Objective: To determine how autonomic dysfunction influences disease progression and survival in Parkinson’s disease (PD).

Background: Autonomic dysfunction is a common feature in PD and a negative prognostic factor in other synucleinopathies such as multiple system atrophy. However its role in the clinical progression and survival in PD has not been defined.

Methods: Retrospective review of the medical records of patients with pathologically confirmed diagnoses of PD. Patients were excluded if: histological diagnoses of concomitant neurodegenerative disease (other than PD), alternative medical conditions responsible for autonomic symptoms or medical records with insufficient clinical information. Autonomic dysfunction was defined by abnormal autonomic function testing or any two of the following symptoms: chronic constipation, upper gastrointestinal dysfunction, urinary urgency, frequency and nocturia without hesitancy, symptomatic or documented orthostatic hypotension (>20mmHg drop in systolic or >10mmHg in diastolic blood pressure), sweating abnormalities or erectile dysfunction. Symptom severity was classified in absent, mild, moderate or severe based on clinical impression to estimate global autonomic dysfunction severity. Seven milestones were selected to assess disease progression: recurrent falls, use of wheelchair, cognitive disability, use of communication aids or unintelligible speech, severe dysphagia or the offering of PEG, use of urinary catheter and placement in residential or nursing home care. Cox proportional hazards models were used to estimate the effect of autonomic dysfunction on the time from symptom onset to the first milestone and survival. Hazard ratios (HR) and 95% Confidence Interval (95%CI) are reported.

Results: 87 patients (34 female and 53 male; age at diagnosis 63.9±10.1 years; disease duration 14.6±7.5 years) were included. 74 (85.1%) patients developed autonomic dysfunction with a median time from diagnosis of 7±7.5 years. Later development of autonomic dysfunction was associated with a longer time to first milestone (HR=0.89; 95%CI 0.85-0.92; p<0.001) and longer survival (time to death HR=0.92; 95%CI 0.88-0.95; p<0.001). Severity of autonomic dysfunction was not associated with significant risk on disease progression or survival.

Conclusions: Early development of autonomic dysfunction (but not its severity) in PD is associated with worse disease progression and shorter survival.

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MDS Abstracts - https://www.mdsabstracts.org/abstract/impact-of-autonomic-dysfunction-on-disease-progression-and-survival-in-parkinsons-disease/