Objective: To evaluate the association between cardiovascular dysautonomia and Mild Cognitive Impairment (MCI) in Parkinson’s Disease (PD) patients.

Background: Dysautonomic dysfunction and cognitive impairment represent the most disabling non-motor features of PD. Recent evidences suggest the association between Orthostatic Hypotension (OH) and PD-Dementia (PDD). However, little is known on the interactions between cardiovascular dysautonomia and MCI.

Method: PD patients belonging to the PACOS cohort underwent a comprehensive instrumental neurovegetative assessment including the study of both parasympathetic and sympathetic function (30:15 ratio, Expiratory-Inspiratory ratio [E-I] and presence of Orthostatic Hypotension [OH]). Diagnosis of MCI was made according to the MDS criteria level II. Logistic regression analysis was performed for each variable by considering the presence of MCI as the outcome. A subgroup analysis has been performed to analyse the association between the neurovegetative tests and the different MCI phenotypes.

Results: We enrolled 185 PD patients of whom 102 (55.1%) were men, mean age was 64.6 ± 9.7 years, mean disease duration of 5.6 ±5.5 years with a mean UPDRS-ME score of 31.7 ± 10.9. MCI was diagnosed in 79 (42.7%) patients.  OH was recorded in 52 (28.1%) patients, altered 30:15 ratio was recorded in 39 (24.1%) patients and an altered E-I ratio was found in 24 patients (19.1%). Presence of MCI was associated with an altered 30:15 ratio (adjOR 2.83; 95%CI 1.25-6.40) but not with an altered E-I ratio, or the presence of OH. Forty-nine (62.0%) patients were classified as naMCI, while 30 (38%) had aMCI. At the univariate analysis an altered 30:15 and the presence of OH were significantly associated with aMCI with, respectively an OR of 3.49 (95% CI 1.36-8.94; p=0.009) and an OR of 2.43 (95% CI 1.05-5.06; p=0.037).

Conclusion: In our study sample, MCI was mainly associated with parasympathetic dysfunction in PD. The presence of an altered parasympathetic function in MCI has been already described in subjects with MCI due to Alzheimer’s Disease, probably related to reduced acetylcholine levels affecting both cognitive function and parasympathethic nervous system function. Concerning the association between OH and the subgroup of aMCI, it could be hypothesized that aMCI and PDD may share the same pathological background with a higher risk of progression to PDD.

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MDS Abstracts - https://www.mdsabstracts.org/abstract/cardiovascular-autonomic-function-and-mci-in-parkinsons-disease/