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Impact of autonomic symptoms on the clinical course of Parkinson’s disease

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Abstract

Purpose

Patients with Parkinson’s disease (PD) exhibit various degrees of autonomic symptoms, which may be associated with Lewy body pathology distributed extensively in the autonomic nervous system. We hypothesized that the severity of autonomic symptoms reflects the severity of PD-related pathology, resulting in poor outcomes. The purpose of this study was to evaluate the impact of autonomic symptoms on PD progression.

Methods

We conducted a follow-up study among consecutive patients with PD at Dokkyo Medical University Hospital. Patients underwent comprehensive baseline evaluations and were classified into high and low autonomic symptom groups using the Scale for Outcomes in Parkinson’s Disease–Autonomic (SCOPA-AUT). The Kaplan‒Meier survival curves were used to analyze the time to discontinuation of their visits because of PD-related endpoints and to evaluate the association with high SCOPA-AUT scores.

Results

Of the 101 patients, 74 (73%) met the inclusion criteria. During the follow-up period (mean 1654 days), 22/74 patients reached PD-related endpoints (death, 4; hospitalization, 9; nursing home institutionalization, 9). PD patients with high SCOPA-AUT scores reached the endpoints faster than those with low SCOPA-AUT scores. A high SCOPA-AUT score, including gastrointestinal, urinary, and thermoregulation domains; high motor symptom scores; and low specific binding ratios (SBRs) on 123I FP-CIT-SPECT (DAT-SPECT) were associated with reaching PD-related endpoints. A high SCOPA-AUT score was associated with reaching the endpoints even after adjustment for covariates.

Conclusions

Patients with high autonomic symptom scores had a greater risk of reaching PD-related endpoints than patients with low autonomic symptom scores.

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Data availability

The data used in this study are available from the corresponding author upon request.

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Acknowledgements

We thank Prof. Yasuo Haruyama, Integrated Research Faculty for Advanced Medical Sciences, Dokkyo Medical University, for the helpful comments regarding the statistical analysis.

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Authors and Affiliations

  1. Department of Neurology, Dokkyo Medical University, 880 Kitakobayashi, Mibu, Shimotsuga, Tochigi, 321-0293, Japan

    Hiroaki Fujita, Keitaro Ogaki, Tomohiko Shiina, Hirotaka Sakuramoto, Narihiro Nozawa & Keisuke Suzuki

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  1. Hiroaki Fujita
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  2. Keitaro Ogaki
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  3. Tomohiko Shiina
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  4. Hirotaka Sakuramoto
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  5. Narihiro Nozawa
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Contributions

Hiroaki Fujita, Keitaro Ogaki, Tomohiko Shiina, Hirotaka Sakuramoto, Narihiro Nozawa, and Keisuke Suzuki: conceptualization. Hiroaki Fujita and Keitaro Ogaki: data curation. Keisuke Suzuki: formal analysis and supervision. Tomohiko Shiina, Hirotaka Sakuramoto, and Narihiro Nozawa: investigation and methodology. Hiroaki Fujita and Narihiro Nozawa: project administration and writing—original draft. Keitaro Ogaki, Tomohiko Shiina, Hirotaka Sakuramoto, Narihiro Nozawa, and Keisuke Suzuki: writing—review and editing. All the authors contributed to the article and approved the submitted version.

Corresponding author

Correspondence to Hiroaki Fujita.

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Ethical approval

This study was performed in accordance with the Declaration of Helsinki and was approved by the Institutional Review Board of Dokkyo Medical University.

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All participants provided written informed consent.

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The authors declare no competing interests.

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Fujita, H., Ogaki, K., Shiina, T. et al. Impact of autonomic symptoms on the clinical course of Parkinson’s disease. Neurol Sci (2024). https://doi.org/10.1007/s10072-024-07422-x

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