Abstract
Purpose
Urban, minority communities are disproportionately affected by the chronic diseases associated with autonomic neuropathy; however validated measures of autonomic symptoms have not been studied in these complex populations. We sought to validate the Autonomic Symptom Profile (ASP) in a low income, medically complex, urban patient population.
Methods
Ninety-seven adults were recruited from the outpatient neurology clinic of an academic medical center serving the East Harlem neighborhood of New York City. Participants completed the ASP, and underwent a comprehensive neurologic examination, and a standardized battery of autonomic function tests (quantitative sweat testing, heart rate response to deep breathing (HRDB), Valsalva maneuver, and tilt table). Burden of chronic disease was summarized using the Charlson co-morbidity index (CCI), and detailed medication history was obtained.
Results
The ASP displayed good internal consistency (Cronbach’s α = .88), even among lower literacy participants. In univariate analyses, the ASP was correlated with HRDB (r = −.301, p = .002), a marker of cardiac autonomic neuropathy, with the CCI (r = .37, p < .001), and with use of medications with autonomic effects [t(95) = −2.13, p = .036]. However, in multivariate analysis, only the CCI remained significant.
Conclusions
In this urban, predominantly minority patient population, the symptoms captured by the ASP were more closely associated with burden of medical disease than with autonomic dysfunction. Due to this lack of specificity, it is essential that results from autonomic questionnaires be interpreted in the context of the neurologic history and exam, burden of co-morbid illness and medications, and most importantly autonomic function tests.
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References
Kennedy WR, Navarro X, Sutherland DE (1995) Neuropathy profile of diabetic patients in a pancreas transplantation program. Neurology 45(4):773–780
Robinson-Papp J, Sharma S, Simpson DM, Morgello S (2013) Autonomic dysfunction is common in HIV and associated with distal symmetric polyneuropathy. J Neurovirol 19(2):172–180
Suarez GA, Opfer-Gehrking TL, Offord KP, Atkinson EJ, O’Brien PC, Low PA (1999) The Autonomic Symptom Profile: a new instrument to assess autonomic symptoms. Neurology 52(3):523–528
Low PA (1993) Composite autonomic scoring scale for laboratory quantification of generalized autonomic failure. Mayo Clin Proc 68(8):748–752
Cai FZ, Lester S, Lu T et al (2008) Mild autonomic dysfunction in primary Sjogren’s syndrome: a controlled study. Arthritis Res Ther 10(2):R31
Low PA, Benrud-Larson LM, Sletten DM, Opfer-Gehrking TL, Weigand SD, O’Brien PC, Suarez GA, Dyck PJ (2004) Autonomic symptoms and diabetic neuropathy: a population-based study. Diabetes Care 27(12):2942–2947
Newton JL, Frith J, Powell D et al (2012) Autonomic symptoms are common and are associated with overall symptom burden and disease activity in primary Sjogren’s syndrome. Ann Rheum Dis 71(12):1973–1979
Solano C, Martinez A, Becerril L et al (2009) Autonomic dysfunction in fibromyalgia assessed by the composite autonomic symptoms scale (COMPASS). J Clin Rheumatol 15(4):172–176
Carter JS, Pugh JA, Monterrosa A (1996) Non-insulin-dependent diabetes mellitus in minorities in the United States. Ann Intern Med 125(3):221–232
Centers for Disease Control and Prevention. HIV/AIDS surveillance report (2014) http://www.cdc.gov/hiv/topics/surveillance/resources/reports/. Accessed 7 2016
Charlson ME, Pompei P, Ales KL, MacKenzie CR (1987) A new method of classifying prognostic comorbidity in longitudinal studies: development and validation. J Chronic Dis 40(5):373–383
Rudolph JL, Salow MJ, Angelini MC, McGlinchey RE (2008) The anticholinergic risk scale and anticholinergic adverse effects in older persons. Arch Intern Med 168(5):508–513
Wilkinson G (1993) Wide range achievement test, 3rd ed. administration manual. Delaware: Wide Range Inc., 1993
Fahn S, Elton RL, UPDRS program members. Unified Parkinsons Disease Rating Scale. In: Fahn S, Marsden CD, Goldstein M, Calne DB, eds. Recent developments in Parkinsons Disease. Vol 2. Florham Park, NJ: Macmillan Healthcare Information; 1987:153-153-163
Hillel AD, Miller RM, Yorkston K, McDonald E, Norris FH, Konikow N (1989) Amyotrophic lateral sclerosis severity scale. Neuroepidemiology 8(3):142–150
Shulman LM, Gruber-Baldini AL, Anderson KE, Fishman PS, Reich SG, Weiner WJ (2010) The clinically important difference on the Unified Parkinson’s Disease Rating Scale. Arch Neurol 67(1):64–70
Acknowledgments
The authors thank Dr. Phillip Low, MD and the faculty and staff of the autonomic laboratory at the Mayo Clinic in Rochester, MN for providing the Autonomic Symptom Profile and instruction on its use.
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Conflict of interest
This work was supported in part by a grant from the National Institute of Neurologic Disorders and Stroke (K23 NS066789, PI: Robinson-Papp). The authors have no relevant conflicts of interest to report.
Ethical standards
All procedures were performed according to a protocol approved by the Icahn School of Medicine at Mount Sinai Institutional Review Board, and are in accordance with the ethical standards laid down in the 1964 Declaration of Helsinki and its later amendments. All participants provided written informed consent.
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Robinson-Papp, J., Sharma, S.K., George, M.C. et al. Assessment of autonomic symptoms in a medically complex, urban patient population. Clin Auton Res 27, 25–29 (2017). https://doi.org/10.1007/s10286-016-0384-4
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DOI: https://doi.org/10.1007/s10286-016-0384-4