Gender Differences and Impact of Autonomic Disturbance on Fatigue and Quality of Life in Parkinson's Disease.

Abstract

Autonomic dysfunction can precede the onset of motor symptoms in Parkinson's disease and are very disabling, but often overlooked. This study was done to assess the presence of autonomic symptoms in PD; evaluate any gender differences and association of autonomic dysfunction with fatigue and quality of life. Demographic profile and disease characteristics of PD patients were assessed. Autonomic symptoms were evaluated by SCOPA-AUT, fatigue by FSS, and QOL with PDQ-39 in patient's vernacular language. Patients with SCOPA-AUT score ≥9 were considered as having autonomic impairment. Gender variation in the involvement of different domains were analyzed along with the risk factors for autonomic dysfunction. Among 94 patients, 59 (63%) had autonomic dysfunction. All SCOPA domains showed significant impairment in PD. Nocturia (69.14%) and constipation (52.12%) constituted most frequent symptoms in our cohort. Mean urinary (7.89 vs. 6.05) and sexual (1.47 vs. 0.42) domain scores were significantly (P < 0.05) higher in males while cardiovascular dysfunction (0.81 vs. 1.64) was predominant in females. Patients with autonomic dysfunction had longer duration of disease (P = 0.033), severe disease (P = 0.0001) with higher UPDRS (P = 0.001). Autonomic symptoms correlated significantly (P < 0.0001) with Fatigue (r = 0.60) also. Patients with autonomic dysfunction had poor QOL (r = 0.67) and mobility, activities of daily living, emotional well-being, stigma, cognition, communication, and bodily-discomfort dimensions were worst affected (P < 0.05). There was a significant variation of autonomic symptoms with gender. Disease severity and duration were significant risk factors for autonomic dysfunction. Also there was a strong co-relation of fatigue and poor QOL with autonomic dysfunction.