Abstract:
Background: Autonomic dysfunction is common in patients with Parkinson’s disease (PD). We report autonomic
function test results in a prevalent, largely untreated, Tanzanian population of PD patients, at different disease
stages and investigate the relationship between autonomic dysfunction and mortality.
Methods: Ewing’s battery of autonomic tests was carried out on a prevalent population of PD patients living in
the rural Hai district of Tanzania. Where possible, all four tests were performed in the patient’s home. The main
outcome of interest was the presence of abnormalities of sympathetic or parasympathetic function. Information
on medications used and other co-morbidities was recorded.
Results: Autonomic function tests were recorded for 29 subjects, of whom 3 were on medication at the time of
assessment. Of the 26 unmedicated patients, 14 (53.8%) had at least one abnormal test result for autonomic
function, of whom only 3 (21.4%) were in late stage disease (Hoehn and Yahr stage IV or V), compared to 7
(58.3%) of 12 with normal autonomic function tests in late stage disease. Ten subjects had died at 5-year follow-up,
but there was no association between mortality and autonomic function test abnormalities.
Conclusions: In unmedicated subjects, many patients in late stage disease had relatively preserved autonomic
function, compared to those in early stage disease. In people with PD who are taking medication, it may be that
when autonomic dysfunction presents in late stage disease it is often due to side effects of medication rather
than the disease itself.
