Objective: To study the prevalence of autonomic dysfunction and to correlate with clinico-imageological features and to assess the impact of autonomic dysfunction on quality of life.

Background: Autonomic dysfunction occurs not only in advanced Parkinson’s disease (PD) but also early in its course. Transcranial ultrasound (TCUS) can pick up substantia nigral abnormalities very early in the disease.

Methods: Forty five PD patients were recruited from a tertiary health care centre in India from Jan 2016-June 2017. PD was diagnosed based on UK-PD society Brain Bank Criteria. Disease staging done by Hoehn and Yahr staging. UPDRS III score in medication ‘on’ and ‘off’ states,SCOPA–AUT questionnaire for autonomic symptoms, PDQ 39 for quality of life and MOCA for cognitive assessment was done in all. All patients were evaluated with cardiovascular autonomic tests-heart rate variation to deep breathing, BP response to standing, heart rate variation to valsalva, heart rate response to standing and diastolic blood pressure to hand grip as well as sympathetic skin response. TCUS through the preauricular acoustic bone windows was done using a phased-array ultrasound system with a 2.5-MHz transducer, in all to measure substantia nigra volume, signal intensity and laterality index.

Results: Out of 45 patients, 34 were men. Mean UPDRS III ‘off’ and ‘on’ scores were 47.7±14.6 and 15.4±7.7 respectively. Tremor was predominant symptom in 24(53%) and 21(47%) had rigidity. Most common self reported autonomic symptoms were constipation and postural dizziness. Mean PDQ-39 sum score was 57.6±34.6 (0-120) and mean total SCOPA-AUT sum score was 6.33 ±5.4. SCOPA- AUT sum score correlated significantly with the disease stage (p < 0.001) as well as PDQ39 scores (p=0.02). Parasympathetic and sympathetic dysfunction were found in 53% (N-24) and 31% (N-19) respectively. Both parasympathetic(p=0.001) and sympathetic dysfunction(p=0.003) on AFT were more in tremor predominant sub group. Abnormal substantia nigral hyperechogenicities were seen in 93% of patients. Significant laterality index was found in 38.44%. There was no correlation between autonomic scores and volume of substantia nigral hyperechogenicity or laterality indices.

Conclusions: Most common self-reported autonomic symptoms were constipation and postural dizziness. AFT showed significant autonomic dysfunction even in those who had no autonomic symptom which correlated with PDQ-39 scores but had no correlation with the volume of substantia nigral hyperechogenicities.

« Back to 2018 International Congress

MDS Abstracts - https://www.mdsabstracts.org/abstract/prevalence-of-autonomic-dysfunction-and-its-correlation-with-clinico-imageological-features-in-parkinsons-disease/