Abstract Details

Title Autonomic Impairment and Risk of Mortality in Early-Onset Parkinson Disease

Topic Neuromuscular and Clinical Neurophysiology (EMG)

Presentation(s) S9 - Autonomic Disorders (11:39 AM-11:51 AM)

Poster/Presentation
Number 003

Background The majority of patients with PD experience some form of autonomic dysfunction, which has been associated with increased cardiovascular mortality.

Objective To describe the frequency and time of onset of autonomic dysfunction relative to Parkinson Disease (PD) onset in Early-Onset Parkinson Disease (EOPD) and explore its association with mortality.

Design/Methods We identified all incident PD cases with motor symptom onset before the age of 50 years (EOPD) evaluated at Mayo Clinic from 1990 to 2022. Sex- and age-matched controls were included for each patient. Medical records were reviewed to confirm clinical diagnosis and assess the presence and time of onset of autonomic symptoms, including constipation, bladder urgency, sweat dysfunction, orthostatic hypotension, and erectile dysfunction, relative to PD motor onset.

Results We included 829 EOPD patients and 829 controls. The median age at PD onset was 42 years (IQR=37-46). Autonomic symptoms were present in 63.4% of EOPD patients, compared to 27.0% of unaffected controls, and preceded motor symptoms in 91.4% of EOPD cases. Forty-seven percent of EOPD patients had constipation, 27.4% bladder urgency, 19.3% orthostatic hypotension, and 15.4% sweat dysfunction. Among male EOPD patients, 36.8% had erectile dysfunction. In EOPD, the presence of any symptoms of autonomic impairment was associated with a 3.06 increased mortality risk; for each additional such reported symptom the relative mortality risk increased by 63% (p < 0.001). EOPD patients with constipation or orthostatic hypotension had a 2.84 and 2.16 fold higher mortality risk, respectively, compared to EOPD patients without these symptoms.

Conclusions Autonomic impairment affects 63.4% of EOPD patients and is associated with a three-fold higher mortality risk, which increases with each additional autonomic failure symptom reported. In our EOPD cohort, autonomic symptoms were most commonly post-dromal features, contrasting with prodromal autonomic impairment seen in Late-Onset Parkinson disease.

Authors/Disclosures
Capucine Piat, MD PRESENTER	Dr. Piat has nothing to disclose.
Aidan Mullan (Mayo Clinic)	Aidan Mullan has nothing to disclose.
Khaled Ghoniem, MD (Mayo Clinic)	Dr. Ghoniem has nothing to disclose.
Emanuele Camerucci, MD (Kansas University Medical Center)	Dr. Camerucci has nothing to disclose.
Pierpaolo Turcano, MD (Rush University Medical Center)	Dr. Turcano has nothing to disclose.
Jeremy K. Cutsforth-Gregory, MD, FAAN (Mayo Clinic)	Dr. Cutsforth-Gregory has received personal compensation in the range of $500-$4,999 for serving as an Editor, Associate Editor, or Editorial Advisory Board Member for AAN. Dr. Cutsforth-Gregory has received publishing royalties from a publication relating to health care.
Eduardo E. Benarroch, MD, FAAN (Mayo Clinic)	Dr. Benarroch has nothing to disclose.
Rodolfo Savica, MD, PhD, FAAN (Mayo Clinic)	The institution of Dr. Savica has received research support from ACADIA Pharmaceuticals, Inc.

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