Autonomic symptoms and dopaminergic treatment in de novo Parkinson's disease

Muller B, Assmus J, Larsen JP, Haugarvoll K, Skeie GO, Tysnes OB, for the ParkWest study group. Autonomic symptoms and dopaminergic treatment in de novo Parkinson's disease. Acta Neurol Scand: 2013: 127: 290-294. (C) 2012 John Wiley & Sons A/S. Objectives Autonomic symptoms are present in early stages of Parkinson's disease (PD), but evidence on how they are influenced by dopaminergic treatment remains unclear. The aim of this study was to investigate the impact of dopaminergic treatment on autonomic symptoms in early PD in a population-based cohort. Methods A total of 171 drug-naive patients with PD were investigated at diagnosis and 12months later. Orthostatic blood pressure was measured, and autonomic symptoms were assessed by a preliminary version of the Movement Disorders Society-sponsored new version of the Unified Parkinson's Disease Rating Scale (range 04). Results In the 82% using dopaminergic treatment after 1year, constipation and orthostatic blood pressure drop increased. There was a tendency towards increased orthostatic dizziness and urinary dysfunction. Dysphagia scores were reduced, and this was associated with higher levodopa-equivalent daily dose. Conclusions Dopaminergic treatment during the first year after initiation seems to have only a minor impact on autonomic symptoms in early PD. It may increase constipation and orthostatic dizziness, while dysphagia can improve. Autonomic symptoms remained mild after 1year of dopaminergic treatment.