When do the symptoms of autonomic nervous system malfunction appear in patients with Parkinson's disease? Kada se pojavljuju simptomi ošteenja autonomnog nervnog sistema kod obolelih od Parkinsonove bolesti?

Background/Aim. Dysautonomia appears in almost all patients with Parkinson's disease (PD) in a certain stage of their condition. The aim of our study was to detect the de- velopment and type of autonomic disorders, find out the factors affecting their manifestation by analyzing the poten- tial association with demographic variables related to clinical presentation, as well as the symptoms of the disease in a PD patient cohort. Methods. The patients with PD treated at the Clinic of Neurology in Belgrade during a 2-year period, divided into 3 groups were studied: 25 de novo patients, 25 patients already treated and had no long-term levodopa therapy-related complications and 22 patients treated with levodopa who manifested levodopa-induced motor compli- cations. Simultaneously, 35 healthy control subjects, matched by age and sex, were also analyzed. Results. Auto- nomic nervous system malfunction was defined by Ewing diagnostic criteria. The tests, indicators of sympathetic and parasympathetic nervous systems, were significantly differ- ent in the PD patients as compared with the controls, sug- gesting the failure of both systems. However, it was shown, in the selected groups of patients, that the malfunction of both systems was present in two treated groups of PD pa- tients, while de novo group manifested only sympathetic dys- function. For this reason, the complete autonomic neu- ropathy was diagnosed only in the treated PD patients, while de novo patients were defined as those with the isolated sympathetic dysfunction. The patients with the complete autonomic neuropathy differed from the subjects without such neuropathy in higher cumulative and motor unified Parkinson's disease rating score (UPDRS) (p < 0.01), activi- ties of daily living scores (p < 0.05), Schwab-England scale (p < 0.001) and Hoehn-Yahr scale. There was no difference between the patients in other clinical-demographic charac- teristics (sex, age at the time of diagnosis, actual age, dura- tion of disease, involved side of the body, pain and freez- ing), but mini mental status (MMS) score and Hamilton de- pression and anxiety rating scale were significantly lower (p < 0.05). Conclusion. Our results confirm a high prevalence of autonomic nervous system disturbances among PD pa- tients from the near onset of disease, with a predominant sympathetic nervous system involvement. The patients who developed complete autonomic neuropathy (both sympa- thetic and parasympathetic) were individuals with consider- able level of functional failure, more severe clinical presen- tation and the existing anxiety and depression.