Objective: To examine the relationship between reported autonomic symptoms and autonomic failure identified by autonomic reflex testing in Parkinson’s disease (PD).

Background: Autonomic failure is common and challenging to treat in PD and is linked to poor outcomes even when it is asymptomatic. Since the relationship between autonomic symptoms and autonomic failure is unclear, we investigated whether a higher burden of autonomic symptoms could predict autonomic failure in PD.

Method: Thirty-one PD participants (≥3 years disease duration, no alternative causes of hypotension) completed the SCOPA-AUT questionnaire, assessing autonomic symptoms in six domains, including cardiovascular symptoms (SCOPA-CV). Autonomic testing included 1) a Tilt Table Test, measuring blood pressure changes in response to a 70-degree upright tilt, 2) heart rate variability during deep breathing (HRDB), and 3) heart rate response to Valsalva. A linear regression model, adjusted for age, was used to analyze the relationship between SCOPA-AUT total score and systolic blood pressure reduction with tilt (SBPFALL). Secondary analyses examined relationships between SCOPA-AUT scores (total and subdomains) and SBPFALL, Valsalva ratio (VR), and HRDB.

Results: Higher SCOPA-AUT total score, indicating higher symptom burden, predicted SBPFALL (β = -0.10, p = 0.026) in this cohort. However, no significant relationship was seen after excluding two outlying SCOPA-AUT scores (β = 0.02, p = 0.58). Secondary analyses revealed a significant relationship between cardiovascular symptoms (SCOPA-CV) and SBPFALL (β= -0.039, p= 0.002). No relationship was found between other SCOPA subdomains and SBPFALL or between SCOPA-AUT scores (total or subdomains) and heart rate variability during deep breathing or Valsalva.

Conclusion: Cardiovascular symptoms, particularly those linked to orthostatic hypotension, correlate with degree of blood pressure reduction during tilt testing in our PD cohort. However, other autonomic symptoms, including total autonomic symptoms burden, do not. Notably, neither total autonomic symptoms nor subcategories were associated with heart rate variability. These findings suggest autonomic failure in different organ systems may arise from distinct mechanisms in PD. This study underscores the importance of using objective biomarkers for diagnosing and managing autonomic failure in PD.

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MDS Abstracts - https://www.mdsabstracts.org/abstract/assessing-the-relationship-between-autonomic-symptom-burden-and-autonomic-failure-in-parkinsons-disease/