Lower Urinary Tract and Gastrointestinal Dysfunction Are Common in Early Parkinson’s Disease

Abstract

Purpose. Autonomic dysfunction is a common nonmotor feature and early manifestation of Parkinsons disease (PD). Autonomic dysfunction in PD is associated with a worse prognosis. We sought to characterize autonomic dysfunction and identify associated factors in patients with early PD. Methods. An observational, cross-sectional, descriptive, and analytical study was conducted to evaluate patients with early PD from the Parkinsons Progression Markers Initiative. We utilized the Scales for Outcomes in Parkinsons Disease-Autonomic dysfunction questionnaire to determine the prevalence and frequencies of autonomic symptomatology. The cohort was grouped into high and low dysautonomic scores. A regression model identified variables that independently explained dysautonomic scores in our early PD cohort. Results. 414 PD patients had a mean age of 61.1 (SD 9.7) years at diagnosis and mean disease duration of 6.7 (SD 6.6) months. Among all patients, 43.7% (181/414) had high dysautonomic scores. Urinary and gastrointestinal symptoms were the most prevalent and frequently reported dysautonomic symptoms. Patients with fatigue (beta = 4.28, p < 0.001 ), probable rapid eye movement sleep behavior disorder (beta = 2.71, p < 0.001 ), excessive daytime sleepiness (beta = 1.88, p = 0.039 ), impulsivity and compulsivity (beta = 2.42, p < 0.001 ), and increasing age (beta = 1.05, p < 0.001 ) were more likely to have high dysautonomic scores. Conclusion. Lower urinary tract and gastrointestinal symptoms are prevalent and frequent in early PD patients. Fatigue, sleep disorders, impulsivity and compulsivity, and age are predictors of autonomic dysfunction. Autonomic symptoms predominated in this group of early PD patients in the disease course and were associated with more severe disease.

Dysautonomia and functional impairment in rare developmental and epileptic encephalopathies: the other nervous system

“…19 In Alzheimer or Parkinson disease, autonomic impairment is recognized as a complication requiring additional therapy and management and may be a marker of disease severity. 20,21 Thus, our findings of a high level of autonomic symptoms and correlation between burden of autonomic symptoms and functional impairment are consistent with findings of autonomic dysfunction seen in other brain conditions.…”

Long-term Risk of Parkinson Disease Following Influenza and Other Infections

“…Urinary tract infections and neurogenic bladder are a particularly significant source of morbidity among patients with PD, [29][30][31] and autonomic dysfunction, predisposing to urinary tract infection, often appears during the prodromal phase. 26,32 Nevertheless, we cannot dismiss the possibility that urinary tract infection is also a risk factor for PD. Moreover, it is possible that the prodromal phase in some patients with PD may be shorter than 10 years, so we cannot completely discount a causal role for other infections within 5 years of diagnosed PD.…”

“…It is possible that urinary tract infections might be a very early manifestation of PD rather than a causative factor. Urinary tract infections and neurogenic bladder are a particularly significant source of morbidity among patients with PD, and autonomic dysfunction, predisposing to urinary tract infection, often appears during the prodromal phase …”

Parkinson‐like early autonomic dysfunction induced by vagal application of DOPAL in rats

“…The evidence from this investigation definitely extends our current understanding of the etiology of PD that may initiate from the peripheral site due presumably to an unusual metabolism of DA and accumulation of DOPAL, consequently mediating α‐Syn aggregation and causing further dysfunction of central dopaminergic system through toxic effect of DOPAL and α‐Syn on axonal transportation, eventually causing an early autonomic dysfunction of BP regulation. This autonomic failure of BP regulation of PD is strongly supported by recent finding that lower urinary track and gastrointestinal dysfunction are common in early PD 52–54 and these non‐motor deficits of during early PD development such as autonomic dysfunction are well described in a recent review article 55 . The better understanding of early autonomic dysfunction and underlying mechanisms is definitely required to offer better therapeutic options to PD patients 56,57 …”