P35.10 Longitudinal study of autonomic and cognitive dysfunction in Parkinson’s disease (original) (raw)

Autonomic dysfunction according to disease progression in Parkinson's disease

Parkinsonism & Related Disorders, 2014

Background: Although autonomic dysfunction is common in patients with Parkinson's disease (PD), few data are available regarding its pattern and quantitative severity with increasing Hoehn and Yahr (H&Y) stage. We conducted autonomic function tests to quantify autonomic dysfunction in PD patients and to elucidate its possible relationship with disease progression. Methods: We performed autonomic function tests including Valsalva ratio, heart rate response to deep breathing, quantitative sudomotor axon reflex test, and head-up tilt test in 66 patients with PD. We compared clinical characteristics and results of autonomic function tests between stages, and correlated the proportion of abnormal patients in each test with their H&Y stage. In addition, logistic regression analyses were conducted to examine the contribution of increasing H&Y stage to impairments of each domain of the autonomic nervous system. Results: We found that PD patients with higher disease stage tended to have impairments in cardiovagal and sudomotor domains of the autonomic nervous system. Cardiovagal function was the domain most influenced by disease progression. Our findings also demonstrated that the pattern of sudomotor impairment in PD was similar to that in patients with peripheral autonomic neuropathy. Conclusions: Our study demonstrates that autonomic dysfunction is not only common in early stage PD but it increases in severity with increasing disease stage. Given that the patterns of sudomotor impairments in PD are similar to those in peripheral neuropathy, our data support a previous hypothesis that pathophysiology of PD involves both the central and peripheral nervous systems.

Assessment of autonomic dysfunction in Parkinson's disease: The SCOPA-AUT

Movement Disorders, 2004

We developed a questionnaire to assess autonomic symptoms in patients with Parkinson's disease (PD) and evaluated its reliability and validity. Based on the results of a postal survey in 46 PD patients, 21 multiple system atrophy patients, and 8 movement disorders specialists, items were included according to their frequency, burden, and clinical relevance. The questionnaire was evaluated in 140 PD patients and 100 controls, and test-retest reliability was established in a sample of 55 PD patients. The SCOPA-AUT consists of 25 items assessing the following regions: gastrointestinal (7), urinary (6), cardiovascular (3), thermoregulatory (4), pupillomotor (1), and sexual (2 items for men and 2 items for women) dysfunction. Test-retest reliability was good. Autonomic problems increased significantly with increasing disease severity for all autonomic regions, except sexual dysfunction. We conclude that SCOPA-AUT is a reliable and valid questionnaire that evaluates autonomic dysfunction in PD.

Differential impact of individual autonomic domains on clinical outcomes in Parkinson’s disease

Journal of Neurology

Introduction While autonomic failure is a well-known prognostic factor for more aggressive disease progression in Parkinson’s disease (PD), with a three- to sevenfold higher risk of dementia and death within 10 years after the diagnosis, the individual impact of cardiovascular, gastrointestinal, urogenital, thermoregulatory, and pupillomotor autonomic domains on PD clinical outcomes remains unclear. Objectives We sought to determine the 5-year risk of developing dementia, falls, postural instability, dysarthria, and dysphagia in PD patients with and without autonomic impairment at baseline and to assess the joint and individual association of each autonomic domain on these key functional outcomes. In addition, we aimed to determine the impact of each autonomic domain on activities of daily living (ADLs) and health-related quality of life (HRQoL). Methods We enrolled 65 consecutive PD patients in a 5-year cohort study involving standardized evaluations of autonomic symptoms, orthosta...

Orthostatic hypotension in Parkinson's disease: association with cognitive decline?

International Journal of Geriatric Psychiatry, 2006

Background Orthostatic hypotension is common in Lewy body disorders and may be related to disease progression and the spread of Lewy body pathology. We therefore hypothesize that PD patients with orthostatic hypotension (OH) have a different cognitive profile compared to PD patients without OH. Methods This cross-sectional study included 175 PD patients. Blood pressure (BP) was measured with a validated digital blood pressure monitor and patients with a systolic BP drop of !20 mmHg or a systolic pressure of <90 mm Hg after standing were considered to have OH. Cognition was assessed using MMSE extended by a selection of computerized cognitive tests focusing on reaction time, sustained attention, working memory and episodic verbal and visual memory. Results Eighty-seven (49.7%) of the PD patients had OH. These patients were significantly more impaired in sustained attention and visual episodic memory compared to PD patients without OH. Conclusion We conclude that there are differences in the neuropsychological performance of patients with PD and OH, supporting the hypothesis that OH might be a marker for disease progression and cognitive decline in PD. Ã Significant results when adjusted for age, levodopa dosage and multiple comparisons; SI ¼ sensitivity index.

Autonomic Failure, Depression and Anxiety in Parkinson's Disease

British Journal of Psychiatry, 1995

Background. The studytested thehypothesis thatsubjects withParkinson's disease (PD) have more autonomic complaints and more attenuation of autonomic reflexes than controls, and thatbothclusters ofvariables arerelated tothepresence ofanxiety and depression. Method. Thirty-two subjects and 32 healthy controls matched by age and sex were prospectively comparedon psychiatric, cognitive and autonomictests. Results. ‘¿ Autonomic' symptoms:weremorefrequent inPD patients thaninhealthy controls; were not related to age or changes in autonomic reflexes; were significantly associated with depression andanxiety (medication was notrelevant totheassociation); anddidnotcorrelate with motor symptoms. Conclusions. The diagnosis of anxiety and depression in some PD subjects is likely to be a behavioural phenocopy caused by autonomic failure. This explains why antidepressant medication is often unhelpful in PD subjects diagnosed as depressed. Morel (1866) first suggested that anxiety and depression may be related to dysfunction of the ‘¿ ganglionar system'. ‘¿ Dysautonomia' has since been described as being accompanied by â€oe¿ emotional outbursts, agitation, insomnia, depression― (Pearson, 1979). Also, vegetative symptoms correlate with panic attacks in Parkinson's disease (PD) (Vasquez et a!, 1993). However, the nature of the relationship between PD and autonomic failure remains unclear. Oppenheimer (1988) proposed that striatomgral degeneration and olivopontocerebellar atrophy were, in fact, different manifestations of multiple system atrophy (MSA), and reported that about 76% of patients with MSA developed Parkinsomsm. In partial confirmation, a post-mortem study has shown that 24°lo of clinically diagnosed PD subjects are, in fact, suffering from MSA, progressive supranuclear palsy, or Alzheimer's disease (Hughes et a!, 1992). Clinical ascertainment is complicated by the fact that MSA â€oe¿ may present with rapidly progressive Parkinsonism without cerebellar or autonomic disturbance―(Lancet, 1992). Goetz eta! (1986) have reported differences between 32 PD subjects and 10 (unmatched) controls in terms of Valsalva response, supine pulse rate, and postural hypotension, but did not seek to correlate these changes with psychiatric status. Depression is often diagnosed in PD (Starkstein eta!,1990), but thehypothesis thatin some cases it may be a behavioural phenocopy, caused by autonomic failure, has not yet been tested (Berrios & Samuel, 1987). The present studysetout:(a)to compare PD subjects and matched healthy controls on vegetative symptoms and status of autonomic reflexes; and (b)toidentify significant associations between autonomic dysfunction and anxiety and depression. Method Thirty-two subjects with PD and 32 age-matched (±2 years) and sex-matched healthy controls were prospectively studied. The PD patients were randomly selected from the database of the University of Cambridge Department of Psychiatry Parkinson's Disease Project. To be entered into this study, patients were diagnosed both by a consultant neurologist and using standard diagnostic criteria (Zetusky et a!, 1985); some were receiving medication for their PD. The control sample was chosen from the panel of healthy volunteers associated with the Cambridge Medical Research Council's Applied Psychology Unit. The research protocol included the following. General demographic and clinical data were obtainedfrom both samples.

Association Between Autonomic Impairment and Structural Deficit in Parkinson Disease

Medicine, 2016

Patients with Parkinson disease (PD) have impaired autonomic function and altered brain structure. This study aimed to evaluate the relationship of gray matter volume (GMV) determined by voxel-based morphometry (VBM) to autonomic impairment in patients with PD.Whole-brain VBM analysis was performed on 3-dimensional T1-weighted images in 23 patients with PD and 15 sex- and age-matched healthy volunteers. The relationship of cardiovascular autonomic function (determined by survey) to baroreflex sensitivity (BRS) (determined from changes in heart rate and blood pressure during the early phase II of the Valsalva maneuver) was tested using least-squares regression analysis. The differences in GMV, autonomic parameters, and clinical data were correlated after adjusting for age and sex.Compared with controls, patients with PD had low BRS, suggesting worse cardiovascular autonomic function, and smaller GMV in several brain locations, including the right amygdala, left hippocampal formation,...

Cognitive Decline in Patients with Parkinson’s Disease

Romanian Journal of Neurology

The goal of our study was to assess the cognitive state in patients with Parkinson′s disease (PD). We studied 62 patients (30 men and 32 women, mean age 71.1± 4.5 years and mean educational level 11.5 ± 1 years). They were admitted to the Clinic of Neurology from Craiova between January 2015 – January 2016 for Parkinson’s disease. All the patients met the diagnostic criteria for Parkinson′s disease. In this study we included only patients in stage I and II on Hoehn and Yahr scale. 35 patients were in stage I and 27 patients in stage II. The patients were treated with levo-dopa monotherapy or dopaminergic agonists monotherapy. We have also included in our study a control group composed of 70 control subjects with the same range of educational level and age. To assess the cognitive state we tested the patients using Cambridge Cognitive Examination (CAMCOG) and the revised version of the Addenbrooke′s Cognitive Examination (ACE-R) at baseline, after 6 months and one year later. For the...

Assessment of cognition in Parkinson's disease

Neurology, 2003

To develop a short, practical instrument that is sensitive to the specific cognitive deficits in Parkinson's disease (PD) for comparing groups in research situations and for assessing change in cognitive functioning over time. Methods: A literature search was conducted to identify the most frequently affected cognitive domains in PD and to select candidate items for the initial scale. This scale was tested in 85 patients and 75 age-, education-, and sex-matched control subjects. Items that met predefined criteria for data quality, reproducibility, and discriminative properties were included in the final scale. Results: The final scale, the SCOPA-COG (SCales for Outcomes of PArkinson's disease-cognition), consists of 10 items with a maximum score of 43, with higher scores reflecting better performance. The test-retest reliability of the total score was 0.78 (intraclass correlation coefficient) and ranged from 0.40 to 0.75 for individual items (weighted). Cronbach's ␣ was 0.83. Construct validity of the scale was supported by the expected correlations with the CAMCOG (Cambridge Cognitive Examination) and the Mini-Mental State Examination (MMSE) and by differences found between groups of participants classified by dementia status and between patients grouped by disease severity. The scale showed a clear trend toward lower cognition scores for patients with more advanced PD. The coefficient of variation of the SCOPA-COG was higher than that of the CAMCOG or the MMSE, indicating a better ability to detect differences between individuals. Conclusion: The SCOPA-COG is a short, reliable, and valid instrument that is sensitive to the specific cognitive deficits in PD.