Journal Reading

HANDINI RAHMI DEWI

Autonomic symptoms and dopaminergic

treatment in de novo Parkinsons disease

Introduction
Autonomic symptoms are common features in Parkinsons
disease (PD) with considerable impact on quality of life and
they are present already in very early PD

Histopathological studies indicate that the

neurodegeneration underlying PD involves both central and
peripheral autonomic structures
On the other hand, autonomic dysfunction is frequently
described as a potential side effect of dopaminergic
treatment

From the total initial baseline population,

we excluded 41 patients because of death
(n = 2), rejected participation (n = 5), use
of dopaminergic medication before
inclusion (n = 10), incomplete data (n =
15) and exclusive treatment with MAO-B
inhibitors (MAO-Bi) after 1 year (n = 9),
leaving 171 patients eligible for this study.

Individuals with previously not

diagnosed PD, fulfilling
acknowledged clinical diagnostic
criteria when assessed both close to
diagnosis (baseline) and after a mean
follow-up time of 28 months were
included (n = 212)

Patients and methods

Examination
Autonomic symptoms were assessed by interview at

baseline and after 12 months using a preliminary

version of the Movement Disorder Societysponsored
new version of the Unified Parkinsons Disease
Rating Scale

Medication

The Levodopa-equivalent daily dose

(LED) at 12-month follow-up was
calculated as follows: LED = milligram
(mg) standard levodopa + mg
sustained release levodopa 90.75 + mg
levodopa taken together with
entacapone 90.25 + mg ropinirole
916.67 + mg pramipexole (salt) 967
[mg pramipexole (salt) equate mg
pramipexole (base) 91.4

Non-PD-medication, whichmay
interfere with the listed autonomic
symptoms, was registered: laxatives
(constipation), cardiovascular acting
agents (orthostatic hypotension and
orthostatic dizziness),
anticholinergics (sialorrhea and
urinary dysfunction) and
antidepressives (sialorrhea)

Result
After 12 months follow-up, 140 of 171 patients (82%) received

dopaminergic treatment (DT), either levodopa only (LD, n = 64) or a

dopamine agonists alone or combined with levodopa (DA, n = 76)

Urinary dysfunction and constipation tended to

be more frequent and dysphagia less frequent

in treated patients at 12-month follow-up
compared with baseline
the regression models showed that higher LED
correlated with reduction in dysphagia severity
score

Discussion

Our results complement the evidence

that dopaminergic medication has
only a minor impact on autonomic
symptoms in early PD and that the
severity of these symptoms remains
low after initiation of symptomatic
treatment.

Although dysphagia is often labelled as

non-responsive to dopaminergic
treatment, partial improvement has
been reported following both
levodopa, apomorphine and
stimulation of the subthalamic nucleus

We conclude that dopaminergic treatment has a

rather minor impact on autonomic symptoms in

patients with early and previously untreated PD. It
may improve dysphagia but lead to increased
constipation and orthostatic dizziness.