Miriam Sklerov1, Chia-Hao Shih2, Nina Browner3, Jose-Alberto Palma4, Martin Styner5, Eran Dayan6,7. 1. Department of Neurology, University of North Carolina, 170 Manning Drive, CB# 7025, Chapel Hill, NC, 27599, USA. sklerovm@neurology.unc.edu. 2. Department of Psychiatry, University of Toledo, Ruppert Health Center 0004, Mail Stop 1193, 3000 Arlington Ave., Toledo, OH, 43614-2598, USA. 3. Department of Neurology, University of North Carolina, 170 Manning Drive, CB# 7025, Chapel Hill, NC, 27599, USA. 4. Department of Neurology, Dysautonomia Center, New York University Medical Center, 530 First Avenue, Suite 9Q, New York, NY, 10016, USA. 5. Department of Psychiatry, University of North Carolina, 352 Medical School Wing C, Chapel Hill, NC, 27516, USA. 6. Biomedical Research Imaging Center, University of North Carolina, 130 Mason Farm Road, CB# 7513, Chapel Hill, NC, 27599, USA. 7. Department of Radiology, University of North Carolina, 130 Mason Farm Road, CB# 7513, Chapel Hill, NC, 27599, USA.
Abstract
PURPOSE: The primary objective of this study was to examine the relationship of longitudinal changes in autonomic symptom burden and longitudinal changes in activities of daily living (ADLs); a secondary analysis examined the impact of depressive symptoms in this relationship. METHODS: Data were retrieved from the Parkinson's Progression Markers Initiative (PPMI), a dataset documenting the natural history of newly diagnosed Parkinson's disease (PD). The analysis focused on data from baseline, visit 6 (24 months after enrollment), and visit 12 (60 months after enrollment). The impact of longitudinal changes in autonomic symptom burden on longitudinal changes in ADLs function was examined. A secondary mediation analysis was performed to investigate whether longitudinal changes in depressive symptoms mediate the relationship between longitudinal changes in autonomic symptom burden and ADLs function. RESULTS: Changes in autonomic symptom burden, cognitive function, depressive symptoms, and motor function all correlated with ADLs. Only changes in ADLs and depression were found to be associated with changes in autonomic symptom burden. We found that longitudinal change in autonomic symptoms was a significant predictor of change in ADLs at 24 and 60 months after enrollment, with the cardiovascular subscore being a major driver of this association. Mediation analysis revealed that the association between autonomic symptoms and ADLs is partially mediated by depressive symptoms. CONCLUSIONS: Longitudinal changes in autonomic symptoms impact ADLs function in patients with early signs of PD, both directly and indirectly through their impact on depressive symptoms. Future investigation into the influence of treatment of these symptoms on outcomes in PD is warranted.
PURPOSE: The primary objective of this study was to examine the relationship of longitudinal changes in autonomic symptom burden and longitudinal changes in activities of daily living (ADLs); a secondary analysis examined the impact of depressive symptoms in this relationship. METHODS: Data were retrieved from the Parkinson's Progression Markers Initiative (PPMI), a dataset documenting the natural history of newly diagnosed Parkinson's disease (PD). The analysis focused on data from baseline, visit 6 (24 months after enrollment), and visit 12 (60 months after enrollment). The impact of longitudinal changes in autonomic symptom burden on longitudinal changes in ADLs function was examined. A secondary mediation analysis was performed to investigate whether longitudinal changes in depressive symptoms mediate the relationship between longitudinal changes in autonomic symptom burden and ADLs function. RESULTS: Changes in autonomic symptom burden, cognitive function, depressive symptoms, and motor function all correlated with ADLs. Only changes in ADLs and depression were found to be associated with changes in autonomic symptom burden. We found that longitudinal change in autonomic symptoms was a significant predictor of change in ADLs at 24 and 60 months after enrollment, with the cardiovascular subscore being a major driver of this association. Mediation analysis revealed that the association between autonomic symptoms and ADLs is partially mediated by depressive symptoms. CONCLUSIONS: Longitudinal changes in autonomic symptoms impact ADLs function in patients with early signs of PD, both directly and indirectly through their impact on depressive symptoms. Future investigation into the influence of treatment of these symptoms on outcomes in PD is warranted.
Authors: Iris van der Lijn; Gera A de Haan; Famke Huizinga; Fleur E van der Feen; A Wijnand F Rutgers; Catherina Stellingwerf; Teus van Laar; Joost Heutink Journal: J Parkinsons Dis Date: 2022 Impact factor: 5.520