Longitudinal Investigation of Autonomic Symptoms in Biologically Confirmed (SAA+) Parkinson's Disease
Longitudinal Investigation of Autonomic Symptoms in Biologically Confirmed (SAA+) Parkinson's Disease
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Original abstract
Background :Autonomic symptoms are common in Parkinson’s disease (PD), impacting quality of life and potentially predicting faster disease progression. Objective: Characterize the five-year progression of autonomic symptoms in early PD and their association with motor and cognitive outcomes, controlling for demographics, comorbidities, and medication use. Methods :We analyzed data from 874 PD participants and 252 healthy controls (HC) enrolled in the Parkinson's Progression Markers Initiative (PPMI). Autonomic symptoms were assessed annually over five years using Scales for Outcomes in Parkinson's disease-Autonomic dysfunction (SCOPA-AUT). Clinical measures included the MDS-UPDRS I-III and Montreal Cognitive Assessment. Generalized estimating equations evaluated longitudinal changes, adjusting for age, sex, medication, and comorbidities. Results :At baseline, 71% of 874 PD participants reported >1 autonomic symptom, increasing to 85% among 287 PD participants with 5-year follow-up; HCs reporting >1 autonomic symptom increased from 40% of 252 participants at baseline to 46% among 145 participants with 5-year follow-up. Gastrointestinal and urinary symptoms were most prevalent in PD and there was suggestion of gastrointestinal progression in PD. Medication use for constipation and urinary dysfunction increased over time in PD. Cardiovascular comorbidities were common and increased in prevalence in both groups. Greater baseline autonomic symptom burden predicted more rapid cognitive decline in PD (p = 0.002).Conclusion :Autonomic symptoms in PD are very common at disease onset, near universal after 5 years, and associated with cognitive decline. The high prevalence and impact of autonomic symptoms in early PD highlights the importance of assessing and managing these symptoms from disease onset.