Gender-specific cardiovascular autonomic responses in Parkinson's disease: Insights from an observational study

Parkinson's disease (PD) is associated with non-motor symptoms (NMS), including cardiovascular dysautonomia. While gender-specific variations in cardiovascular autonomic responses are documented in healthy individuals, their presence in PD patients remains unclear. This study aimes to investigate gender-related differences in cardiovascular autonomic function using a full battery of cardiovascular reflex tests and SCOPA-AUT.

Ninety idiopathic PD patients (52 males, 38 females) were enrolled, including drug-naïve (dnPD) and pharmacologically treated (PDot). The cohort was predominantly early-mid stage (87 % in H&Y ≤ 2 and 13 % in H&Y 3). Cardiovascular reflexes were evaluated through head-up tilt test (HUTT), Valsalva manoeuvre (VM), Deep Breathing, Handgrip test and Cold Face test and SCOPA-AUT was administered. Orthostatic hypotension (OH) occurred in 28 % of females and 13 % of males. Statistical significance was set at p < 0.05.

No differences were found between dnPD females and dnPD males at autonomic tests. Among PDot patients, females exhibited a lower ΔHR during the 3rd and 10th minutes of HUTT (p = 0.041) and a greater ΔsBP during the 10th minute of HUTT (p = 0.046) compared with males. SCOPA-AUT showed no differences in dnPD patients; however, PDot females reported higher cardiovascular symptom severity than males (p = 0.02).

PDot females exhibited greater autonomic impairment during HUTT and a higher cardiovascular symptom burden, likely influenced by hormonal factors, central dopaminergic circuitry and dopaminergic therapy effects. Autonomic function tests are crucial for identifying gender-specific autonomic responses and facilitating a personalized approach to the management of cardiovascular dysautonomia in PD.