Supplementary Material for: Autonomic Symptoms Correlate with Non-Autonomic Non-Motor Symptoms and Sleep Problems in Patients with Parkinson’s Disease

<b><i>Objective:</i></b> The objective of this study was to clarify the relationship between autonomic and non-autonomic non-motor symptoms in patients with Parkinson’s disease (PD). <b><i>Methods:</i></b> Sixty-five PD patients were included in this study (27 men and 38 women; aged 68.5 ± 10.0; Hoehn and Yahr (HY) stage 2.6 ± 1.1). The autonomic symptoms were evaluated by the Japanese version of the Scales for outcomes in PD autonomic (SCOPA-AUT) questionnaire. The patients were assessed with the mini-mental state examination (MMSE), PD sleep evaluation scale-2 (PDSS-2), Epworth sleepiness scale (ESS) and Beck’s depression inventory II (BDI-II). The Non-Motor Symptom Scale (NMSS) total scores and subscores of non-autonomic non-motor symptom domains (sleep/fatigue, mood/cognition, perceptual problems/hallucination, and attention/memory) were evaluated. A dopamine transporter (DAT) scan, metaiodobenzylguanidine (MIBG) myocardial scintigraphy, and card type olfactory identification test (open essence [OE, Wako]) were performed. <b><i>Results:</i></b> The SCOPA-AUT total score was positively correlated with the disease duration, HY stage, levodopa equivalent dose, PDSS-2, ESS, BDI-II and non-autonomic NMSS and inversely correlated with the MMSE. The high-SCOPA-AUT group (≥9) had lower MMSE scores and higher PDSS-2, ESS, BDI-II and non-motor NMSS scores than the low-SCOPA-AUT group (&lt; 9). The DAT scan, MIBG uptake and OE score did not differ between the groups. In a stepwise linear regression analysis, which excluded possibly overlapping items among the scales, the subtotals of PDSS-2 items, except for item 8 (nocturia), (<i>p</i> &lt; 0.0001) and non-autonomic NMSS domains (<i>p</i> = 0.00040) were significant predictors of the total SCOPA-AUT score. <b><i>Conclusion:</i></b> Our study shows significant correlations among autonomic symptoms, PD-related sleep problems and non-autonomic non-motor symptoms in PD patients.

<b><i>研究目的：</i></b> 本研究旨在阐明帕金森病（Parkinson’s Disease, PD）患者自主神经与非自主神经非运动症状之间的关联。<b><i>方法：</i></b> 本研究共纳入65例帕金森病患者（男27例，女38例；年龄68.5±10.0岁；Hoehn-Yahr（HY）分期2.6±1.1）。自主神经症状采用帕金森病自主神经症状评价量表（Scales for Outcomes in PD Autonomic, SCOPA-AUT）日文版进行评估。对所有患者实施简易精神状态检查（mini-mental state examination, MMSE）、帕金森病睡眠评估量表-2（PD sleep evaluation scale-2, PDSS-2）、爱泼沃斯嗜睡量表（Epworth sleepiness scale, ESS）及贝克抑郁量表第二版（Beck’s Depression Inventory II, BDI-II）评估。同时测定非运动症状量表（Non-Motor Symptom Scale, NMSS）的总分，以及非自主神经非运动症状领域的子评分，涵盖睡眠/疲劳、情绪/认知、感知障碍/幻觉及注意力/记忆维度。此外，所有患者均接受多巴胺转运体（dopamine transporter, DAT）显像、间碘苄胍（metaiodobenzylguanidine, MIBG）心肌闪烁显像，以及卡片式嗅觉识别试验（开放香精[OE, Wako]）检测。<b><i>结果：</i></b> SCOPA-AUT总分与病程、HY分期、左旋多巴等效剂量、PDSS-2、ESS、BDI-II及非自主神经NMSS评分呈正相关，与MMSE评分呈负相关。高SCOPA-AUT组（≥9分）的MMSE评分低于低SCOPA-AUT组（<9分），而PDSS-2、ESS、BDI-II及非运动NMSS评分则显著更高。两组患者的DAT显像结果、MIBG摄取率及OE评分均无显著差异。在排除量表间可能存在重叠条目的逐步线性回归分析中，除第8项（夜尿症）外的PDSS-2条目小计（<i>p</i> < 0.0001）与非自主神经NMSS领域得分（<i>p</i> = 0.00040）是SCOPA-AUT总分的显著预测因子。<b><i>结论：</i></b> 本研究证实，帕金森病患者的自主神经症状、帕金森病相关睡眠障碍与非自主神经非运动症状之间存在显著相关性。