Autonomic Symptoms Correlate with Non-Autonomic Non-Motor Symptoms and Sleep Problems in Patients with Parkinson’s Disease

Abstract

Objective: The objective of this study was to clarify the relationship between autonomic and non-autonomic non-motor symptoms in patients with Parkinson’s disease (PD). Methods: Sixty-five PD patients were included in this study (27 men and 38 women; aged 68.5 ± 10.0; Hoehn and Yahr (HY) stage 2.6 ± 1.1). The autonomic symptoms were evaluated by the Japanese version of the Scales for outcomes in PD autonomic (SCOPA-AUT) questionnaire. The patients were assessed with the mini-mental state examination (MMSE), PD sleep evaluation scale-2 (PDSS-2), Epworth sleepiness scale (ESS) and Beck’s depression inventory II (BDI-II). The Non-Motor Symptom Scale (NMSS) total scores and subscores of non-autonomic non-motor symptom domains (sleep/fatigue, mood/cognition, perceptual problems/hallucination, and attention/memory) were evaluated. A dopamine transporter (DAT) scan, metaiodobenzylguanidine (MIBG) myocardial scintigraphy, and card type olfactory identification test (open essence [OE, Wako]) were performed. Results: The SCOPA-AUT total score was positively correlated with the disease duration, HY stage, levodopa equivalent dose, PDSS-2, ESS, BDI-II and non-autonomic NMSS and inversely correlated with the MMSE. The high-SCOPA-AUT group (≥9) had lower MMSE scores and higher PDSS-2, ESS, BDI-II and non-motor NMSS scores than the low-SCOPA-AUT group (< 9). The DAT scan, MIBG uptake and OE score did not differ between the groups. In a stepwise linear regression analysis, which excluded possibly overlapping items among the scales, the subtotals of PDSS-2 items, except for item 8 (nocturia), (p < 0.0001) and non-autonomic NMSS domains (p = 0.00040) were significant predictors of the total SCOPA-AUT score. Conclusion: Our study shows significant correlations among autonomic symptoms, PD-related sleep problems and non-autonomic non-motor symptoms in PD patients.

Lower Urinary Tract and Gastrointestinal Dysfunction Are Common in Early Parkinson’s Disease

“…The factors associated with autonomic dysfunction in our cohort of patients with early PD are in line with those of previous studies, suggesting age, disease severity, and other nonmotor symptoms may affect autonomic dysfunction [ 12 , 20 – 26 ] [ 13 , 23 , 27 ]. Our study is the first to report an association between impulsivity and compulsivity and apathy with autonomic dysfunction in patients with early PD.…”

“…To assure that dysautonomic symptoms were most likely related to PD and not to aging, the SCOPA-AUT scores were divided into two categories. Previous studies have utilized cutoff scores between 9 and 13.1 based on their own criteria [ 12 , 13 ]. We arbitrarily selected a cutoff of 10 based on the mean (SD) of the total SCOPA-AUT score of the control patients, who reported a score of 5.8 (3.7).…”

Parkinson’s Disease Motor and Non-Motor Features Accompanying Insomnia and Excessive Daytime Sleepiness Symptoms, a Large Population-Based Study

“…As shown here and previously reported [15,19,20,46], non-motor and autonomic symptoms affect sleep quality and are related to EDS. Some of these manifestations can directly induce sleep fragmentation, such as nocturia.…”

Sleep Issues in Parkinson's Disease and Their Management

“…An aforementioned study which demonstrated 209 of 412 patients with PD suffered from insomnia found that urinary symptoms significantly contributed to difficulty falling asleep and multiple awakenings [11]. One recent study administered the SCOPA-AUT, a measure of dysautonomia in PD, and found that a higher score in patients with PD was positively correlated with questions evaluating poor sleep on both the PDSS-2 and NMS questionnaire [34]. Treatment of nocturia may focus initially on behavioral interventions, such as reduction of fluid intake in the evening and adjustment of diuretic agents to the morning.…”