Objective: Identify autonomic digestive symptoms of Parkinson disease (PD)
Identify correlations between autonomic dysfunction and alpha-synuclein immunochemical staining in the upper digestive tract.

Background: Pathological processes of neurodegenerative diseases depend on the topographical distribution of protein aggregates. The autonomic nervous system and gastro-intestinal tract dysfunction in PD are due to alpha synuclein aggregation and often precede motor symptoms. Identifying the pathological landscape autonomic dysfunction within the gastrointestinal system is of a clinical and prognostic value in PD.

Method: We recruited patients within the neurology department of Charles Nicolle Hospital in Tunisia from 2013 to 2022. We identified in our patient, demographics, clinical and paraclinical characteristics of our patients. Autonomic and digestive tract dysfunction were evaluated using GID and Scopa- Aut scores.

Results: 30 patients were included in the study (16♂ / 14♀). Mean of age was 65 years. 8 patients had inaugural motor symptoms, while 20 had non-motor symptoms in the first place and 2 had both at the same time. Non-motor symptoms were gastrointestinal and psychiatric. Autonomic complaints were constipation (56%), hypersalivation (20%), and orthostatic hypotension (13%). Autonomic dysfunction severity (evaluated with Scopa score) was correlated with motor disability (evaluated with UPDRS-MD score(P<0,05) and to Hoehn and Yahr scale). A positive correlation was observed between enteric synucleinopathy and digestive tract, motor, urinary, cardio-vascular, thermic, and pupillary dysfunctions.

Conclusion: Alpha synuclein aggregates precede the neurodegenerative phase and motor symptoms of PD by many years. Alterations are not restricted to the central nervous system and basal ganglia, but extend to the peripheral and autonomic nervous system. This highlights the importance that should be given to non-motor symptoms for clinical observations and therapeutic considerations of PD patients.

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MDS Abstracts - https://www.mdsabstracts.org/abstract/autonomic-dysfunction-and-its-correlation-witn-synucleinopathy-an-immunohistological-study-in-tunisian-patients-with-parkinson-disease/