Abstract
Differential diagnosis of parkinsonian syndromes is a major challenge in movement disorders. Dysautonomia is a common feature but may vary in clinical severity and onset. The study attempted to find a pattern of autonomic abnormalities discriminative for patients with different parkinsonian syndromes. The cross-sectional study included 38 patients with multiple system atrophy (MSA), 32 patients with progressive supranuclear palsy (PSP), 26 patients with idiopathic Parkinson’s disease (IPD) and 27 age-matched healthy controls. Autonomic symptoms were evaluated by a standardized questionnaire. The performance of patients and controls was compared on five autonomic function tests: deep breathing, Valsalva manoeuvre, tilt-table testing, sympathetic skin response, pupillography, and 24-h ambulatory blood pressure monitoring (ABPM). Disease severity was significantly lower in IPD than PSP and MSA. Except for pupillography, none of the laboratory autonomic tests distinguished one patient group from the other alone or in combination. The same was observed on the questionnaire. Receiver operating characteristic curve revealed discriminating performance of pupil diameter in darkness and nocturnal blood pressure change. The composite score of urogenital and vasomotor domains significantly distinguished MSA from IPD patients but not from PSP. Our study supports the observation that even mild IPD is frequently indistinguishable from more severe MSA and PSP. Thus, clinical combination of motor and non-motor symptoms does not exclusively point at MSA. Pupillography, ABPM and the questionnaire may assist in delineating the three syndromes when applied in combination.
Similar content being viewed by others
References
(1996) Consensus statement on the definition of orthostatic hypotension, pure autonomic failure, and multiple system atrophy. The Consensus Committee of the American Autonomic Society and the American Academy of Neurology. Neurology 46:1470
Abbott RD, Petrovitch H, White LR, Masaki KH, Tanner CM, Curb JD, Grandinetti A, Blanchette PL, Popper JS, Ross GW (2001) Frequency of bowel movements and the future risk of Parkinson’s disease. Neurology 57:456–462
Bensimon G, Ludolph A, Agid Y, Vidailhet M, Payan C, Leigh PN (2009) Riluzole treatment, survival and diagnostic criteria in Parkinson plus disorders: the NNIPPS study. Brain 132:156–171
Bordet R, Benhadjali J, Destee A, Hurtevent JF, Bourriez JL, Guieu JD (1996) Sympathetic skin response and R–R interval variability in multiple system atrophy and idiopathic Parkinson’s disease. Mov Disord 11:268–272
Braune S, Reinhardt M, Schnitzer R, Riedel A, Lucking CH (1999) Cardiac uptake of [123I]MIBG separates Parkinson’s disease from multiple system atrophy. Neurology 53:1020–1025
Chaudhuri KR, Martinez-Martin P (2008) Quantitation of non-motor symptoms in Parkinson’s disease. Eur J Neurol 15(Suppl 2):2–8
Chaudhuri KR, Healy DG, Schapira AH (2006) Non-motor symptoms of Parkinson’s disease: diagnosis and management. Lancet Neurol 5:235–245
De Marinis M, Stocchi F, Gregori B, Accornero N (2000) Sympathetic skin response and cardiovascular autonomic function tests in Parkinson’s disease and multiple system atrophy with autonomic failure. Mov Disord 15:1215–1220
Friedrich C, Rudiger H, Schmidt C, Herting B, Prieur S, Junghanns S, Schweitzer K, Globas C, Schols L, Berg D, Reichmann H, Ziemssen T (2008) Baroreflex sensitivity and power spectral analysis in different extrapyramidal syndromes. J Neural Transm 115:1527–1536
Gilman S, Low P, Quinn N, Albanese A, Ben-Shlomo Y, Fowler C, Kaufmann H, Klockgether T, Lang A, Lantos P, Litvan I, Mathias C, Oliver E, Robertson D, Schatz I, Wenning G (1998) Consensus statement on the diagnosis of multiple system atrophy. American Autonomic Society and American Academy of Neurology. Clin Auton Res 8:359–362
Gurevich TY, Groozman GB, Giladi N, Drory VE, Hausdorff JM, Korczyn AD (2004) R–R interval variation in Parkinson’s disease and multiple system atrophy. Acta Neurol Scand 109:276–279
Hoehn MM, Yahr MD (1967) Parkinsonism: onset, progression and mortality. Neurology 17:427–442
Holmberg B, Kallio M, Johnels B, Elam M (2001) Cardiovascular reflex testing contributes to clinical evaluation and differential diagnosis of Parkinsonian syndromes. Mov Disord 16:217–225
Hughes AJ, Daniel SE, Kilford L, Lees AJ (1992) Accuracy of clinical diagnosis of idiopathic Parkinson’s disease: a clinico-pathological study of 100 cases. J Neurol Neurosurg Psychiatry 55:181–184
Jörg J (2001) Autonome Diagnostik und Schlafpolygraphie in Klinik und Praxis. Steinkopf, Darmstadt
Korchounov A, Kessler KR, Yakhno NN, Damulin IV, Schipper HI (2005) Determinants of autonomic dysfunction in idiopathic Parkinson’s disease. J Neurol 252:1530–1536
Litvan I, Agid Y, Calne D, Campbell G, Dubois B, Duvoisin RC, Goetz CG, Golbe LI, Grafman J, Growdon JH, Hallett M, Jankovic J, Quinn NP, Tolosa E, Zee DS (1996) Clinical research criteria for the diagnosis of progressive supranuclear palsy (Steele–Richardson–Olszewski syndrome): report of the NINDS-SPSP international workshop. Neurology 47:1–9
Magalhaes M, Wenning GK, Daniel SE, Quinn NP (1995) Autonomic dysfunction in pathologically confirmed multiple system atrophy and idiopathic Parkinson’s disease—a retrospective comparison. Acta Neurol Scand 91:98–102
Magerkurth C, Schnitzer R, Braune S (2005) Symptoms of autonomic failure in Parkinson’s disease: prevalence and impact on daily life. Clin Auton Res 15:76–82
Omboni S, Smit AA, van Lieshout JJ, Settels JJ, Langewouters GJ, Wieling W (2001) Mechanisms underlying the impairment in orthostatic tolerance after nocturnal recumbency in patients with autonomic failure. Clin Sci (Lond) 101:609–618
Papapetropoulos S, Argyriou AA, Chroni E (2006) No correlation between the clinical severity of autonomic symptoms (SCOPA-AUT) and electrophysiological test abnormalities in advanced Parkinson’s disease. Mov Disord 21:430–431
Pickering TG, Hall JE, Appel LJ, Falkner BE, Graves J, Hill MN, Jones DW, Kurtz T, Sheps SG, Roccella EJ (2005) Recommendations for blood pressure measurement in humans and experimental animals. Part 1. Blood pressure measurement in humans: a statement for professionals from the Subcommittee of Professional and Public Education of the American Heart Association Council on High Blood Pressure Research. Circulation 111:697–716
Piha SJ, Halonen JP (1994) Infrared pupillometry in the assessment of autonomic function. Diabetes Res Clin Pract 26:61–66
Poewe W (2008) Non-motor symptoms in Parkinson’s disease. Eur J Neurol 15(Suppl 1):14–20
Riley DE, Chelimsky TC (2003) Autonomic nervous system testing may not distinguish multiple system atrophy from Parkinson’s disease. J Neurol Neurosurg Psychiatry 74:56–60
Schmidt C, Herting B, Prieur S, Junghanns S, Schweitzer K, Globas C, Schols L, Antoni S, Ferger D, Reichmann H, Wilhelm H, Berg D, Ziemssen T (2007) Pupil diameter in darkness differentiates progressive supranuclear palsy (PSP) from other extrapyramidal syndromes. Mov Disord 22:2123–2126
Schmidt C, Herting B, Prieur S, Junghanns S, Schweitzer K, Globas C, Schöls L, Reichmann H, Berg D, Ziemssen T (2008a) Autonomic dysfunction in different subtypes of multiple system atrophy. Mov Disord 23:1766–1772
Schmidt C, Herting B, Prieur S, Junghanns S, Schweitzer K, Reichmann H, Berg D, Ziemssen T (2008b) Autonomic dysfunction in patients with progressive supranuclear palsy. Mov Disord 23:2083–2089
Schmidt C, Herting B, Prieur S, Junghanns S, Schweitzer K, Globas C, Schols L, Reichmann H, Berg D, Ziemssen T (2009) Valsalva manoeuvre in patients with different Parkinsonian disorders. J Neural Transm 116:875–880
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
Smith SA (1982) Reduced sinus arrhythmia in diabetic autonomic neuropathy: diagnostic value of an age-related normal range. Br Med J (Clin Res Ed) 285:1599–1601
Smith SA, Smith SE (1999) Pupil function: tests and disorders. In: Mathias CJ, Bannister SR (eds) Autonomic failure, 4th edn. Oxford University Press, Oxford, pp 245–253
Verbaan D, Marinus J, Visser M, van Rooden SM, Stiggelbout AM, van Hilten JJ (2007) Patient-reported autonomic symptoms in Parkinson disease. Neurology 69:333–341
Vinik AI, Maser RE, Mitchell BD, Freeman R (2003) Diabetic autonomic neuropathy. Diabetes Care 26:1553–1579
Visser M, Marinus J, Stiggelbout AM, Van Hilten JJ (2004) Assessment of autonomic dysfunction in Parkinson’s disease: the SCOPA-AUT. Mov Disord 19:1306–1312
Walter BL (2008) Cardiovascular autonomic dysfunction in patients with movement disorders. Cleve Clin J Med 75(Suppl 2):S54–S58
Ziemssen T, Schmidt C, Herting B, Reichmann H (2006) Autonomic dysfunction in Parkinson’s disease and multiple system atrophy. Akt Neurol 33:385–393
Conflict of interest statement
None.
Author information
Authors and Affiliations
Corresponding author
Rights and permissions
About this article
Cite this article
Reimann, M., Schmidt, C., Herting, B. et al. Comprehensive autonomic assessment does not differentiate between Parkinson’s disease, multiple system atrophy and progressive supranuclear palsy. J Neural Transm 117, 69–76 (2010). https://doi.org/10.1007/s00702-009-0313-y
Received:
Accepted:
Published:
Issue Date:
DOI: https://doi.org/10.1007/s00702-009-0313-y