Skip to main content
PMC home page
Journal of Neurology, Neurosurgery, and Psychiatry logoLink to Journal of Neurology, Neurosurgery, and Psychiatry
. 1999 Nov;67(5):620–623. doi: 10.1136/jnnp.67.5.620

Time course of symptomatic orthostatic hypotension and urinary incontinence in patients with postmortem confirmed parkinsonian syndromes: a clinicopathological study

G Wenning 1, C Scherfler 1, R Granata 1, S Bosch 1, M Verny 1, K Chaudhuri 1, K Jellinger 1, W Poewe 1, I Litvan 1
PMCID: PMC1736638  PMID: 10519868

Abstract

OBJECTIVE—Although both orthostatic hypotension and urinary incontinence have been reported in a number of parkinsonian syndromes, such as Parkinson's disease (PD), multiple system atrophy (MSA), dementia with Lewy bodies (DLB), corticobasal degeneration (CBD), and progressive supranuclear palsy (PSP), differences in the evolution of these features have not been studied systematically in pathologically confirmed cases.
METHODS—77 cases with pathologically confirmed parkinsonian syndromes (PD, n=11; MSA, n=15; DLB, n=14; CBD, n=13; PSP, n=24), collected up to 1994, formed the basis for a multicentre clinicopathological study organised by the NINDS to improve the differential diagnosis of parkinsonian disorders. The present study determined the time course—that is, latency to onset and duration from onset to death, of symptomatic orthostatic hypotension, and urinary incontinence in the NINDS series. Furthermore, the diagnostic validity of a predefined latency to onset within 1 year of disease onset of symptomatic orthostatic hypotension or urinary incontinence was analysed.
RESULTS—Significant group differences for latency, but not duration, of symptomatic orthostatic hypotension and urinary incontinence were found. Latencies to onset of either feature were short in patients with MSA, intermediate in patients with DLB, CBD, and PSP, and long in those with PD. Symptomatic orthostatic hypotension occurring within the first year after disease onset predicted MSA in 75% of cases; early urinary incontinence was less predictive for MSA (56%).
CONCLUSION—Latency to onset, but not duration, of symptomatic orthostatic hypotension or urinary incontinence differentiates PD from other parkinsonian syndromes, particularly MSA.



Full Text

The Full Text of this article is available as a PDF (75.3 KB).

Selected References

These references are in PubMed. This may not be the complete list of references from this article.

  1. Bannister R., Oppenheimer D. R. Degenerative diseases of the nervous system associated with autonomic failure. Brain. 1972;95(3):457–474. doi: 10.1093/brain/95.3.457. [DOI] [PubMed] [Google Scholar]
  2. Beck R. O., Betts C. D., Fowler C. J. Genitourinary dysfunction in multiple system atrophy: clinical features and treatment in 62 cases. J Urol. 1994 May;151(5):1336–1341. doi: 10.1016/s0022-5347(17)35246-1. [DOI] [PubMed] [Google Scholar]
  3. Burkhardt C. R., Filley C. M., Kleinschmidt-DeMasters B. K., de la Monte S., Norenberg M. D., Schneck S. A. Diffuse Lewy body disease and progressive dementia. Neurology. 1988 Oct;38(10):1520–1528. doi: 10.1212/wnl.38.10.1520. [DOI] [PubMed] [Google Scholar]
  4. Goldstein D. S., Holmes C., Cannon R. O., 3rd, Eisenhofer G., Kopin I. J. Sympathetic cardioneuropathy in dysautonomias. N Engl J Med. 1997 Mar 6;336(10):696–702. doi: 10.1056/NEJM199703063361004. [DOI] [PubMed] [Google Scholar]
  5. Kimber J. R., Watson L., Mathias C. J. Distinction of idiopathic Parkinson's disease from multiple-system atrophy by stimulation of growth-hormone release with clonidine. Lancet. 1997 Jun 28;349(9069):1877–1881. doi: 10.1016/s0140-6736(96)10168-9. [DOI] [PubMed] [Google Scholar]
  6. Kosaka K. Diffuse Lewy body disease in Japan. J Neurol. 1990 Jun;237(3):197–204. doi: 10.1007/BF00314594. [DOI] [PubMed] [Google Scholar]
  7. Litvan I., Agid Y., Calne D., Campbell G., Dubois B., Duvoisin R. C., Goetz C. G., Golbe L. I., Grafman J., Growdon J. H. Clinical research criteria for the diagnosis of progressive supranuclear palsy (Steele-Richardson-Olszewski syndrome): report of the NINDS-SPSP international workshop. Neurology. 1996 Jul;47(1):1–9. doi: 10.1212/wnl.47.1.1. [DOI] [PubMed] [Google Scholar]
  8. Litvan I., Hauw J. J., Bartko J. J., Lantos P. L., Daniel S. E., Horoupian D. S., McKee A., Dickson D., Bancher C., Tabaton M. Validity and reliability of the preliminary NINDS neuropathologic criteria for progressive supranuclear palsy and related disorders. J Neuropathol Exp Neurol. 1996 Jan;55(1):97–105. doi: 10.1097/00005072-199601000-00010. [DOI] [PubMed] [Google Scholar]
  9. Litvan I., Mangone C. A., McKee A., Verny M., Parsa A., Jellinger K., D'Olhaberriague L., Chaudhuri K. R., Pearce R. K. Natural history of progressive supranuclear palsy (Steele-Richardson-Olszewski syndrome) and clinical predictors of survival: a clinicopathological study. J Neurol Neurosurg Psychiatry. 1996 Jun;60(6):615–620. doi: 10.1136/jnnp.60.6.615. [DOI] [PMC free article] [PubMed] [Google Scholar]
  10. Magalhães M., Wenning G. K., Daniel S. E., Quinn N. P. Autonomic dysfunction in pathologically confirmed multiple system atrophy and idiopathic Parkinson's disease--a retrospective comparison. Acta Neurol Scand. 1995 Feb;91(2):98–102. doi: 10.1111/j.1600-0404.1995.tb00414.x. [DOI] [PubMed] [Google Scholar]
  11. McKeith I. G., Galasko D., Kosaka K., Perry E. K., Dickson D. W., Hansen L. A., Salmon D. P., Lowe J., Mirra S. S., Byrne E. J. Consensus guidelines for the clinical and pathologic diagnosis of dementia with Lewy bodies (DLB): report of the consortium on DLB international workshop. Neurology. 1996 Nov;47(5):1113–1124. doi: 10.1212/wnl.47.5.1113. [DOI] [PubMed] [Google Scholar]
  12. Palace J., Chandiramani V. A., Fowler C. J. Value of sphincter electromyography in the diagnosis of multiple system atrophy. Muscle Nerve. 1997 Nov;20(11):1396–1403. doi: 10.1002/(sici)1097-4598(199711)20:11<1396::aid-mus7>3.0.co;2-5. [DOI] [PubMed] [Google Scholar]
  13. Papp M. I., Kahn J. E., Lantos P. L. Glial cytoplasmic inclusions in the CNS of patients with multiple system atrophy (striatonigral degeneration, olivopontocerebellar atrophy and Shy-Drager syndrome). J Neurol Sci. 1989 Dec;94(1-3):79–100. doi: 10.1016/0022-510x(89)90219-0. [DOI] [PubMed] [Google Scholar]
  14. Papp M. I., Lantos P. L. Accumulation of tubular structures in oligodendroglial and neuronal cells as the basic alteration in multiple system atrophy. J Neurol Sci. 1992 Feb;107(2):172–182. doi: 10.1016/0022-510x(92)90286-t. [DOI] [PubMed] [Google Scholar]
  15. Pramstaller P. P., Wenning G. K., Smith S. J., Beck R. O., Quinn N. P., Fowler C. J. Nerve conduction studies, skeletal muscle EMG, and sphincter EMG in multiple system atrophy. J Neurol Neurosurg Psychiatry. 1995 May;58(5):618–621. doi: 10.1136/jnnp.58.5.618. [DOI] [PMC free article] [PubMed] [Google Scholar]
  16. Quinn N. P., Marsden C. D. The motor disorder of multiple system atrophy. J Neurol Neurosurg Psychiatry. 1993 Dec;56(12):1239–1242. doi: 10.1136/jnnp.56.12.1239. [DOI] [PMC free article] [PubMed] [Google Scholar]
  17. Sakakibara R., Hattori T., Tojo M., Yamanishi T., Yasuda K., Hirayama K. Micturitional disturbance in progressive supranuclear palsy. J Auton Nerv Syst. 1993 Nov;45(2):101–106. doi: 10.1016/0165-1838(93)90122-b. [DOI] [PubMed] [Google Scholar]
  18. Sandroni P., Ahlskog J. E., Fealey R. D., Low P. A. Autonomic involvement in extrapyramidal and cerebellar disorders. Clin Auton Res. 1991 Jun;1(2):147–155. doi: 10.1007/BF01826212. [DOI] [PubMed] [Google Scholar]
  19. Singer C., Weiner W. J., Sanchez-Ramos J. R. Autonomic dysfunction in men with Parkinson's disease. Eur Neurol. 1992;32(3):134–140. doi: 10.1159/000116810. [DOI] [PubMed] [Google Scholar]
  20. Stocchi F., Carbone A., Inghilleri M., Monge A., Ruggieri S., Berardelli A., Manfredi M. Urodynamic and neurophysiological evaluation in Parkinson's disease and multiple system atrophy. J Neurol Neurosurg Psychiatry. 1997 May;62(5):507–511. doi: 10.1136/jnnp.62.5.507. [DOI] [PMC free article] [PubMed] [Google Scholar]
  21. Thomaides T., Bleasdale-Barr K., Chaudhuri K. R., Pavitt D., Marsden C. D., Mathias C. J. Cardiovascular and hormonal responses to liquid food challenge in idiopathic Parkinson's disease, multiple system atrophy, and pure autonomic failure. Neurology. 1993 May;43(5):900–904. doi: 10.1212/wnl.43.5.900. [DOI] [PubMed] [Google Scholar]
  22. Valldeoriola F., Valls-Solé J., Tolosa E. S., Marti M. J. Striated anal sphincter denervation in patients with progressive supranuclear palsy. Mov Disord. 1995 Sep;10(5):550–555. doi: 10.1002/mds.870100504. [DOI] [PubMed] [Google Scholar]
  23. Wenning G. K., Ben Shlomo Y., Magalhães M., Daniel S. E., Quinn N. P. Clinical features and natural history of multiple system atrophy. An analysis of 100 cases. Brain. 1994 Aug;117(Pt 4):835–845. doi: 10.1093/brain/117.4.835. [DOI] [PubMed] [Google Scholar]
  24. Wenning G. K., Litvan I., Jankovic J., Granata R., Mangone C. A., McKee A., Poewe W., Jellinger K., Ray Chaudhuri K., D'Olhaberriague L. Natural history and survival of 14 patients with corticobasal degeneration confirmed at postmortem examination. J Neurol Neurosurg Psychiatry. 1998 Feb;64(2):184–189. doi: 10.1136/jnnp.64.2.184. [DOI] [PMC free article] [PubMed] [Google Scholar]

Articles from Journal of Neurology, Neurosurgery, and Psychiatry are provided here courtesy of BMJ Publishing Group

RESOURCES