Parkinson’s disease (PD)1 is a chronic neurodegenerative progressive
neurological disease with clinical features viz rigidity, bradykinesia, rest
tremor and postural instability. Assymetry is a prominent feature of this
disease. PD ranks second among the common neurodegenerative disease
next only to Alzheimer’s dementia.
The pathological characteristic of PD is intraneuronal alpha synuclein
positive Lewy bodies and loss of neuronal cell. Apart from classical motor symptoms PD patients also develop non motor symptoms. Non motor
symptoms cause a major disability in PD and the prominently contribute to decreasing quality of life especially in advanced stages of disease.
The major non motor symptoms are olfactory loss, psychiatric disturbances of depression and anxiety, sleep disorders, cognitive dysfunction, and
chiefly the Autonomic Dysfunction. Autonomic symptoms in Parkinson’s disease (PD) were first reported in 1817 by James Parkinson himself.
He described abnormalities of salivation and sweating, and dysfunction of the alimentary tract and urinary bladder. Patients rarely volunteer symptoms
of autonomic disturbance in clinic, and perhaps because of this, there has been little interest in autonomic dysfunction in PD until recent years.
Demonstration of the importance of dysautonomia in Parkinsonism patients, led to a recent resurgence in this area. The introduction of standardised
diagnostic criteria for PD has improved diagnostic accuracy, and reports since the introduction of these guidelines continue to suggest that between
50% and 80% of subjects have objective evidence of autonomic involvement.
Autonomic nervous system dysfunction in Parkinson’s disease is a common problem and it has to be identified early to initiate proper
treatment. We conclude the following from our study.
1. The prevalence of ANS dysfunction is significantly high in PD patients of 83.7% . The prevalence is 82.75% in males and 85.2% in
females.
2. The prevalence of ANS dysfunction in Males increases as the Hoehn and Yahr stage increases as evidenced by 68.7% of males in
stage I and 100% of males in stage IV and V have ANS dysfunction.
3. The prevalence of ANS dysfunction in Females increases as the Hoehn and Yahr stage increases as evidenced by 80.9% of females
in stage I and 100% of Females in stage IV and V have ANS dysfunction.
4. Sexual dysfunction(84.7%) is the most common ANS dysfunction in males followed by gastrointestinal(56.9%), and thermoregulatory
(51.3%) autonomic disturbances.
5. Urinary disturbances(78.3%), is the most common ANS dysfunction in females followed by thermoregulatory(65.2%),, and
cardiovascular disturbances(56.5%).
6. There is a significant correlation between the age and ANS dysfunction. The severity of dysfunction worsens as the age
advances, which is statistically significant (p value<0.0001) 7. There is no significant correlation between the sex and severity of
ANS dysfunction.
8. As the disease duration advances the severity of dysfunction increases which is statistically significant (p value<0.0001). Patient
with disease duration less than 5 years had no or only mild ANS dysfunction, whereas with patients with disease duration more than
10 years had predominantly moderate to severe ANS dysfunction in all patients.
9. There exists a significant correlation between Hoehn and Yahr staging and severity of ANS dysfunction. Patient in stage I had no
ANS dysfunction(26.4%) or only mild dysfunction(62.3%) whereas patients in stage IV and V have severe ANS dysfunction
(100%)
