Objective: To compare clinical features between those with and without dysautonomia in a cohort with other prodromal Parkinson’s disease (PPD) markers.

Background: Dysautonomia has been associated with PPD. However, its relationship with other clinical features in individuals with particular PPD markers requires further exploration. Such descriptive data may help to identify prodromal subgroups and motivate hypotheses for analytic studies.

Method: Data were from Parkinson’s Progression Markers Initiative baseline visit. Participants with the following PPD markers were included: hyposmia and/or REM sleep behavior disorder, LRRK2 or GBA mutation. Healthy control (HC) participants were also included. A +/- binary variable for each Scales for Outcomes in Parkinson’s Disease-Autonomic (SCOPA-AUT) subdomain score was generated based on whether it was > or ≤ HC cohort median score for that particular subdomain. +/- binary variables for neurogenic orthostasis, supine hypertension, low pulse pressure were derived from vital sign measurements. Age, MDS-UPDRS-III, dysautonomia-inducing medication use were compared between PPD participants with +/- scores. Wilcoxon rank-sum or Pearson’s chi-squared test was used as appropriate, with p≤0.05 considered significant.

Results: 467 PPD and 198 HC participants were included. Among PPD participants overall, median age was higher in those with + vs – SCOPA-AUT gastrointestinal (63.25, IQR 57.58-68.75 vs 61.08, IQR 56.25-66.08), urinary (64.33, IQR 58.92-69.59 vs 60.96, IQR 56.00-66.17), sexual (63.25, IQR 58.08-67.50 vs 60.25, IQR 54.04-65.08) scores, and neurogenic orthostasis (66.42, IQR 61.75-70.50 vs 61.79, IQR 56.58-67.16), and lower in those with low pulse pressure (60.46, IQR 55.16-65.17 vs 63.21, IQR 58.46-68.54). Median MDS-UPDRS-III was higher in those with + vs – SCOPA-AUT gastrointestinal (2, IQR 0-5 vs 1, IQR 0-3), urinary (2, IQR 0-6 vs 1, IQR 0-3), pupillomotor (2, IQR 0-6 vs 1, IQR 0-3.5) scores, and lower in those with low pulse pressure (3.5, IQR 2-7 vs 1, IQR 0-4). Dysautonomia-inducing medication use did not differ between those with positive/negative scores.

Conclusion: In general, PPD participants with dysautonomia were older and had more parkinsonism compared to those without dysautonomia, except for those with low pulse pressure. These clinical differences may be valuable for identifying PPD subgroups for cohort studies and understanding associated features of dysautonomia in PPD.

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MDS Abstracts - https://www.mdsabstracts.org/abstract/clinical-features-associated-with-dysautonomia-in-prodromal-parkinsons-disease/