Objective: The aim of this study is to perform a preliminary investigation of the prevalence of cardiac autonomic dysfunction in newly diagnosed Parkinson’s patients. We suspect that the prevalence of autonomic dysfunction will be similar to that seen later in the disease, albeit the symptoms less severe, suggesting rationale for early screening.

Background: Autonomic dysfunction is a known association with Parkinson’s disease, especially neurogenic orthostatic hypotension and supine hypertension.[1-4] Although classically thought to be a late finding, it has been previously shown that autonomic dysfunction can be observed very early in the course of Parkinson’s disease.[3] Reported prevalence of ANS dysfunction varies widely, 30-80%. Incidence and severity of ANS dysfunction doesn’t correlate with UPDRS. The hypothesized etiology is synuclein deposition within autonomic nerves.[1] In fact, for many Parkinson’s patients, managing their severe symptomatic dysautonomia can be the most difficult aspect of treatment, resulting in increased risk of falls, cognitive impairment, cardiac MI, arrhythmia, and stroke.[2]

Method: Cardiac function was assessed in six randomly selected treatment naïve, newly diagnosed patients with Parkinson’s. Each patient underwent head-up tilt-table testing, ECG, and cardiac transthoracic echo to evaluate for evidence of cardiac and/or autonomic dysfunction.

Results: While only one patient suffered clinical symptoms of autonomic failure manifesting as nOH and supine HTN, all patients exhibited early signs of SNS failure. At least two of the patients studied exhibited a constant interbeat interval and 100% of the patients had measurable sympathetic neurocirculatory failure. As anticipated, the severity of autonomic dysfunction did not correlate with disease stage as assessed by UPDRS score.

Conclusion: Despite the known high prevalence of autonomic failure in PD, cardiovascular comorbidities are not routinely screened for in PD patients. Our preliminary data suggests that when analyzed properly, tilt table testing, ECG, and ECHO can be used cheaply and effectively to detect early stages of SNS failure, even before clinical symptoms manifest. In this preliminary study, 100% of patients exhibited some level of autonomic failure, supporting a rationale for early screening. Early detection and treatment may ultimately help ameliorate the future risk of falls, cardiac MI, arrhythmia, and stroke, all known associations of autonomic dysfunction.

References: [1] Jain, Samay, and David S. Goldstein. “Cardiovascular dysautonomia in Parkinson disease: from pathophysiology to pathogenesis.” Neurobiology of disease 46.3 (2012): 572-580. [2] Espay, Alberto J., et al. “Neurogenic orthostatic hypotension and supine hypertension in Parkinson’s disease and related synucleinopathies: prioritisation of treatment targets.” The Lancet Neurology 15.9 (2016): 954-966. [3] Kim, Joong-Seok, et al. “Cardiovascular Autonomic Dysfunction in Mild and Advanced Parkinson’s Disease.” Journal of movement disorders 9.2 (2016): 97. [4] Goldstein, David S. “Dysautonomia in Parkinson’s disease: neurocardiological abnormalities.” The Lancet Neurology 2.11 (2003): 669-676.

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