title: Autonomic dysfunction in subjects at high risk for Parkinson's disease.
abstract: Aim of this project was to evaluate autonomic dysfunction in subjects proposed to be at high risk to develop Parkinson's disease (PD) compared to control subjects and PD patients at different disease stages. Combinations of substantia nigra hyperechogenicity (SN+) assessed by transcranial ultrasound (TCS), hyposmia, lifetime prevalence of depression and mild PD-specific motor signs were used to identify subjects at high risk for motor Parkinson's disease (HR-PD). Supine and standing blood pressure (BP), hearth rate (HR), orthostatic, urinary, sexual and bowel symptoms were evaluated in HR-PD, healthy control subjects and PD patients, divided into mild and advanced stages. The study group consisted of 113 PD patients (mild PD n = 71, advanced PD, n = 42), 40 HR-PD individuals and 50 controls. Compared to controls, HR-PD subjects complained more often about urinary (p = 0.002) and bowel dysfunction (p = 0.001) and had a higher diastolic BP drop after standing (p = 0.01). The cumulative number of autonomic symptoms differentiated PD as well as HR-PD significantly from controls (p < 0.001). Advanced PD patients presented often and severe orthostatic symptoms, not significantly different from mild PD after concomitant medication correction. Our results support the presence of urinary and bowel dysfunction in subjects at high risk for motor PD. Presence and severity of orthostatic symptoms was higher during stages and increase in advanced stages, at least partly due to increase in dopaminergic and conflicting medication. Understanding the progression of non-motor aspects in PD might offer the possibility to use them as targets for disease-modifying therapies.
authors.affiliation: Department of Neurodegeneration, Hertie Institute for Clinical Brain Research, University of Tuebingen, Hoppe Seyler-Strasse 3, 72076, Tuebingen, Germany.|German Center of Neurodegenerative Diseases, University of Tübingen, Tuebingen, Germany.
authors.forename: Inga
authors.initials: I
authors.lastname: Liepelt-Scarfone
authors.affiliation: Department of Neurodegeneration, Hertie Institute for Clinical Brain Research, University of Tuebingen, Hoppe Seyler-Strasse 3, 72076, Tuebingen, Germany. pilottoandreae@gmail.com.|Neurology Unit, Department of Clinical and Experimental Sciences, University of Brescia, Brescia, Italy. pilottoandreae@gmail.com.
authors.forename: Andrea
authors.identifier: http://orcid.org/0000-0003-2029-6606
authors.initials: A
authors.lastname: Pilotto
authors.affiliation: Department of Neurodegeneration, Hertie Institute for Clinical Brain Research, University of Tuebingen, Hoppe Seyler-Strasse 3, 72076, Tuebingen, Germany.|German Center of Neurodegenerative Diseases, University of Tübingen, Tuebingen, Germany.
authors.forename: Katharina
authors.initials: K
authors.lastname: Müller
authors.affiliation: Department of Neurodegeneration, Hertie Institute for Clinical Brain Research, University of Tuebingen, Hoppe Seyler-Strasse 3, 72076, Tuebingen, Germany.|German Center of Neurodegenerative Diseases, University of Tübingen, Tuebingen, Germany.
authors.forename: Christian
authors.initials: C
authors.lastname: Bormann
authors.affiliation: Department of Neurodegeneration, Hertie Institute for Clinical Brain Research, University of Tuebingen, Hoppe Seyler-Strasse 3, 72076, Tuebingen, Germany.|German Center of Neurodegenerative Diseases, University of Tübingen, Tuebingen, Germany.
authors.forename: Katharina
authors.initials: K
authors.lastname: Gauss
authors.affiliation: Department of Neurodegeneration, Hertie Institute for Clinical Brain Research, University of Tuebingen, Hoppe Seyler-Strasse 3, 72076, Tuebingen, Germany.|German Center of Neurodegenerative Diseases, University of Tübingen, Tuebingen, Germany.
authors.forename: Isabel
authors.initials: I
authors.lastname: Wurster
authors.affiliation: Janssen Research and Development, Janssen-Pharmaceutical Companies of Johnson & Johnson, Raritan, USA.
authors.forename: Johannes
authors.initials: J
authors.lastname: Streffer
authors.affiliation: Department of Neurodegeneration, Hertie Institute for Clinical Brain Research, University of Tuebingen, Hoppe Seyler-Strasse 3, 72076, Tuebingen, Germany.|German Center of Neurodegenerative Diseases, University of Tübingen, Tuebingen, Germany.
authors.forename: Daniela
authors.initials: D
authors.lastname: Berg
mesh_terms: D000368:Aged; D001342:Autonomic Nervous System Diseases / Q000209:etiology / Q000503:physiopathology*; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D010300:Parkinson Disease / Q000150:complications / Q000503:physiopathology*; D062706:Prodromal Symptoms; D012306:Risk; D012720:Severity of Illness Index
keywords: Autonomic; Bowel; Parkinson’s disease; Prodromal; Urinary