Abstract
Background: Autonomic symptoms are common in older adults, and a large body of literature focusing on age-related diseases shows that autonomic symptoms in these diseases constrain Health-Related Quality of Life (HRQoL). To our best knowledge, the association between autonomic symptoms in older adults, independent of specific diseases, and HRQoL has not yet been assessed.Aim: To assess the frequency and the effect of autonomic symptoms in general, as well as orthostatic intolerance, vasomotor, secretomotor, gastrointestinal, bladder, and pupillomotor symptoms, on HRQoL in older adults.Methods: Cross-sectional data of the fourth visit of the Tübinger evaluation of Risk factors for Early detection of Neurodegeneration (TREND) study were included. Autonomic symptoms, as assessed with the Composite Autonomic Symptom Score 31 (COMPASS 31), were quantified and compared with HRQoL, as assessed with the EuroQol five-level version (EQ-5D-5L). Statistical analyses included Spearman's rank correlation and multiple linear regression analysis.Results: The analysis included 928 participants with a median of 68 years; 47% were women. Of those, 85% reported at least one autonomic symptom. Gastrointestinal and secretomotor symptoms were most common. The COMPASS 31 total score and all subdomains were significantly associated with reduced HRQoL. Among the subdomains, the strongest correlations with HRQoL were found for gastrointestinal and bladder symptoms. Overall, autonomic symptoms alone explained 20% of the variance of HRQoL; when depressive mood was added, the model explained 32%.Conclusion: Autonomic symptoms are associated with HRQoL and depressive symptoms in older adults.
Highlights
Autonomic symptoms are common in older adults, and a large body of literature focusing on age-related diseases shows that autonomic symptoms in these diseases constrain Health-Related Quality of Life (HRQoL)
The autonomic nervous system deteriorates with age at a structural and functional level and includes orthostatic intolerance, vasomotor, secretomotor, gastrointestinal, bladder, and pupillomotor symptoms
Structural changes explaining autonomic symptoms have been described in detail during the last years in the gut, with the activation of a senescence-associated phenotype and neurodegenerative changes being involved in these pathological processes [1]
Summary
The autonomic nervous system deteriorates with age at a structural and functional level and includes orthostatic intolerance, vasomotor, secretomotor, gastrointestinal, bladder, and pupillomotor symptoms. Similar results are found in patients with autonomic diabetic neuropathy due to type II diabetes mellitus; cardiac and vascular autonomic dysfunctions, including changes in blood pressure and heart rate variability, are associated with lower HRQoL and explain, together with depressive symptoms, anxiety and symptoms of peripheral neuropathy, 42–68% of the variance of HRQoL [18]. In particular in PD, the association of autonomic symptoms with HRQoL has Abbreviations: HRQoL, Health-Related Quality of Life; TREND, Tübinger evaluation of Risk factors for Early detection of Neurodegeneration; COMPASS 31, Composite Autonomic Symptom Score 31; EQ-5D-5L, EuroQol five-level version; PD, Parkinson’s disease; RBD, REM sleep behavior disorder; ICD-10, International Classification of Diseases, Tenth Revision; BDI-I, Beck Depression Inventors; VAS, Visual Analog Scale; VIF, Variance inflation factor; RSA, Respiratory sinus arrhythmia. The association between autonomic symptoms in older adults, independent of specific diseases, and HRQoL has not yet been assessed
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