide information leading to broad therapeutic intervention.…”

Dizziness in patients with early stages of Parkinson's disease: Prevalence, clinical characteristics and implications

“…The most common type was presyncope (40.5%), followed by non‐specific or vague pattern (29.7%), disequilibrium (24.3%) and vertigo (5.4%). Recent studies showed that patients in even early stages of PD have dysautonomia, including orthostatic hypotension . Accordingly, it is possible that a considerable number of the present patients might have dysautonomia, including orthostatic hypotension.…”

Sudomotor and Cardiovascular Dysfunction in Patients with Early Untreated Parkinson's Disease

“…They are known to be more prevalent in advanced PD, but also may occur in early stages of the disease [1,2]. Certain autonomic features, such as constipation, can precede the onset of motor symptoms [3]. A proposed six-stage pathological staging of PD suggests a predictable sequence of lesions with ascending progression from medullary or olfactory nuclei to the cortex.…”