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Objective   Autonomic symptoms are common in  α -synuclein disorders: multiple system atrophy (MSA), Parkinson's disease (PD), dementia with Lewy bodies (DLB), and Parkinson's disease with dementia (PDD). These symptoms may precede the motor findings/clinical diagnosis by years. Erectile dysfunction (ED) is an autonomic symptom that has rarely been studied in these  α -synuclein disorders. In this population-based, case-control study, we investigated the association between premonitory erectile dysfunction surfacing prior to the clinical-motor manifestations of these  α -synucleinopathies.Methods   We used the medical record-linkage system of the Rochester Epidemiology Project to identify cases of  α -synucleinopathies in Olmsted County from 1991 to 2010. Each male case was matched by age (±1 year) of symptom onset and sex to a control. We reviewed complete medical records of cases and controls to detect erectile dysfunction prior to the clinical-motor onset of  α -synucleinopathies of any type. We used conditional logistic regression to calculate the odds ratio of all  α -synucleinopathies, as well as by type, adjusting for diabetes, coffee, and smoking.Results   A history of male erectile dysfunction was associated with 1.5-fold increased odds of an  α -synucleinopathy diagnosis of any type in univariate analyses ( p =0.06). When stratifying  α -synucleinopathies by type, early erectile dysfunction was most frequent in MSA cases than matched controls (45% vs. 9%). Premotor phase ED was next most frequent among the DLB cases (46% vs. 27% among the controls; OR = 2.83,  p =0.03; when adjusted for diabetes, smoking, and coffee, OR = 2.98,  p =0.04). Premotor phase ED was not significantly associated with PD or PDD.Conclusions   Early erectile dysfunction may be a premotor symptom of MSA and DLB, reflecting premonitory dysautonomia. It was not associated with premotor PD or PDD.

Erectile Dysfunction Preceding Clinically Diagnosed α-Synucleinopathies: A Case-Control Study in Olmsted County