好色先生

好色先生

Explore the latest content from across our publications
Join The AAN

Log In

Forgot Password?
Create New Account

Loading... please wait

Abstract Details

Predictors of Phenoconversion in Pure Autonomic Failure: A Systematic Review and Meta-Analysis
Autonomic Disorders
P10 - Poster Session 10 (8:00 AM-9:00 AM)
7-004
To quantitatively determine predictors of phenoconversion in pure autonomic failure (PAF) and estimate phenoconversion frequency through meta-analysis.
PAF is an alpha-synucleinopathy with predominantly peripheral autonomic features, often accompanied by rapid eye movement sleep behavior disorder or anosmia. A subset of patients develop motor or cognitive features meeting criteria for Lewy body diseases (LBDs), including Parkinson’s disease and dementia with Lewy bodies, or multiple system atrophy (MSA). While phenoconversion predictors have been proposed, their accuracy remains uncertain. As disease-modifying therapies for alpha-synucleinopathies advance, determining these predictors and their accuracy is an urgent need.
Following PRISMA guidelines, we searched PubMed, Scopus, and Web of Science through July 10, 2025, for longitudinal studies of PAF patients with documented conversion to LBDs or MSA. Study quality was assessed with the Newcastle-Ottawa Scale. Random-effects models estimated pooled odds ratios (ORs) with 95% confidence intervals (CIs) for predictors reported in ≥3 studies. Phenoconversion rates were estimated with Freeman-Tukey transformation and inverse-variance weighting.

Among 774 records screened, 11 studies met inclusion criteria, and eight cohorts (855 patients) contributed to meta-analyses. Pooled, 32% (95% CI: 26–39%) converted: 20% (12–28%) to LBDs and 10% (7–14%) to MSA. Predictors of overall phenoconversion were dream enactment behavior (OR 3.23, 95% CI: 1.81–5.74), subtle motor signs (OR 5.41, 0.99–29.56), and urinary dysfunction/catheterization (OR 2.42, 1.57–3.75; OR 3.63, 1.73–7.64). LBD conversion was predicted by dream enactment (OR 3.47, 1.50-8.06) and hyposmia (OR 2.05, 1.16-3.62); MSA by dream enactment (OR 3.78, 2.07-6.91), constipation (OR 2.34, 1.21-4.51), subtle motor signs (OR 7.22, 1.11-48.08), urinary symptoms (OR 7.06, 3.67-13.61), and catheterization (OR 8.16, 3.76-17.71).
This systematic review and meta-analysis provides a comprehensive synthesis of predictors of phenoconversion in PAF. Identifying these predictors may improve prognostic accuracy and enable earlier intervention, which is of particular importance with emerging disease-modifying therapies.
Authors/Disclosures
Sara Massucco, MD
PRESENTER 		Dr. Massucco has received research support from Italian Ministry of University and Research. Dr. Massucco has received research support from Beth Israel Deaconess Medical Center.
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.
Vincenzo Donadio, MD, PhD Prof. Donadio has received personal compensation in the range of $500-$4,999 for serving on a Scientific Advisory or Data Safety Monitoring board for Argenx.
Horacio C. Kaufmann, MD, FAAN (NYU Langone Health - NYU Dysautonomia Center) Dr. Kaufmann has received personal compensation in the range of $50,000-$99,999 for serving as a Consultant for Theravance. Dr. Kaufmann has received personal compensation in the range of $5,000-$9,999 for serving as a Consultant for Teva Pharmaceuticals. Dr. Kaufmann has received personal compensation in the range of $500-$4,999 for serving as a Consultant for Curasen Therapeutics. Dr. Kaufmann has received personal compensation in the range of $5,000-$9,999 for serving as a Consultant for Lundbeck. Dr. Kaufmann has received personal compensation in the range of $5,000-$9,999 for serving as a Consultant for AskBio. Dr. Kaufmann has received personal compensation in the range of $5,000-$9,999 for serving as a Consultant for BioArctic. Dr. Kaufmann has received personal compensation in the range of $10,000-$49,999 for serving as a Consultant for Sanofi. Dr. Kaufmann has received personal compensation in the range of $5,000-$9,999 for serving as an Editor, Associate Editor, or Editorial Advisory Board Member for Spinger. The institution of Dr. Kaufmann has received research support from Biogen. The institution of Dr. Kaufmann has received research support from Vaxxinity. Dr. Kaufmann has received publishing royalties from a publication relating to health care.
Christopher H. Gibbons, MD, FAAN (Beth Israel Deaconess Medical Center) Dr. Gibbons has received personal compensation for serving as an employee of CND Life Sciences. Dr. Gibbons has or had stock in CND Life Sciences.Dr. Gibbons has received publishing royalties from a publication relating to health care.
Pushpa Narayanaswami, MD, MBBS, FAAN (Beth Israel Deaconess Medical Center) Dr. Narayanaswami has received personal compensation in the range of $50,000-$99,999 for serving as a Consultant for UCB. Dr. Narayanaswami has received personal compensation in the range of $500-$4,999 for serving as a Consultant for CVS. Dr. Narayanaswami has received personal compensation in the range of $500-$4,999 for serving on a Scientific Advisory or Data Safety Monitoring board for Sanofi. Dr. Narayanaswami has received personal compensation in the range of $5,000-$9,999 for serving on a Scientific Advisory or Data Safety Monitoring board for Janssen. Dr. Narayanaswami has received personal compensation in the range of $500-$4,999 for serving on a Scientific Advisory or Data Safety Monitoring board for Argenx USA. Dr. Narayanaswami has received personal compensation in the range of $500-$4,999 for serving on a Scientific Advisory or Data Safety Monitoring board for Alexion. Dr. Narayanaswami has received personal compensation in the range of $0-$499 for serving on a Scientific Advisory or Data Safety Monitoring board for Argenx. Dr. Narayanaswami has received personal compensation in the range of $0-$499 for serving on a Scientific Advisory or Data Safety Monitoring board for NMD pharma. Dr. Narayanaswami has received personal compensation in the range of $500-$4,999 for serving on a Scientific Advisory or Data Safety Monitoring board for EMD-Serono (Merck usa). Dr. Narayanaswami has received personal compensation in the range of $0-$499 for serving on a Scientific Advisory or Data Safety Monitoring board for Immuneabs. Dr. Narayanaswami has received personal compensation in the range of $500-$4,999 for serving on a Scientific Advisory or Data Safety Monitoring board for Viridian. Dr. Narayanaswami has received personal compensation in the range of $500-$4,999 for serving on a Scientific Advisory or Data Safety Monitoring board for Cabaletta-Bio. Dr. Narayanaswami has received personal compensation in the range of $500-$4,999 for serving on a Scientific Advisory or Data Safety Monitoring board for Immunovant. Dr. Narayanaswami has received personal compensation in the range of $5,000-$9,999 for serving on a Scientific Advisory or Data Safety Monitoring board for Amgen. Dr. Narayanaswami has received personal compensation in the range of $500-$4,999 for serving on a Scientific Advisory or Data Safety Monitoring board for Dianthus. Dr. Narayanaswami has received personal compensation in the range of $500-$4,999 for serving on a Scientific Advisory or Data Safety Monitoring board for Cartesian. Dr. Narayanaswami has received personal compensation in the range of $500-$4,999 for serving on a Scientific Advisory or Data Safety Monitoring board for Vor Bio. Dr. Narayanaswami has received personal compensation in the range of $5,000-$9,999 for serving as an Editor, Associate Editor, or Editorial Advisory Board Member for Muscle and Nerve, Wiley. Dr. Narayanaswami has received personal compensation in the range of $10,000-$49,999 for serving as an Editor, Associate Editor, or Editorial Advisory Board Member for Neurology. Dr. Narayanaswami has or had stock in Dr. Reddys laboratories.Dr. Narayanaswami has or had stock in Doximity. The institution of Dr. Narayanaswami has received research support from Alexion. The institution of Dr. Narayanaswami has received research support from NIH. The institution of Dr. Narayanaswami has received research support from Argenx. The institution of Dr. Narayanaswami has received research support from Cabaletta Bio. Dr. Narayanaswami has received publishing royalties from a publication relating to health care. Dr. Narayanaswami has a non-compensated relationship as a Member, Finance Committee with AANEM that is relevant to AAN interests or activities.
Roy L. Freeman, MD (Beth Israel Deaconess Hosp) Dr. Freeman has received personal compensation in the range of $50,000-$99,999 for serving as a Consultant for Cutaneous Diagnostic Life Sciences. Dr. Freeman has received personal compensation in the range of $10,000-$49,999 for serving as a Consultant for Vertex. Dr. Freeman has received personal compensation in the range of $10,000-$49,999 for serving as a Consultant for Theravance. Dr. Freeman has received personal compensation in the range of $10,000-$49,999 for serving as an officer or member of the Board of Directors for Inhibikase. Dr. Freeman has received personal compensation in the range of $10,000-$49,999 for serving as an Editor, Associate Editor, or Editorial Advisory Board Member for Elsevier. The institution of Dr. Freeman has received research support from NIH. The institution of Dr. Freeman has received research support from Theravance. The institution of Dr. Freeman has received research support from Biohaven. The institution of Dr. Freeman has received research support from Lundbeck. Dr. Freeman has received research support from Regeneron.