Objective: To delineate the impact of non-motor markers (REM sleep behavior disorder (RBD), orthostatic hypotension (OH), cardiac sympathetic denervation, hyposmia) on neuronal injury in early-stage Parkinson disease (PD), we measured the plasma neurofilament light chain (NFL) level of PD patients and evaluated its relationship with these markers.

Background: NFL is a candidate biomarker for disease progression in Parkinson disease (PD), but the impact of OH and other non-motor markers on its level is largely unknown.

Method: The study population comprised a cross-sectional cohort of 77 patients with PD and 54 controls. OH was assessed using 5-min head-up tilt-table test. Other clinical parameters such as RBD, Unified Parkinson Disease Rating Scale (UPDRS), cognition, Cross‐Cultural Smell Identification Test (CCSIT), white matter hyperintensity (WMH), cardiac metaiodobenzylguanidine (MIBG) and striatal dopamine transporter (DAT) uptake were assessed. Plasma NFL levels were measured using Simoa platform.

Results: During the follow-up period, 70 patients remained PD, 5 patients converted to Parkinson-plus syndrome (P+ converter), and 2 were lost to follow up. The age-adjusted mean plasma NFL level tended to be higher in the PD group (10.40 pg/mL) compared with controls (9.51 pg/mL, p=0.151). In PD group, the plasma NFL level was higher in those with OH (n=13, median 15.31 pg/mL) than those without OH (n=57, 9.21 pg/mL, p<0.001). P+ converter group had the highest plasma NFL level (38.17 pg/mL, p<0.001) at baseline. In a multiple regression analysis, OH was associated with a higher plasma NFL level regardless of age, disease duration, RBD, CCSIT score, UPDRS, cardiac MIBG or DAT uptake, and WMH.

Conclusion: PD with OH was associated with a higher plasma NFL level compared to PD without OH, indicating more severe neuronal injury.

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MDS Abstracts - https://www.mdsabstracts.org/abstract/plasma-neurofilament-light-chain-level-and-orthostatic-hypotension-in-early-parkinson-disease/