Department of Neurology, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA.
Department of Radiology, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA.
J Parkinsons Dis. 2022;12(3):1059-1067. doi: 10.3233/JPD-213075.
Autonomic dysfunction and depression are common non-motor symptoms of Parkinson's disease (PD) that confer poorer prognosis. These PD symptoms may have overlapping pathophysiologic underpinnings.
To investigate associations between autonomic and depression symptoms in early PD, and their evolution over time.
We obtained data from the Parkinson's Progression Markers Initiative, a prospective open-access database of early PD. Regression analyses were used to model effects of depression on autonomic symptoms in controls and in PD at baseline, visit 6 (24 months after baseline), and visit 12 (60 months after baseline), correcting for multiple comparisons.
Data from 421 people with PD at baseline, 360 at visit 6, 300 at visit 12, and 193 controls were included. When controlling for age, depression, and anti-hypertensive medications, depression predicted autonomic symptoms in all groups. Accounting for motor symptoms did not alter these associations. When comparing groups, the influence of depression on autonomic symptoms was stronger in all PD groups compared to controls, and strongest in PD at visit 12. Depression predicted the presence of orthostatic hypotension only in the PD group at visit 12.
We demonstrated the important impact of depression on autonomic symptoms in early and middle stages of PD, which are independent of motor symptoms. Though the physiologic basis of these two PD symptoms are not fully understood, our findings add to pathologic evidence of a shared mechanistic substrate, separate from that responsible for PD motor symptoms. These findings may influence clinical management and development of novel therapies.
自主神经功能障碍和抑郁是帕金森病（PD）的常见非运动症状，预示着更差的预后。这些 PD 症状可能具有重叠的病理生理基础。
研究早期 PD 中自主神经症状和抑郁症状之间的关联及其随时间的演变。
我们从帕金森进展标志物倡议（Parkinson's Progression Markers Initiative）获得了数据，这是一个早期 PD 的前瞻性开放获取数据库。回归分析用于在基线时、第 6 次访视（基线后 24 个月）和第 12 次访视（基线后 60 个月）时，在对照组和 PD 中，对抑郁对自主神经症状的影响进行建模，校正了多次比较。
纳入了 421 名基线时患有 PD 的患者、360 名第 6 次访视时、300 名第 12 次访视时和 193 名对照组患者的数据。在控制年龄、抑郁和抗高血压药物的情况下，抑郁在所有组中都预测了自主神经症状。这些关联不因运动症状而改变。当比较组时，与对照组相比，抑郁对所有 PD 组自主神经症状的影响更强，而在第 12 次访视时 PD 组的影响最强。在第 12 次访视时，抑郁仅预测 PD 组存在直立性低血压。
我们证明了抑郁对早期和中期 PD 自主神经症状的重要影响，这些症状与运动症状无关。尽管这两种 PD 症状的生理基础尚未完全了解，但我们的发现增加了一个共同机制基础的病理证据，与导致 PD 运动症状的机制基础不同。这些发现可能会影响临床管理和新疗法的开发。
