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01-04-2018 | Original Communication

Heterogeneous pattern of autonomic dysfunction in Parkinson’s disease

Authors: Laurène Leclair-Visonneau, Laurent Magy, Christelle Volteau, Thomas Clairembault, Séverine Le Dily, Cécile Préterre, Arnaud Peyre, Philippe Damier, Michel Neunlist, Yann Péréon, Pascal Derkinderen

Published in: Journal of Neurology | Issue 4/2018

Abstract

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.

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Title: Heterogeneous pattern of autonomic dysfunction in Parkinson’s disease
Authors: Laurène Leclair-Visonneau
Laurent Magy
Christelle Volteau
Thomas Clairembault
Séverine Le Dily
Cécile Préterre
Arnaud Peyre
Philippe Damier
Michel Neunlist
Yann Péréon
Pascal Derkinderen
Publication date: 01-04-2018
Publisher: Springer Berlin Heidelberg
Published in: Journal of Neurology / Issue 4/2018
Print ISSN: 0340-5354
Electronic ISSN: 1432-1459
DOI: https://doi.org/10.1007/s00415-018-8789-8

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Heterogeneous pattern of autonomic dysfunction in Parkinson’s disease

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