Abstract
Objectives
To determine demographic or disease-related factors that may influence the severity of autonomic dysfunction in idiopathic Parkinson’s disease (IPD).
Methods
532 patients with IPD aged between 55 and 75 years were included. Severity of autonomic dysfunction was assessed using a 9-item autonomic dysfunction score (ADS). In addition, several demographic factors (e. g. age, gender, comorbidities) and disease- related (e. g. motor stage, disease duration, antiparkinsonian therapy) factors were recorded. A group of 67 age-matched healthy volunteers served as a control group. Demographic and clinical data of this cross-sectional survey were analyzed by a logistic stepwise regression model to determine independent predictors of autonomic dysfunction.
Results
IPD patients showed significantly higher ADS values than controls, even in the youngest age groups and in mild disease stages. Hoehn&Yahr (H&Y) stage, disease duration, age at onset and various therapy combinations all showed significant correlations with ADS. However, stepwise logistic regression revealed that age (OR 10.71; CI 7.17–16.0) and arterial hypertension (OR 3.05; CI 1.66–5.58) were the only independent risk factors associated with autonomic dysfunction. Linear regression indicated that ADS increases with age in controls as well as in patients, but with a significantly steeper slope in the latter.
Conclusions
Autonomic dysfunction as an inherent feature of IPD is present already in early disease stages. According to a logistic regression model, the severity of autonomic dysfunction in IPD is primarily related to demographic but not to disease-related factors. This and the differences in predictors for motor versus autonomic decline may indicate at least partly independent neurodegenerative processes.
Similar content being viewed by others
References
Appenzeller O, Goss JE (1971) Autonomic deficits in Parkinson’s syndrome. Arch Neurol 24:50–57
Awerbuch GI, Sandyk R (1994) Autonomic functions in early stages of Parkinson’s disease. Int J Neurosci 74:9–16
Barbeau A (1984) Etiology of Parkinson’s disease: A research strategy. Can J Neurol Sci 11:24–28
Benarroch EE, Schmeichel AS, Parisi JE (2000) Involvement of the ventrolateral medulla in parkinsonism with autonomic failure. Neurology 54:963–968
Braak H, Braak E (2000) Pathoanatomy of Parkinson’s disease. J Neurol 247 (Suppl 2):3–10
Braak H, Del Tredici K, Rüb U, et al. (2003) Staging of brain pathology related to sporadic Parkinson’s disease. Neuropathol Aging 24:197–211
Bradley JG, Davis KA (2003) Orthostatic hypotension. Am Fam Physician 68:2393–2398
Camerlingo M, Aillon C, Bottacchi E, et al. (1986) Parasympathetic assessment in Parkinson’s disease. Adv Neurol 45:267–269
Daniel SE, Lees AJ (1993) Parkinson’s Disease Society Brain Bank, London: Overview and Research. J Neural Transm 39(Suppl):165–172
Del Tredici K, Rüb U, DeVos RA, Bohl JR, Braak H (2002) Where does Parkinson disease pathology begin in the brain? J Neuropathol Exp Neurol 61:413–426
Edwards L, Pfeiffer RF, Quigley EM, Hofman R, Balluff M (1991) Gastrointestinal symptoms in Parkinson’s disease. Mov Disord 6:151–156
Fahn S, Elton RL, and members of the UPDRS development committee (1987) Unified Parkinson’s Disease rating scale. In: Fahn S, Marsden CD, Goldstein M (eds) Recent development in Parkinson’s disease II. McMillan, New York, pp 153–163
Gerritsen J, Dekker JM, TenVoorde BJ, et al. (2001) Impaired autonomic function is associated with increased mortality, especially in subjects with diabetes, hypertension, or a history of cardiovascular disease: the Hoorn Study. Diabetes Care 24:1793–1798
Gilman S, Low PA,Quinn N, et al. (1999) Consensus statement on the diagnosis of multiple system atrophy. J Neurol Sci 163:94–98
Goetz CG, Lutge W, Tanner CM (1986) Autonomic dysfunction in Parkinson’s disease. Neurology 36:73–75
Haapaniemi TH, Kallio MA, Korpelainen JT, et al. (2000) Levodopa, bromocriptine and selegiline modify cardiovascular responses in Parkinson’s disease. J Neurol 247:868–874
Jankovic J, Kapadia AS (2001) Functional decline in Parkinson’s disease. Arch Neurol 58:1611–1615
Johannes CB, Araujo AB, Feldman HA, et al. (2000) Incidence of erectile dysfunction in men 40 to 69 years old: longitudinal results from the Massachusetts male aging study. J Urol 163:460–463
Jost WH (1995) Disorders of autonomic regulation in Parkinson’s syndrome. Fortschr Neurol Psychiatr 63:194–205
Jost WH (1997) Gastrointestinal motility problems in patients with Parkinson’s disease. Effects of antiparkinsonian treatment and guideline for management. Drugs Aging 10:249–258
Jost WH (2003) Autonomic dysfunction in idiopathic Parkinson’s disease. J Neurol 250(Suppl 1):28–30
Korchounov A, Kessler KR, Schipper HI (2004) Differential effects of various treatment combinations on cardiovascular dysfunction in patients with Parkinson’s disease. Acta Neurol Scand 109:45–51
Korczyn AD (1989) Autonomic nervous system screening in patients with early Parkinson’s disease. In: Przuntek H, Riederer P (eds) Early diagnosis and preventive therapy in Parkinson’s disease. Springer, Wien, pp 41–48
Kupsky WJ, Grimes MM, Sweeting J, Bertsch R, Cote LJ (1987) Parkinson’s disease and megacolon: concentric hyaline inclusions (Lewy bodies) in enteric ganglion cells. Neurology 37:1253–1255
Kubis N, Faucheux BA, Ransmayr G, et al. (2000) Preservation of midbrain catecholaminergic neurons in very old human subjects. Brain 123:366–373
Langston JW, Forno LS (1978) The hypothalamus in Parkinson’s disease. Ann Neurol 3:129–133
Lin HH, Torng PL, Sheu BC, Shau WY, Huang SC (2003) Urodynamically age-specific prevalence of urinary incontinence in women with urinary symptoms. Neurourol Urodyn 22:29–32
Mann DM, Yates PO (1983) Possible role of neuromelanin in the pathogenesis of Parkinson’s disease. Mech Ageing Dev 21:193–203
Martignoni E, Micieli G, Cavallini A, et al. (1986) Autonomic disorders in idiopathic Parkinsonism. J Neural Transm 22(Suppl):149–161
Martignoni E, Pacchetti C, Godi L, Micieli G, Nappi G (1995) Autonomic disorders in Parkinson’s disease. J Neural Transm 45(Suppl):11–19
Mathias CJ (2002) Neurodegeneration, parkinsonian syndromes and autonomic failure. Auton Neurosci 96:50–58
Muthane U, Yasha TC, Shankar SK (1998) Low numbers and no loss of melanized nigral neurons with increasing age in normal human brains from India. Ann Neurol 43:283–287
Olanow CW, Watts RL, Koller WC (2001) An algorithm (decision tree) for the management of Parkinson’s disease (2001): treatment guidelines. Neurology 56(Suppl 5):1–88
Orskov L, Jacobsen J, Dupont E, de Fine Olivarius B, Christensen NJ (1987) Autonomic function in parkinsonian patients related to duration of disease. Neurology 37:1173–1178
Pacchetti C, Sibilla L, Bruggi P, et al. (1990) Autonomic disturbances in Parkinson’s disease and Multisystem Atrophy: Clinical aspects. Funct Neurol 5(Suppl 4):49–56
Perkiomaki JS, Ikaheimo MJ, Pikkujamsa SM, et al. (1996) Dispersion of QT interval and autonomic modulation of heart rate in hypertensive men with and without left ventricular hypertrophy. Hypertension 28:16–21
Quigley EM (1996) Gastrointestinal dysfunction in Parkinson’s disease. Semin Neurol 16:245–250
Sandyk R, Awerbuch GI (1992) Dysautonomia in Parkinson’s disease: relationship to motor disability. Int J Neurosci 64:23–33
Sandyk R (1997) The accelerated aging hypothesis of Parkinson’s disease is not supported by the pattern of circadian melatonin secretion. Int J Neurosci 90:271–275
Siddiqui MF, Rast S, Lynn MJ, Auchus AP, Pfeiffer RF (2002) Autonomic dysfunction in Parkinson’s disease: a comprehensive symptom survey. Parkinsonism Relat Disord 8:277–284
Singer C, Weiner WJ, Sanchez-Ramos JR (1992) Autonomic dysfunction in men with Parkinson’s disease. Eur Neurol 32:134–140
Thulesius O (1976) Pathophysiological classification and diagnosis of orthostatic hypotension. Cardiology 61 (Suppl 1):180–196
Tilvis RS, Hakala SM, Valvanne J, Erkinjuntti T (1996) Postural hypotension and dizziness in a general aged population: a four-year follow-up of the Helsinki Aging Study. J Am Geriatr Soc 44:809–814
Turkka JT (1987) Correlation of the severity of autonomic dysfunction to cardiovascular reflexes and to plasma noradrenaline levels in Parkinson’s disease. Eur Neurol 26:203–210
van Dijk JG, Haan J, Zwinderman K, et al. (1993) Autonomic nervous system dysfunction in Parkinson’s disease: relationships with age, medication, duration, and severity. J Neurol Neurosurg Psychiatry 56:1090–1095
Wakabayashi W, Takahashi H(1997) Neuropathology of autonomic nervous system in Parkinson’s disease. Eur Neurol 38(Suppl 2):2–7
Author information
Authors and Affiliations
Corresponding author
Rights and permissions
About this article
Cite this article
Korchounov, A., Kessler, K.R., Yakhno, N.N. et al. Determinants of autonomic dysfunction in idiopathic Parkinson’s disease. J Neurol 252, 1530–1536 (2005). https://doi.org/10.1007/s00415-005-0909-6
Received:
Revised:
Accepted:
Issue Date:
DOI: https://doi.org/10.1007/s00415-005-0909-6