title: Autonomic function in a prevalent Tanzanian population with Parkinson's disease and its relationship to disease duration and 5-year mortality.
abstract: BACKGROUND
  Autonomic dysfunction is common in patients with Parkinson's disease (PD). We report autonomic function test results in a prevalent, largely untreated, Tanzanian population of PD patients, at different disease stages and investigate the relationship between autonomic dysfunction and mortality.
  
  
  METHODS
  Ewing's battery of autonomic tests was carried out on a prevalent population of PD patients living in the rural Hai district of Tanzania. Where possible, all four tests were performed in the patient's home. The main outcome of interest was the presence of abnormalities of sympathetic or parasympathetic function. Information on medications used and other co-morbidities was recorded.
  
  
  RESULTS
  Autonomic function tests were recorded for 29 subjects, of whom 3 were on medication at the time of assessment. Of the 26 unmedicated patients, 14 (53.8%) had at least one abnormal test result for autonomic function, of whom only 3 (21.4%) were in late stage disease (Hoehn and Yahr stage IV or V), compared to 7 (58.3%) of 12 with normal autonomic function tests in late stage disease. Ten subjects had died at 5-year follow-up, but there was no association between mortality and autonomic function test abnormalities.
  
  
  CONCLUSIONS
  In unmedicated subjects, many patients in late stage disease had relatively preserved autonomic function, compared to those in early stage disease. In people with PD who are taking medication, it may be that when autonomic dysfunction presents in late stage disease it is often due to side effects of medication rather than the disease itself.
authors.affiliation: Department of Internal Medicine, Muhimbili University College of Health Sciences, Dar es Salaam, Tanzania. ariseric4@gmail.com.
authors.forename: Eric
authors.initials: E
authors.lastname: Aris
authors.forename: Catherine L
authors.initials: CL
authors.lastname: Dotchin
authors.forename: William K
authors.initials: WK
authors.lastname: Gray
authors.forename: Richard W
authors.initials: RW
authors.lastname: Walker
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D017776:Autonomic Pathways / Q000502:physiology*; D001794:Blood Pressure; D005260:Female; D018737:Hand Strength; D006339:Heart Rate; D006801:Humans; D008297:Male; D008875:Middle Aged; D010300:Parkinson Disease / Q000401:mortality / Q000503:physiopathology*; D012424:Rural Population; D012720:Severity of Illness Index; D016019:Survival Analysis; D013636:Tanzania