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

Background: Autonomic dysfunction can precede the onset of motor symptoms in Parkinson's disease and are very disabling, but often overlooked. Objective: 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. Methods: 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. Results: 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). Conclusions: 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.