Differential impact of individual autonomic domains on clinical outcomes in Parkinson’s disease

Abstract

Introduction While autonomic failure is a well-known prognostic factor for more aggressive disease progression in Parkinson’s disease (PD), with a three- to sevenfold higher risk of dementia and death within 10 years after the diagnosis, the individual impact of cardiovascular, gastrointestinal, urogenital, thermoregulatory, and pupillomotor autonomic domains on PD clinical outcomes remains unclear. Objectives We sought to determine the 5-year risk of developing dementia, falls, postural instability, dysarthria, and dysphagia in PD patients with and without autonomic impairment at baseline and to assess the joint and individual association of each autonomic domain on these key functional outcomes. In addition, we aimed to determine the impact of each autonomic domain on activities of daily living (ADLs) and health-related quality of life (HRQoL). Methods We enrolled 65 consecutive PD patients in a 5-year cohort study involving standardized evaluations of autonomic symptoms, orthostatic hypotension, and motor and non-motor features, including cognitive function. Associations were estimated as odds ratio and adjusted for PD duration, age, and baseline motor impairment. Results Cardiovascular dysautonomia was associated with a sevenfold higher risk of developing dementia (95%CI: 1.154–50.436; p = 0.035) and a fivefold higher risk of falls (95%CI: 1.099–18.949; p = 0.039), as well as significantly higher impairment in ADLs (p = 0.042) and HRQoL (p = 0.031). No relevant associations were found between the other autonomic domains and these outcomes. Conclusions Cardiovascular dysautonomia, but not other domains, showed an association with worse 5-year clinical outcomes in PD. Our data suggest a specific role for cardiovascular autonomic dysregulation in the pathogenic mechanisms of PD progression.

The correlation of orthostatic hypotension in Parkinson disease with the disease course and severity and its impact on quality of life

“…Changes in body position make the blood vessels unable to contract timely and effectively, resulting in insufficient effective blood volume and OH. [ 18 ] It was found that the blood level of norepinephrine in PD patients decreased significantly with the increase of the Hoehn&Yahr stage, suggesting severe disease conditions. [ 19 ] A retrospective study on 1318 patients with PD found that the risk of OH was higher in PD patients with longer disease course, higher Hoehn&Yahr stage, and more severe disease.…”