Abstract Details

Title Autonomic Testing Profiles in Scans Without Evidence of Dopaminergic Deficit (SWEDD)

Topic Movement Disorders

Presentation(s) P4 - Poster Session 4 (5:30 PM-6:30 PM)

Poster/Presentation
Number 10-050

Objective

To study patients with SWEDD with autonomic testing and determine the degree and pattern of autonomic dysfunction.

Background The diagnosis of SWEDD (Scans without Evidence of Dopaminergic Deficit), is given to patients with clinical Parkinsonism, but without evidence of dopaminergic deficit on Ioflupane I123 SPECT imaging (DaTscan). To date, there has been no description of formal autonomic testing in this patient population.

Design/Methods

All patients who received a diagnosis of SWEDD and had formal autonomic testing at Mayo Clinic, MN were retrospectively reviewed. The Composite Autonomic Scoring Scale (CASS) for quantification of autonomic failure was used. The Modified Hoehn and Yahr score(HYHS) was used to determine the severity of Parkinsonism.

Results Out of 1874 patients who have had DaTscan imaging at Mayo Clinic, 13 patients met criteria. The median age of symptom onset was 56.0 (IQR 40.5-75.5). 12/13 had autonomic dysfunction on ARS and/or TST. The median CASS score was 2.50 (IQR 1.00-3.00). 7/13 had a pattern of distal anhidrosis and 3 had diffuse anhidrosis on TST and/or QSART testing. Patients with a distal pattern of anhidrosis had a median score of 3.0 (IQR 2.38-4.25) on the Hoehn and Yahr scale versus 2.0 for those with a diffuse pattern (p=0.048). Patients with more Parkinsonism were more likely to be responsive to L-Dopa, with higher HYHS in the dopa-responsive versus non dopa-responsive (p=0.26). There was no correlation between degree of Parkinsonism, and CASS score (p=0.25), age of symptom onset and degree of autonomic dysfunction (p=0.69).

Conclusions Our findings suggest that autonomic dysfunction is present in most patients with clinical Parkinsonism with SWEDD. The pattern of dysfunction on autonomic tests is suggestive of the degree of clinical Parkinsonism. Autonomic testing may predict level of dopa-responsiveness in patients with Parkinsonism.

Authors/Disclosures
Lauren Jackson, MD (Mayo Clinic) PRESENTER	Dr. Jackson has nothing to disclose.
Pierpaolo Turcano, MD (Rush University Medical Center)	Dr. Turcano has nothing to disclose.
Derek W. Stitt, MD (Mayo Clinic)	Dr. Stitt has nothing to disclose.
Elizabeth A. Coon, MD, FAAN (Mayo Clinic)	Dr. Coon has received publishing royalties from a publication relating to health care. Dr. Coon has a non-compensated relationship as a Non-Voting Member of the Board of Directors with UCNS that is relevant to AAN interests or activities.
Rodolfo Savica, MD, PhD, FAAN (Mayo Clinic)	The institution of Dr. Savica has received research support from ACADIA Pharmaceuticals, Inc.

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