Objective: To define prevalence, severity, and predictors of dysautonomia symptoms in patients with Parkinson’s disease (PD) recruited at the Hoehn and Yahr stage 1 prospectively followed for three years.

Background: Clinical correlates of autonomic nervous system (ANS) dysfunction in early PD have been addressed mainly cross-sectionally and few data are available regarding its longitudinal changes.

Method: This is a combined cross-sectional and longitudinal prospective study of ANS dysfunction using the SCOPA-AUT in PD patients at the Hoehn and Yahr stage 1 with disease duration <2 years. PD patients (n=107) were compared to healthy controls (HC, n=79), and then followed-up for over 3 years. The severity of PD, depression, anxiety, apathy and cognitive impairment were evaluated using rating scales.

Results: At least one symptom of ANS dysfunction was present in 71% of PD patients in comparison to 30.4% of HC, and in all PD patients after three years. The overall severity of autonomic dysfunction was mild (SCOPA-AUT mean ±SD; 4.16 ± 5.0), but worsened by 23%, 86% and 0.3% during the 1st, 2nd and 3rd year respectively. Nighttime voiding (38.3%), constipation (30.8%) and straining for defecation (29%) were the most common symptoms. Prevalence and severity of urinary, gastrointestinal, and cardiovascular dysfunction increased, in contrast to thermoregulatory and pupillomotor symptoms. Frequency of multi-domain dysfunction rose from 49% to 79%. Psychiatric symptoms and age, but not motor impairment, were associated with dysautonomia symptoms.

Conclusion: ANS dysfunctionwas frequent in the initial motor stage of PD and progressed, yet remaining mild, within 3 years. An independent progression of dysautonomia from motor disability and its associations with non-motor, mainly psychiatric symptoms and age support the non-motor clustering in PD.

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MDS Abstracts - https://www.mdsabstracts.org/abstract/autonomic-dysfunction-in-early-parkinsons-disease-a-prospective-study/