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Autonomic Dysfunction in Early Parkinson's Disease: Results from the United Kingdom Tracking Parkinson's Study
Author(s) -
Malek Naveed,
Lawton Michael A.,
Grosset Katherine A.,
Bajaj Nin,
Barker Roger A.,
Burn David J.,
Foltynie Tom,
Hardy John,
Morris Huw R.,
Williams Nigel M.,
BenShlomo Yoav,
Wood Nicholas W.,
Grosset Donald G.
Publication year - 2016
Publication title -
movement disorders clinical practice
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 0.754
H-Index - 18
ISSN - 2330-1619
DOI - 10.1002/mdc3.12454
Subject(s) - parkinson's disease , medicine , orthostatic vital signs , rem sleep behavior disorder , levodopa , sexual dysfunction , cohort , rating scale , depression (economics) , epworth sleepiness scale , cardiology , disease , psychology , polysomnography , developmental psychology , blood pressure , economics , macroeconomics , apnea
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.