Self-reported autonomic dysfunction could be a predictive marker for sarcopenia in Parkinson's disease

Autonomic dysfunction and motor symptoms are prevalent in Parkinson's disease (PD). Motor symptoms influence sarcopenia; however, the association between sarcopenia and non-motor symptoms, particularly autonomic dysfunction, remains unclear. This study determined the effect of autonomic dysfunction on sarcopenia in patients with PD.

Consecutive patients with PD (Hoehn and Yahr stages 1-3) without apparent dementia were screened. The Scales for Outcomes in Parkinson's Disease-Autonomic Questionnaire (SCOPA-AUT) was utilized to evaluate the severity of autonomic dysfunction. Sarcopenia was assessed using the 2019 Asian Diagnostic Criteria. This study examined whether the SCOPA-AUT and its domains were associated with sarcopenia and used receiver operating characteristic analysis to evaluate their predictive performance.

Of the 124 patients (76 [61%] men; median age, 68 years) included, sarcopenia was identified in 31 (25%). Poisson regression analysis with a robust variance estimator showed that a higher SCOPA-AUT score is associated with sarcopenia (prevalence ratio 1.078, 95% CI 1.034-1.122, p < 0.001). Regarding SCOPA-AUT domains, higher scores for gastrointestinal functioning, urinary functioning and pupillomotor functioning were significantly associated with sarcopenia. Receiver operating characteristic analysis showed that the optimal cut-off value for SCOPA-AUT was 16 (area under the curve 0.730, 95% CI 0.615-0.844). For each SCOPA-AUT domain, a cut-off of 8 for gastrointestinal functioning (area under the curve 0.744, 95% CI 0.630-0.858) predicted sarcopenia more reliably than urinary and pupillomotor functioning.

Higher SCOPA-AUT scores, particularly in the gastrointestinal function domain, might be an optimal predictive marker for sarcopenia in patients with PD. Geriatr Gerontol Int 2025; 25: 1074-1081.