Long-term clinical evaluation in patients with Parkinson's disease and early autonomic involvement.
OBJECTIVE
To evaluate in a prospective longitudinal study the evolution of functional disability and the response to dopaminergic therapy in PD patients with and without autonomic involvement.


METHODS
Sixty untreated consecutive patients with PD underwent autonomic cardiovascular function evaluation using the five autonomic tests of Ewing. An integrated index (Autonomic Score=AS), taking in account the results of all subtests, was calculated. Patients were treated with pergolide and bromocriptine during a 5-year follow-up until the level of functional disability was sufficient to warrant the initiation of levodopa therapy.


RESULTS
Results of autonomic testing were compared with those of a group of age-matched healthy subjects. A value of AS>2 was considered as indicative of autonomic failure. Eighteen patients with PD (35%) showed AS>2 (autonomically impaired group=AI), the remaining 33 (65%) had AS<2 (nonautonomically impaired group=non-AI). During the follow-up levodopa was added to the treatment regimen of 10/18 (55%) patients in AI group, and 6/33 (18%) patients in non-AI group (p<.01).


CONCLUSIONS
The increased occurrence of levodopa adjunct in autonomically impaired PD suggests that there is a more rapid deterioration of functional performance in parkinsonian patients with early autonomic involvement.
Department of Neuroscience, University of Pisa, Italy.
Claudio
C
Lucetti
Gianna
G
Gambaccini
Paolo
P
Del Dotto
Roberto
R
Ceravolo
Chiara
C
Logi
Giuseppe
G
Rossi
Luigi
L
Murri
Ubaldo
U
Bonuccelli
D000368:Aged; D000978:Antiparkinson Agents / Q000627:therapeutic use; D001341:Autonomic Nervous System / Q000503:physiopathology*; D001971:Bromocriptine / Q000627:therapeutic use; D004185:Disability Evaluation; D018450:Disease Progression; D018491:Dopamine Agonists / Q000009:adverse effects / Q000627:therapeutic use; D004359:Drug Therapy, Combination; D005260:Female; D005500:Follow-Up Studies; D006439:Hemodynamics / Q000502:physiology; D006801:Humans; D007980:Levodopa / Q000627:therapeutic use; D008137:Longitudinal Studies; D008297:Male; D008875:Middle Aged; D010300:Parkinson Disease / Q000188:drug therapy / Q000503:physiopathology*; D010479:Pergolide / Q000627:therapeutic use; D011379:Prognosis; D016019:Survival Analysis
D000978:Antiparkinson Agents; D018491:Dopamine Agonists; D010479:Pergolide; D001971:Bromocriptine; D007980:Levodopa