The effect of dysautonomia on motor, behavioral and cognitive fluctuations in Parkinson’s disease

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Background Motor and non-motor fluctuations adversely impact quality of life in Parkinson’s disease (PD). Dysautonomia, a feature frequently associated with PD and a possible adverse effect of dopaminergic therapy, may be comorbid with fluctuations. Objectives We sought to evaluate the effect of dysautonomia on motor and non-motor fluctuations in PD Methods Two hundred subjects with PD were evaluated in both “on” and “off” dopamine states to assess changes in symptoms related to dopaminergic fluctuations. Multivariable logistic regression was performed to assess the association of dysautonomia with motor, cognitive, and psychiatric worsening from ON to OFF states with adjustment for disease duration, levodopa equivalent daily dosage (LEDD), and dopamine agonist LEDD. Results Subjects with dysautonomia had greater odds of clinically meaningful change in motor features (OR 3.0), cognition (OR 3.4) and anxiety (OR 4.3) compared to those without dysautonomia. Conclusions Dysautonomia may be a contributory mechanism behind fluctuations in PD. The exact nature of this relationship deserves further evaluation.