Autonomic cardiovascular dysregulation and other non-motor manifestations of Parkinson’s disease

Most patients with Parkinson’s disease (PD) experience autonomic cardiovascular dysfunction (insufficiency), which, together with other nonmotor manifestations, negatively affects quality of life and disease progression.

Objective: to assess the relationship between autonomic cardiovascular dysfunction and other non-motor symptoms of PD.

Material and methods. A total of 252 patients with PD Hoehn and Yahr stages I–III were examined. The evaluation included: a questionnaire aimed at identifying symptoms of orthostatic intolerance (OI), orthostatic test, evaluation using the Unified Parkinson’s Disease Rating Scale (UPDRS I–IV), the Schwab and England Activities of Daily Living Scale (Sch&En), the Mini-Mental State Examination (MMSE), the Non-Motor Symptoms Questionnaire (NMSQ), the Beck Depression Inventory, the Spielberger State-Trait Anxiety Inventory, the Glasgow Dyspepsia Severity Score (GDSS), the Gastrointestinal Symptom Rating Scale (GSRS), the Bristol Stool Form Scale (BSFS), and the International Prostate Symptom Score (IPSS). A subset of patients (n=31) underwent heart rate variability (HRV) assessment.

Results. Among patients with OI symptoms (35.3% of all participants) we found the worst non-motor outcomes UPDRS I (p<0.0001), cognitive and affective disturbances, sleep disorders, worse NMSQ scores (p=0.038), MMSE scores (p=0.007), IPSS scores (p=0.006), GDSS scores (p<0.0001), GSRS scores (p=0.004), and greater tendency toward constipation according BSFS (p=0.001; Mann–Whitney U test for independent samples). Significant negative correlations in HRV indices (TP, LF, HF, SDNN, RMSSD) were associated with the same non-motor components of UPDRS, depression and anxiety scales, GSRS, and IPSS.

Conclusion. The data indicate that one-third of stages I–III PD patients exhibit clinical signs of autonomic dysregulation affecting the cardiovascular system, gastrointestinal tract, and bladder. These are closely associated with other non-motor symptoms of PD, forming a unified neurodegenerative process involving both central and peripheral components of the nervous system. We propose that OI symptoms may serve as clinical markers of emerging widespread autonomic failure.

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