Naveed Malek1, Michael A Lawton2, Katherine A Grosset3, Nin Bajaj4, Roger A Barker5, David J Burn6, Tom Foltynie7, John Hardy8, Huw R Morris9, Nigel M Williams10, Yoav Ben-Shlomo2, Nicholas W Wood11, Donald G Grosset3. 1. Department of Neurology Ipswich Hospital NHS Trust Ipswich United Kingdom. 2. School of Social and Community Medicine University of Bristol Bristol United Kingdom. 3. Institute of Neurological Sciences Queen Elizabeth University Hospital Glasgow United Kingdom. 4. Department of Neurology Queen's Medical Centre Nottingham United Kingdom. 5. Department of Clinical Neurosciences John van Geest Centre for Brain Repair Cambridge United Kingdom. 6. Institute of Neuroscience University of Newcastle Newcastle upon Tyne United Kingdom. 7. Sobell Department of Motor Neuroscience UCL Institute of Neurology London United Kingdom. 8. Reta Lila Weston Laboratories Department of Molecular Neuroscience UCL Institute of Neurology London United Kingdom. 9. Department of Clinical Neuroscience UCL Institute of Neurology London United Kingdom. 10. Institute of Psychological Medicine and Clinical Neurosciences MRC Centre for Neuropsychiatric Genetics and Genomics Cardiff University Cardiff United Kingdom. 11. Department of Molecular Neuroscience UCL Institute of Neurology London United Kingdom.
Abstract
BACKGROUND: Autonomic dysfunction is common in the later stages of Parkinson's disease (PD), but less is known about its presence and severity in early disease. OBJECTIVE: To analyze features of autonomic dysfunction in recent onset PD cases, and their relationship to motor severity, medication use, other nonmotor symptoms (NMS), and quality-of-life scores. METHODS: Detailed patient-reported symptoms of autonomic dysfunction were assessed in a multicenter cohort study in PD cases that had been diagnosed within the preceding 3.5 years. RESULTS: There were 1746 patients (1132 males, 65.2%), mean age 67.6 years (SD 9.3), mean disease duration 1.3 years (SD 0.9), mean Movement Disorder Society Unified Parkinson's Disease Rating Scale motor score 22.5 (SD 12.1). Orthostatic symptoms were reported by 39.6%, male erectile dysfunction by 56.1%, and female anorgasmia by 57.4%. Sialorrhea was an issue in 51.4% of patients, constipation in 43.6%, and dysphagia in 20.1%. Autonomic features increased with higher modified Hoehn and Yahr stages (P < 0.001). The severity of autonomic dysfunction was associated with the postural instability gait difficulty motor phenotype [β-coefficient 1.7, 95% confidence interval (CI) 0.7, 2.6, P < 0.001], depression (β-coefficient 4.1, CI 3.0, 5.2, P < 0.001), and excess daytime sleepiness (β-coefficient 3.1, CI 1.9, 4.2, P < 0.001). Dopamine agonists were the only drug class associated with greater autonomic dysfunction (P = 0.019). The severity of autonomic dysfunction strongly correlated with the presence of other NMS (ρ = 0.717, P < 0.001), and with poorer quality-of-life scores (ρ = 0.483, P < 0.001). CONCLUSIONS: Autonomic dysfunction is common in early PD. Autonomic dysfunction correlates with the presence of other NMS, and with worse quality of life.
BACKGROUND: Autonomic dysfunction is common in the later stages of Parkinson's disease (PD), but less is known about its presence and severity in early disease. OBJECTIVE: To analyze features of autonomic dysfunction in recent onset PD cases, and their relationship to motor severity, medication use, other nonmotor symptoms (NMS), and quality-of-life scores. METHODS: Detailed patient-reported symptoms of autonomic dysfunction were assessed in a multicenter cohort study in PD cases that had been diagnosed within the preceding 3.5 years. RESULTS: There were 1746 patients (1132 males, 65.2%), mean age 67.6 years (SD 9.3), mean disease duration 1.3 years (SD 0.9), mean Movement Disorder Society Unified Parkinson's Disease Rating Scale motor score 22.5 (SD 12.1). Orthostatic symptoms were reported by 39.6%, male erectile dysfunction by 56.1%, and female anorgasmia by 57.4%. Sialorrhea was an issue in 51.4% of patients, constipation in 43.6%, and dysphagia in 20.1%. Autonomic features increased with higher modified Hoehn and Yahr stages (P < 0.001). The severity of autonomic dysfunction was associated with the postural instability gait difficulty motor phenotype [β-coefficient 1.7, 95% confidence interval (CI) 0.7, 2.6, P < 0.001], depression (β-coefficient 4.1, CI 3.0, 5.2, P < 0.001), and excess daytime sleepiness (β-coefficient 3.1, CI 1.9, 4.2, P < 0.001). Dopamine agonists were the only drug class associated with greater autonomic dysfunction (P = 0.019). The severity of autonomic dysfunction strongly correlated with the presence of other NMS (ρ = 0.717, P < 0.001), and with poorer quality-of-life scores (ρ = 0.483, P < 0.001). CONCLUSIONS: Autonomic dysfunction is common in early PD. Autonomic dysfunction correlates with the presence of other NMS, and with worse quality of life.
Entities:
Keywords:
Parkinson's disease; autonomic dysfunction; sexual dysfunction
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