Early Autonomic Burden in Prodromal Parkinson's Disease Predicts Cognitive Impairment

Autonomic dysfunction is a known contributor to cognitive impairment in Parkinson's disease (PD), but its impact during prodromal stage is unknown.

The aim was to determine whether early autonomic burden predicts incident cognitive impairment in prodromal PD.

We analyzed data from Parkinson's Progression Markers Initiative participants. Autonomic dysfunction was defined as Scales for Outcomes in Parkinson's Disease Autonomic Dysfunction score ≥13, documented prior to phenoconversion. Cox regression assessed the predictors of cognitive impairment, and mixed-effects analysis of variance compared domain-specific cognitive trajectories.

Data on 382 participants were analyzed. Early autonomic dysfunction was significantly associated with increased risk of mild cognitive impairment or dementia (P < 0.001), especially in semantic fluency and letter-number sequencing. Cardiovascular autonomic burden, specifically, was a strong independent predictor (HR = 5.21, P = 0.01).

Autonomic dysfunction in prodromal PD is a risk factor for cognitive decline, providing opportunity for early risk stratification and intervention. © 2026 The Author(s). Movement Disorders published by Wiley Periodicals LLC on behalf of International Parkinson and Movement Disorder Society.