Will Your Pure Autonomic Failure Patients Convert to Parkinsonism?

A prospective study confirms that many patients will, and delineates which clinical features are predictive.

To shed light on which cases of pure autonomic failure will convert to a synucleinopathy (Parkinson disease, dementia with Lewy bodies, or multiple system atrophy), investigators prospectively followed 74 patients from five U.S. medical centers for 5 years. Mean age was 68, there was documented pre-existing autonomic failure for a mean of 5 years.

Follow-up at 4 years revealed that 25 patients (34%) had a new diagnosis of dementia with Lewy bodies (13 patients), Parkinson disease (6), or multiple system atrophy (MSA; 6). A probable diagnosis of rapid eye movement (REM) sleep behavior disorder was associated with the later development of a synucleinopathy (odds ratio, 7.1). The annual risk for conversion was 14% per year. Patients who did not…

Reviewing Author

Michael S. Okun, MD

Disclosures

Consultant/Advisory BoardParkinson’s Foundation; Tourette Association of America

Speaker’s BureauMedscape/WebMD CME, Movement Disorders Society CME, American Academy of Neurology CME

RoyaltiesBooks4Patients; Demos; Cambridge; Taylor and Francis; Robert Rose; Public Affairs

Grant/Research SupportNational Institutes of Health; Parkinson’s Foundation; Tourette Association of America; University of Florida Foundation

Editorial BoardsTremor and Other Hyperkinetic Movements; JAMA Neurology

Leadership Positions in Professional SocietiesParkinson’s Foundation (Medical Advisor)