Autonomic symptoms in early-stage Parkinson’s patients and their relationship with cognition and disease parameters

Year 2023, Volume: 5 Issue: 4, 498 - 502, 27.10.2023

Esma Kobak Tur , Eren Gözke

https://doi.org/10.38053/acmj.1355855

Cited By: 1

Abstract

Aims: Autonomic dysfunction is a prevalent feature throughout various stages of the disease and can significantly exacerbate the overall impact of the condition. Moreover, it is linked to accelerated disease advances and diminished vitality rates in individuals with Parkinson’s disease (PD). The main goal of this study is to evaluate the prevalence of autonomic symptoms and cognitive findings and investigate their associations with disease-related factors in early-stage PD patients.
Methods: A total of 49 individuals diagnosed with PD were enrolled in this study. Disease severity was assessed using the Unified Parkinson’s Disease Rating Scale (UPDRS), and the disease stage was determined through the modified Hoehn & Yahr Rating Scale (mHYRS). By the mH&Y scale, only individuals in the early stages (≤2.5) of the disease were included in this investigation. The evaluation of autonomic symptoms in PD was conducted using the Scales for Outcomes in Parkinson’s Disease for Autonomic Symptoms (SCOPA-AUT) scale. The cognitive functions of the patients were assessed utilizing the Turkish version of the Montreal Cognitive Assessment Scale (MOCA-TR).
Results: The study included 44% (n=22) females and 56% (n=27) males as participants. The average age was 61.5±10.1 years. The mean SCOPA-AUT score was 18.9±9.36, with the most prevalent autonomic symptoms related to the gastrointestinal system. A positive correlation was shown with autonomic symptoms and disease stages (p=0.024, r=0.322). However, no significant relationship was found between autonomic symptoms, other disease parameters, and cognition. We observed a notable inverse correlation between the disease stage and cognitive status (p=0.003, r=-0.417).
Conclusion: Our study concluded that autonomic dysfunctions manifest from the early stages of Parkinson’s disease and can intensify as the disease progresses. Identifying and addressing these dysfunctions at an early stage would play a pivotal role in lessening the overall impact of the disease.

Keywords

Autonomic dysfunction, Parkinson, SCOPA-AUT, MOCA

References

• Khoo TK, Yarnall AJ, Duncan GW, et al. The spectrum of nonmotor symptoms in early Parkinson disease. Neurology. 2013;80(3):276-281.
• Djaldetti R, Lev N, Melamed E. Lesions outside the CNS in Parkinson’s disease. Mov Disord. 2009;24(6):793-800.
• Merola A, Romagnolo A, Comi C, et al. Prevalence and burden of dysautonomia in advanced Parkinson’s disease. Mov Disord. 2017;32(5):796-797.
• Mendoza-Velásquez JJ, Flores-Vázquez JF, Barrón-Velázquez E, Sosa-Ortiz AL, Illigens BW, Siepmann T. Autonomic dysfunction in α-synucleinopathies. Front Neurol. 2019;10:363.
• Siddiqui MF, Rast S, Lynn MJ, Auchus AP, Pfeiffer RF. Autonomic dysfunction in Parkinson’s disease: a comprehensive symptom survey. Parkinsonism Relat Disord. 2002;8(4):277-284.
• Stanković I, Petrović I, Pekmezović T, et al. Longitudinal assessment of autonomic dysfunction in early Parkinson’s disease. Parkinsonism Relat Disord. 2019;66:74-79.
• De Pablo-Fernandez E, Tur C, Revesz T, Lees AJ, Holton JL, Warner TT. Association of autonomic dysfunction with disease progression and survival in Parkinson disease. JAMA Neurol. 2017;74(8):970-976.
• Idiaquez J, Benarroch EE, Rosales H, Milla P, Ríos L. Autonomic and cognitive dysfunction in Parkinson’s disease. Clin Auton Res. 2007;17(2):93-98
• Aygun D. , Akpinar C. K. , Yon S. , Onar M. K. Effect of clinical autonomic dysfunction on cognitive functions in Parkinson’s disease. Dicle Med J. 2017;44(3):225-231.
• Postuma RB, Berg D, Stern M, et al. MDS clinical diagnostic criteria for Parkinson’s disease. Mov Disord. 2015;30(12):1591-1601. doi:10.1002/mds.26424
• 11.Tomlinson CL, Stowe R, Patel S, Rick C, Gray R, Clarke CE. Systematic review of levodopa dose equivalency reporting in Parkinson’s disease. Mov Disord. 2010;25(15):2649-2653.
• Goetz CG, Poewe W, Rascol O, et al. Movement Disorder Society Task Force report on the Hoehn and Yahr staging scale: status and recommendations. Mov Disord. 2004;19(9):1020-1028.
• Rodriguez-Blazquez C, Forjaz MJ, Frades-Payo B, de Pedro-Cuesta J, Martinez-Martin P. Longitudinal Parkinson’s Disease Patient Study, Estudio Longitudinal de Pacients con Enfermedad da Parkinson Group. Independent validation of the scales for outcomes in Parkinson’s disease-autonomic (SCOPA-AUT). Eur J Neurol. 2010;17(2):194-201.
• Ozdilek B, Kenangil G. Validation of the Turkish Version of the Montreal Cognitive Assessment Scale (MoCA-TR) in patients with Parkinson’s disease. Clin Neuropsychol. 2014;28(2):333-343.
• Parkinson J. An essay on the shakıng palsy. Arch Neurol. 1969;20(4):441-445.
• den Hartog Jager Wa, Bethlem J. The distribution of Lewy bodies in the central and autonomic nervous systems in idiopathic paralysis agitans. J Neurol Neurosurg Psychiatry. 1960;23(4):283-290.
• Iwanaga K, Wakabayashi K, Yoshimoto M, et al. Lewy body-type degeneration in cardiac plexus in Parkinson’s and incidental Lewy body diseases. Neurology. 1999;52(6):1269-1271.
• Sung HY, Park JW, Kim JS. The frequency and severity of gastrointestinal symptoms in patients with early Parkinson’s disease. J Mov Disord. 2014;7(1):7-12.
• Verbaan D, Marinus J, Visser M, van Rooden SM, Stiggelbout AM, van Hilten JJ. Patient-reported autonomic symptoms in Parkinson disease. Neurology. 2007;69(4):333-341.
• Arı S, Candan F, Işık N, Öztop Ö, Aydın Cantürk İ, Arıcı Düz Ö. Autonomic symptoms in idiopathic Parkinson’s disease. Cumhuriyet Med J. 2014;36(3):344-349
• Zadikoff C, Fox SH, Tang-Wai DF, et al. A comparison of the mini mental state exam to the Montreal cognitive assessment in identifying cognitive deficits in Parkinson’s disease. Mov Disord. 2008;23(2):297-299.