Key result
MSA and PSP link to ~90% peak prevalence of abnormal autonomic responses alongside smaller vagus nerves.
Why the study?
Vagal atrophy is associated with autonomic dysfunction in Parkinson's disease, but analyses of the vagus nerve in atypical Parkinsonian syndromes had not yet been performed.
Is vagal atrophy associated with autonomic dysfunction in multiple system atrophy and progressive supranuclear palsy?
Cross-Sectional (n=170)
No
Is vagal atrophy associated with autonomic dysfunction in multiple system atrophy and progressive supranuclear palsy?
Vagal atrophy is present in progressive supranuclear palsy and correlates with autonomic dysfunction, suggesting vagus nerve ultrasound may serve as a marker for autonomic dysregulation in atypical Parkinsonian syndromes.
Answers are grounded in this paper and cite their sources.
Supports vagal atrophy-autonomic dysfunction link in PSP; leaves open ultrasound as biomarker pending prospective validation.
Background: Vagal atrophy is a hallmark of Parkinson's disease (PD) and has been found to be associated with autonomic dysfunction, while analyses of the vagus nerve (VN) in atypical Parkinsonian syndromes (APS) have not yet been performed. We here investigate the characteristics of the VN in multiple system atrophy (MSA) and progressive supranuclear palsy (PSP) and, in a second step, its potential as a possible biomarker for orthostatic dysregulation. Objectives: The aim was to compare the VN pathology in MSA and PSP with healthy individuals and patients with PD as a differentiating factor and to further analyse the correlation of the VN with clinical parameters and cardiovascular response. Design: We conducted a monocentric, cross-sectional cohort study in 41 APS patients and compared nerve ultrasound (NUS) parameters with 90 PD patients and 39 healthy controls. Methods: In addition to a detailed neurological history and examination, several clinical severity and motor scores were obtained. Autonomic symptoms were reported in the Scales for Outcomes in Parkinson's Disease - Autonomic questionnaire. Further scores were used to detect other non-motor symptoms, quality of life and cognition. Additionally, we performed a head up tilt test (HUTT) and NUS of the VN. We conducted correlation analyses of the VN cross-sectional area (CSA) with clinical scores and the heart rate and blood pressure variability parameters of the HUTT. Results: The examination demonstrated a high prevalence of abnormal autonomic response in both MSA (90%) and PSP (80%). The VN CSA correlated with spectral parameters of the HUTT, which are associated with sympatho-vagal imbalance. In addition, the CSA of the VN in patients with PD and PSP were significantly smaller than in healthy controls. In MSA, however, there was no marked vagal atrophy in comparison. Conclusion: The occurrence of autonomic dysfunction was high in MSA and PSP, which underlines its impact on these syndromes. Our findings indicate a connection between vagal pathology and autonomic dysfunction and might contribute to a better comprehension of APS. To further evaluate the clinical relevance and the VN as a possible marker of autonomic dysfunction in APS, prospective longitudinal observations are necessary.
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Kleinz et al. (2024) conducted a cross-sectional in Multiple system atrophy and progressive supranuclear palsy (n=170). Nerve ultrasound of the vagus nerve vs. Healthy controls and Parkinson's disease patients was evaluated on Vagus nerve cross-sectional area and abnormal autonomic response. Abnormal autonomic response was highly prevalent in multiple system atrophy (90%) and progressive supranuclear palsy (80%), and vagus nerve cross-sectional area was significantly smaller in PSP.
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