Objective: Clarify the relationship between autonomic dysfunction, disease severity and NMS in PD patients.

Background: Parkinson’s disease (PD) is characterized by a combination of motor and non-motor symptoms (NMS). Autonomic symptoms (AS) are common NMS that can significantly impact the quality of life of PD patients and can occur during the early stage of PD.

Method: This retrospective study included patients from the department of neurology of the National Institute of Neurology Mongi Ben Hmida in Tunis, Tunisia, diagnosed with PD between 1980 and 2023. The diagnosis of PD was confirmed according to the Movement Disorder Society (MDS) diagnostic criteria of PD. The MDS Unified Parkinson’s Disease Rating Scale (MDS-UPDRS) motor was used to estimate motor disability and Hoehn and Yahr (H&Y) stage was used to rate disease severity. The items 1.10, 1.11 et 1.12 from MDS-UPDRS part I, the items2.2, 2.3 from MDS-UPDRS part II and Scales for Outcomes in Parkinson’s Disease – Autonomic Dysfunction (SCOPA-AUT) were applied to evaluate AS in patients with PD.

Results: We included 150 patients (sex-ratio M/F=74/76) with a mean age of 64 years [28-96]. Thirty patients (20%) had a severe motor disorder (MDS-UPDRS> 59) and 11.3% of patients had a severe stage of the disease. One hundred and thirteen patients (75.3%) had motor complications (motor fluctuations and/or L-Dopa induced dyskinesia). The mean score of SCOPA-AUT was 23.19 [8-52]. Gastrointestinal, urinary, and cardiovascular dysfunction were reported respectively in 50.7%, 45.3% and 42%. Eight patients (5.3%) had fecal incontinence and 46 (30.7%) had urinary incontinence. Orthostatic hypotension was observed in 42%.

Constipation, urinary problems, and orthostatic hypotension were significantly correlated with severity of PD (p=0.0001, p=0.013 and p=0.007) and motor fluctuations (p=0.001, p=0.002 and p=0.001). Nevertheless, Neither L-Dopa induced dyskinesia nor levodopa dose was associated to AS (p=0.215 and p=0.106).

The SCOPA-AUT score was correlated with Epworth Sleepiness Scale, rapid-eye-movement sleep behavior disorder, sexual dysfunction, depression and cognitive impairment (p=0.0001).

Conclusion: AS are associated with significant morbidity and mortality. Our study demonstrates that AS increase with both the severity and the stage of PD and are significantly intrigued by other NMS.

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MDS Abstracts - https://www.mdsabstracts.org/abstract/autonomic-dysfunction-in-parkinsons-disease-link-with-disease-severity-and-other-non-motor-signs/