Objective: To examine the profile of autonomic dysfunction and the utility of the SCOPA-AUT scale in distinguishing patients with early Parkinson’s disease (PD) and MSA-parkinsonism (MSA-P) within the first three years from symptom onset.

Background: One of the characteristics of MSA-P and PD is autonomic dysfunction. Autonomic failure is severe, progressive and widespread in MSA-P, often occurring early in the disease course, in up to 30% of patients may precede motor impairment. In PD, autonomic dysfunction is a common feature of advanced disease, although mild to moderate symptoms may be detected in the early stages. Early differentiation of these two parkinsonian disorders is mainly based on the detection of dysautonomia and data on the usefulness of the SCOPA-AUT scale in such differentiation are still lacking.

Method: A total of 70 patients with PD and 27 patients with MSA-P with disease duration ≤3 years were included. Demographic and clinical features were obtained using a semistructured interview. Motor and non-motor features of both diseases were evaluated using Hoehn and Yahr scale, MDS-UPDRS, UMSARS, HDRS, HARS, Apathy scale, ACE-R and MMSE. Autonomic dysfunction was assessed using the SCOPA-AUT scale. Finally, patients were further monitored and after 3.2 years of follow-up all met the criterion of probable PD, ie MSA-P.

Results: Patients with MSA-P reported higher scores across all SCOPA-AUT subdomains compared to patients with PD at early disease stages. The difference between disorders was particularly significant for urinary symptoms. Among early symptoms of dysautonomia, gastrointestinal and urinary autonomic domains, together with younger age, were predictive of the final diagnosis of probable MSA-P instead of PD.

Conclusion: Overall, the SCOPA-AUT may be useful in distinguishing patients with MSA-P and PD at early disease stages. Younger patients, reporting higher scores on SCOPA-AUT gastrointestinal and SCOPA-AUT urinary subdomains were more likely to be diagnosed with probable MSA-P at the last neurological examination. Larger studies with postmortem diagnostic validation and employment of autonomic function testing are needed to evaluate the utility of the SCOPA-AUT scale in differential diagnosis of synucleinopathies.

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MDS Abstracts - https://www.mdsabstracts.org/abstract/the-profile-of-dysautonomia-in-the-early-stages-of-parkinsons-disease-and-multiple-system-atrophy-the-importance-of-using-the-scopa-aut-scale/