Heterogeneous pattern of autonomic dysfunction in Parkinson’s disease
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Dysautonomic symptoms are frequent non-motor complaints in patients with Parkinson’s disease. Numerous neuropathological studies have shown that Lewy bodies and neurites, the pathological hallmarks of Parkinson’s disease, are widely distributed throughout the peripheral autonomic nervous systems and across end organs. However, few investigations integrally explored the symptoms and physiology of dysautonomia in Parkinson’s disease. We, therefore, performed a comprehensive evaluation of the autonomic function in a prospective group of 45 patients with idiopathic Parkinson’s disease. Autonomic components (pupillomotor, tear, salivary, cardiovascular, digestive, urinary, sexual, sudomotor functions and skin sensitivity) were evaluated using questionnaires and functional tests. Skin biopsy was performed for intraepidermal nerve fibre density quantification. In addition, all patients underwent polysomnography and a complete neuropsychological and neurological assessment. The analysis association of autonomic components showed that dysautonomic signs and symptoms were heterogeneously distributed among patients. Skin denervation as assessed by intraepidermal nerve fibre density quantification was only associated with quantitative thermal sensory testing (OR = 12.0, p = 0.02), constipation (OR = 5.5, p = 0.01) and ocular dryness symptoms (OR = 8.29, p = 0.04). Cognitive alteration was associated with cardiovascular symptoms (OR = 4.33, p = 0.03) and dysfunction (OR = 5.83, p = 0.02) as well as with constipation (OR = 5.38, p = 0.02). Axial motor impairment and rapid eye movement (REM) sleep behaviour disorder were not related to any of the autonomic complaint or dysfunction. Our results show that autonomic functions are affected in a heterogeneous pattern in Parkinson’s disease, thereby suggesting that the progression of autonomic dysfunction follows an erratic rather than a stepwise progression.
KeywordsDysautonomia Electrophysiology Intraepidermal nerve fibre density Parkinson’s disease Cognitive alteration
Autonomic nervous system
Enteric nervous system
Intraepidermal nerve fibre
Mattis dementia rating scale
Mini-mental state examination
Montreal cognitive assessment
Nerve conduction velocity
Non-motor symptoms questionnaire
Quantitative thermal sensory testing
Rapid eye movement sleep behaviour disorder
Rapid eye movement
SCales for Outcomes in PArkinson’s disease-autonomic symptoms
Sympathetic skin response
Unified Parkinson’s disease rating scale part III
Laurence Richard, Fanny Maquin, Monique Marguerite, Aurélie Grateau, Marion Rigot, Monica Roy, Aurélie Delhumeau and Alexandra Gosseaume for technical assistance, collecting and monitoring data. Tiphaine Rouaud, Violaine Talmant, Mirela Faighel and Marylène Jacq-Foucher for their help in selecting patients. David Laplaud and Paul Sauleau for their advices regarding data analysis. Patients and relatives for giving their time in participating in the study.
Nantes University Hospital was the study promoter. This work was supported by a Grant from Nantes University Hospital (Appel d’offre interne 2012, Grant number RC12_0264) and France Parkinson.
Compliance with ethical standards
Conflicts of interest
Authors report no disclosure relevant to the research covered in this article.
Ethical standard statement
This study was carried out in accordance with the Declaration of Helsinki, conducted with the approval of the local Ethical Committee (Comité de protection des personnes Ouest VI, France).
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