Autonomic function and motor subtypes in Parkinson's disease: a multicentre cross-sectional study

Area of Science:

• Neuroscience
• Clinical Neurology
• Autonomic Medicine

Background:

• Autonomic symptoms (AS) are prevalent and significantly impact Parkinson's disease (PD) patients' quality of life.
• Understanding the heterogeneity of AS and their relationship with PD subtypes is crucial for effective management.

Purpose of the Study:

• To identify clinical factors predicting AS incidence in PD.
• To characterize AS profiles across different PD motor subtypes (postural instability and gait disturbances [PIGD], tremor dominant [TD], indeterminate).
• To explore the relationship between motor subtypes and specific domains of autonomic dysfunction.

Main Methods:

• Analysis of cross-sectional data from 714 PD patients and 194 healthy controls.
• Stratification of patients by PD motor subtypes (PIGD, TD, indeterminate).
• Assessment of autonomic dysfunction using the Scales for Outcomes in Parkinson's Disease-Autonomic dysfunction score and domain-specific evaluations.

Main Results:

• PD patients exhibited higher overall and domain-specific AS scores compared to controls.
• Significant overlap was observed across different AS domains.
• PIGD and indeterminate subtypes showed higher prevalence of pupillomotor and thermoregulatory symptoms.
• TD and indeterminate subtypes were more prone to cardiovascular issues.
• Sexual dysfunction was notably higher in the PIGD subtype.
• Gastrointestinal and urinary symptoms did not show a clear association with specific subtypes.

Conclusions:

• Autonomic symptoms in PD are highly heterogeneous.
• Distinct autonomic dysfunction profiles exist across PD motor subtypes.
• These findings provide valuable insights into the underlying mechanisms of AS in PD and suggest subtype-specific clinical considerations.