Impact of autonomic symptoms on the clinical course of Parkinson’s disease

Abstract Purpose Autonomic dysfunction is a candidate marker for predicting clinical outcomes in patients with Parkinson's disease (PD), butthe impact of the severity of autonomic symptoms on the subsequent progression of PD has not been fully elucidated. The purpose of this study was to investigate the impact of the severity of autonomic symptoms on the clinical prognosis of patients with PD. Methods Seventy-four consecutive patients with PD were classified into two groups, defined by severe or mild autonomic symptoms, using the Scales for Outcomes in PD–autonomic dysfunction (SCOPA-AUT). The time to endpoints (discontinuation of visits because of hospital admission, death, or institutionalization) was evaluated retrospectively four to six years after the initial evaluation and compared between the two groups. We also investigated factors associated with poor prognosis. Results The patients with high SCOPA-AUT scores reached the endpoints in a shorter time than those with low SCOPA-AUT scores (median time, 1452 days vs. 1699 days; P=0.006). The proportion of patients who were admitted or died was significantly higher among the patients with high SCOPA-AUT scores than among those with low SCOPA-AUT scores (43.9% vs. 12.1%, P =0.003). In the Cox survival analysis, high SCOPA-AUT (hazard ratio, 3.646; 95% CI, 1.143-11.633; p = 0.029) and Movement Disorder Society Unified Parkinson’s Disease Rating Scale (MDS-UPDRS) Part III (hazard ratio, 1.036; 95% CI, 1.005-1.069; p = 0.024) scores were associated with faster progression. Conclusions The clinical course of PD was poor when autonomic symptoms were severe.