Key result
Pressure recovery time (PRT) during autonomic testing significantly differentiated early-stage MSA-P from IPD (P=0.004), with a 5.5 s cut-off providing 71.4% sensitivity and 72.7% specificity.
Why the study?
Differential diagnosis of idiopathic Parkinson disease and multiple system atrophy-Parkinson type is challenging because they share features of parkinsonism and autonomic dysfunction, especially when symptoms are relatively mild.
Does quantitative autonomic function testing differentiate early-stage multiple system atrophy-Parkinson type from idiopathic Parkinson disease?
Observational (n=36)
No
Does quantitative autonomic function testing differentiate early-stage multiple system atrophy-Parkinson type from idiopathic Parkinson disease?
PRT may aid early MSA-P vs IPD differentiation; hypothesis-generating and requires prospective validation before practice change.
BACKGROUND: Differential diagnosis of idiopathic Parkinson disease (IPD) and multiple system atrophy-Parkinson type (MSA-P) is challenging since they share clinical features with parkinsonism and autonomic dysfunction. To distinguish MSA-P from IPD when the symptoms are relatively mild, we investigated the usefulness of the quantitative fractionalized autonomic indexes and evaluated the correlations of autonomic test indexes and functional status. METHODS: Thirty-six patients with parkinsonism (22 with IPD and 14 with MSA-P) in Soonchunhyang University Bucheon Hospital from February 2014 to June 2015 were prospectively enrolled in the study. We compared fractionalized autonomic indexes and composite autonomic scoring scale between patients with IPD and MSA-P with Hoehn and Yahr (H&Y) score ≤3. Parasympathetic indexes included expiratory/inspiratory ratio during deep breathing, Valsalva ratio (VR), and regression slope of systolic blood pressure (BP) in early phase II (vagal baroreflex sensitivity) during Valsalva maneuver. Sympathetic adrenergic indexes were pressure recovery time (PRT) and adrenergic baroreflex sensitivity (BRSa) (BP decrement associated with phase 3 divided by the PRT), sympathetic index 1, sympathetic index 3, early phase II mean BP drop, and pulse pressure reduction rate. Additionally, we compared the unified multiple system atrophy rating scale (UMSARS) and H&Y scores and the autonomic indexes in all patients. RESULTS: PRT was significantly different between the IPD and MSA-P groups (P = 0.004) despite the similar BP drop during tilt. Cut-off value of PRT was 5.5 s (sensitivity, 71.4%; specificity, 72.7%). VR (r = -0.455, P = 0.009) and BRSa (r = -0.356, P = 0.036) demonstrated a significant correlation with UMSARS and H&Y scores. CONCLUSIONS: Among the cardiovascular autonomic indexes, PRT can be a useful parameter in differentiating the early stage of MSA-P from that of IPD. Moreover, VR, and BRSa may be the optimal indexes in determining functional symptom severity.
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Park et al. (2019) conducted an observational in Idiopathic Parkinson disease and multiple system atrophy-Parkinson type (n=36). Quantitative autonomic function test was evaluated on Pressure recovery time (PRT) (p=0.004). Pressure recovery time (PRT) during autonomic testing significantly differentiated early-stage MSA-P from IPD (P=0.004), with a 5.5 s cut-off providing 71.4% sensitivity and 72.7% specificity.
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