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Autonomic dysfunction in Parkinson's disease: A prospective cohort study.
Mov Disord. 2018 03; 33(3):391-397.MD

Abstract

BACKGROUND

Dysautonomia is a frequent and disabling complication of PD, with an estimated prevalence of 30-40% and a significant impact on the quality of life.

OBJECTIVES

To evaluate the rate of progression of dysautonomia and, in particular, orthostatic hypotension, in a cohort of unselected PD patients, and assess the extent to which the progression of dysautonomia affects activities of daily living, health-related quality of life, and health care utilization in PD.

METHODS

We recruited 131 consecutive patients into a 12-month, prospective, observational cohort study. Clinical measures included the International Parkinson and Movement Disorder Society/UPDRS, the Scale for Outcomes in Parkinson Disease-Autonomic, the Orthostatic Hypotension Symptoms Assessment, and orthostatic blood pressure measurements. Health care utilization was quantified as the number of hospitalizations, emergency room visits, and outpatient clinic evaluations.

RESULTS

The overall severity of autonomic symptoms, as measured by the the Orthostatic Hypotension Symptoms Assessment total score, worsened by 20% over 12 months (P < 0.001), with an overall increase in orthostatic hypotension prevalence from 31.1% to 46.7% (P < 0.001). Worsening of autonomic symptoms was independently associated with deterioration in daily living activities (P = 0.021) and health-related quality of life (P = 0.025) adjusting for disease duration, cognitive impairment, and motor severity. Regardless of symptomatic status, orthostatic hypotension was associated with greater deterioration in daily living activities, health care utilization, and falls (P ≤ 0.009) compared to patients without orthostatic hypotension.

CONCLUSIONS

The severity of autonomic symptoms progressed by 20% over 1 year and was independently associated with impairments in daily living activities and health-related quality of life. Symptomatic and asymptomatic orthostatic hypotension were both associated with increased prevalence of falls and health care utilization. © 2017 International Parkinson and Movement Disorder Society.

Authors+Show Affiliations

Gardner Family Center for Parkinson's Disease and Movement Disorders, Department of Neurology, University of Cincinnati, Cincinnati, Ohio, USA.Department of Neuroscience "Rita Levi Montalcini", University of Turin, Torino, Italy.Gardner Family Center for Parkinson's Disease and Movement Disorders, Department of Neurology, University of Cincinnati, Cincinnati, Ohio, USA.Gardner Family Center for Parkinson's Disease and Movement Disorders, Department of Neurology, University of Cincinnati, Cincinnati, Ohio, USA.Gardner Family Center for Parkinson's Disease and Movement Disorders, Department of Neurology, University of Cincinnati, Cincinnati, Ohio, USA.Department of Medical Sciences, Autonomic Unit and Hypertension Unit, University of Turin, Torino, Italy.Department of Neuroscience "Rita Levi Montalcini", University of Turin, Torino, Italy.Gardner Family Center for Parkinson's Disease and Movement Disorders, Department of Neurology, University of Cincinnati, Cincinnati, Ohio, USA.

Pub Type(s)

Journal Article
Research Support, N.I.H., Extramural

Language

eng

PubMed ID

29278286

Citation

Merola, Aristide, et al. "Autonomic Dysfunction in Parkinson's Disease: a Prospective Cohort Study." Movement Disorders : Official Journal of the Movement Disorder Society, vol. 33, no. 3, 2018, pp. 391-397.
Merola A, Romagnolo A, Rosso M, et al. Autonomic dysfunction in Parkinson's disease: A prospective cohort study. Mov Disord. 2018;33(3):391-397.
Merola, A., Romagnolo, A., Rosso, M., Suri, R., Berndt, Z., Maule, S., Lopiano, L., & Espay, A. J. (2018). Autonomic dysfunction in Parkinson's disease: A prospective cohort study. Movement Disorders : Official Journal of the Movement Disorder Society, 33(3), 391-397. https://doi.org/10.1002/mds.27268
Merola A, et al. Autonomic Dysfunction in Parkinson's Disease: a Prospective Cohort Study. Mov Disord. 2018;33(3):391-397. PubMed PMID: 29278286.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - Autonomic dysfunction in Parkinson's disease: A prospective cohort study. AU - Merola,Aristide, AU - Romagnolo,Alberto, AU - Rosso,Michela, AU - Suri,Ritika, AU - Berndt,Zoe, AU - Maule,Simona, AU - Lopiano,Leonardo, AU - Espay,Alberto J, Y1 - 2017/12/26/ PY - 2017/09/04/received PY - 2017/11/09/revised PY - 2017/11/19/accepted PY - 2017/12/27/pubmed PY - 2019/6/14/medline PY - 2017/12/27/entrez KW - Parkinson's disease KW - autonomic KW - orthostatic hypotension KW - supine hypertension SP - 391 EP - 397 JF - Movement disorders : official journal of the Movement Disorder Society JO - Mov Disord VL - 33 IS - 3 N2 - BACKGROUND: Dysautonomia is a frequent and disabling complication of PD, with an estimated prevalence of 30-40% and a significant impact on the quality of life. OBJECTIVES: To evaluate the rate of progression of dysautonomia and, in particular, orthostatic hypotension, in a cohort of unselected PD patients, and assess the extent to which the progression of dysautonomia affects activities of daily living, health-related quality of life, and health care utilization in PD. METHODS: We recruited 131 consecutive patients into a 12-month, prospective, observational cohort study. Clinical measures included the International Parkinson and Movement Disorder Society/UPDRS, the Scale for Outcomes in Parkinson Disease-Autonomic, the Orthostatic Hypotension Symptoms Assessment, and orthostatic blood pressure measurements. Health care utilization was quantified as the number of hospitalizations, emergency room visits, and outpatient clinic evaluations. RESULTS: The overall severity of autonomic symptoms, as measured by the the Orthostatic Hypotension Symptoms Assessment total score, worsened by 20% over 12 months (P < 0.001), with an overall increase in orthostatic hypotension prevalence from 31.1% to 46.7% (P < 0.001). Worsening of autonomic symptoms was independently associated with deterioration in daily living activities (P = 0.021) and health-related quality of life (P = 0.025) adjusting for disease duration, cognitive impairment, and motor severity. Regardless of symptomatic status, orthostatic hypotension was associated with greater deterioration in daily living activities, health care utilization, and falls (P ≤ 0.009) compared to patients without orthostatic hypotension. CONCLUSIONS: The severity of autonomic symptoms progressed by 20% over 1 year and was independently associated with impairments in daily living activities and health-related quality of life. Symptomatic and asymptomatic orthostatic hypotension were both associated with increased prevalence of falls and health care utilization. © 2017 International Parkinson and Movement Disorder Society. SN - 1531-8257 UR - https://www.unboundmedicine.com/medline/citation/29278286/Autonomic_dysfunction_in_Parkinson's_disease:_A_prospective_cohort_study_ DB - PRIME DP - Unbound Medicine ER -