Autonomic Dysfunction and Risk of Mortality in Early-Onset Parkinson's Disease

Area of Science:

• Neurology
• Cardiovascular Medicine
• Gerontology

Background:

• Dysautonomia is a frequent complication in Parkinson's disease (PD), linked to higher cardiovascular mortality.
• Early-onset Parkinson's disease (EOPD) presents before age 50 and may have distinct autonomic profiles.
• Understanding autonomic dysfunction in EOPD is crucial for risk stratification and patient management.

Purpose of the Study:

• To determine the frequency and timing of autonomic dysfunction in patients with EOPD relative to motor symptom onset.
• To investigate the association between autonomic symptoms and mortality risk in EOPD.

Main Methods:

• Retrospective cohort study of patients with EOPD (motor onset <50 years) and age-/sex-matched controls.
• Medical record review to identify and date autonomic symptoms (constipation, bladder urgency, orthostatic intolerance, sweat dysfunction, erectile dysfunction).
• Statistical analysis to compare symptom prevalence and assess mortality risk associated with autonomic impairment.

Main Results:

• 63.4% of EOPD patients experienced autonomic symptoms, compared to 27.0% of controls; 91.4% of symptoms preceded or coincided with motor onset.
• Common symptoms included constipation (47%), bladder urgency (27.4%), orthostatic intolerance (19.3%), and sweat dysfunction (15.4%).
• Autonomic impairment correlated with a 2.71-fold increased mortality risk in EOPD, with each additional symptom increasing risk by 50% (p < 0.001).

Conclusions:

• Autonomic dysfunction is highly prevalent in EOPD and significantly increases mortality risk.
• The presence and number of autonomic symptoms are dose-dependent predictors of mortality in EOPD.
• Autonomic symptoms in EOPD typically manifest after motor symptom onset, unlike the prodromal pattern in late-onset PD.