Date Published: July 6, 2017
Publisher: Public Library of Science
Author(s): Younsoo Kim, Jin Myoung Seok, Jongkyu Park, Kun-Hyun Kim, Ju-Hong Min, Jin Whan Cho, Suyeon Park, Hyun-jin Kim, Byoung Joon Kim, Jinyoung Youn, Pedro Gonzalez-Alegre.
Differentiation of multiple system atrophy with predominant parkinsonism (MSA-P) and Parkinson’s disease (PD) is important, but an effective tool for differentiation has not been identified. We investigated the efficacy of the composite autonomic symptom scale 31 (COMPASS 31) questionnaire as a tool for evaluating autonomic function in parkinsonism patients. In this study, we enrolled drug-naïve patients with MSA-P and PD, and administered the COMPASS-31 and an objective autonomic dysfunction test (AFT). Demographic and clinical data, including parkinsonism and autonomic dysfunction, were compared between the two groups. Additionally, we determined the optimal COMPASS 31 cut-off score to differentiate MSA-P from PD for use as a screening tool. In this study, 27 MSA-P patients and 41 PD patients were recruited. The total COMPASS 31 score was well correlated with the objective AFT results. When we compared the COMPASS 31 score between the two groups, MSA-P patients showed higher total scores and sub-scores in the orthostatic intolerance, gastrointestinal, and bladder domains compared with PD patients. Similarly, MSA-P patients had more abnormalities in expiration to inspiration ratio, Valsalva ratio and pressure recovery time than PD patients in objective AFT. With 13.25 as the cut-off score for diagnosis of MSA-P, the total COMPASS-31 score demonstrated high sensitivity (92.6%) and moderate specificity (51.2%) with an area under the curve of 0.765. Based on our results, the COMPASS 31 is an effective tool for evaluation of autonomic function in patients with parkinsonism. The COMPASS-31 could be used as a sensitive and convenient screening tool, especially for the differentiation between MSA-P and PD.
Multiple system atrophy with predominant parkinsonism (MSA-P) and Parkinson’s disease (PD) are different in terms of disease progression and survival. Nevertheless, because MSA-P and PD share similar motor symptoms, differential diagnosis at an early stage is difficult. Although autonomic dysfunction is a characteristic symptom of MSA , autonomic function is also commonly involved in PD even from an early stage [2, 3]. Therefore, precise evaluation of autonomic dysfunction is important for diagnosis in patients with parkinsonism. Previous studies have used an objective autonomic function test (AFT) for differentiation of MSA-P in patients with parkinsonism, but optimal evaluation of autonomic dysfunction in patients with parkinsonism is still controversial [4–8]. Additionally, questionnaires on autonomic dysfunction could easily be assessed in the clinic, but only a few studies have investigated the clinical implications of these scales in patients with parkinsonism [7, 8].
This is the first study to investigate the COMPASS 31 for differential diagnosis between MSA-P and PD. Because parkinsonism and autonomic dysfunction are common to both MSA-P and PD, it is difficult to differentiate one from the other. Therefore, precise evaluation of autonomic dysfunction is important and helpful. In this study, COMPASS 31 scores were well-correlated with objective AFT results in patients with parkinsonism. Furthermore, there was a significant difference in COMPASS 31 score between MSA-P and PD patients, and COMPASS 31 total score showed high sensitivity for the diagnosis of MSA-P. Based on these results, the COMPASS 31 could be a convenient and useful tool for screening MSA-P in patients with parkinsonism even from an early stage.