J Clin Neurol.  2014 Oct;10(4):314-319. 10.3988/jcn.2014.10.4.314.

Dysautonomia in Narcolepsy: Evidence by Questionnaire Assessment

• Klein G
• Burghaus L
• Vaillant M
• Pieri V
• Fink GR
• Diederich

• KMID: 2287510
• DOI: http://doi.org/10.3988/jcn.2014.10.4.314

Abstract

BACKGROUND AND PURPOSE
Excessive daytime sleepiness and sudden sleep attacks are the main features of narcolepsy, but rapid-eye-movement sleep behavior disorder (RBD), hyposmia, and depression can also occur. The latter symptoms are nonmotor features in idiopathic Parkinson's disease (IPD). In the present study, IPD-proven diagnostic tools were tested to determine whether they are also applicable in the assessment of narcolepsy.
METHODS
This was a case-control study comparing 15 patients with narcolepsy (PN) and 15 control subjects (CS) using the Scales for Outcomes in Parkinson's Autonomic Test (SCOPA-AUT), Parkinson's Disease Nonmotor Symptoms (PDNMS), University of Pennsylvania Smell Test, Farnsworth-Munsell 100 Hue test, Beck Depression Inventory, and the RBD screening questionnaire.
RESULTS
Both the PN and CS exhibited mild hyposmia and no deficits in visual tests. Frequent dysautonomia in all domains except sexuality was found for the PN. The total SCOPA-AUT score was higher for the PN (18.47+/-10.08, mean+/-SD) than for the CS (4.40+/-3.09), as was the PDNMS score (10.53+/-4.78 and 1.80+/-2.31, respectively). RBD was present in 87% of the PN and 0% of the CS. The PN were more depressed than the CS. The differences between the PN and CS for all of these variables were statistically significant (all p<0.05).
CONCLUSIONS
The results of this study provide evidence for the presence of dysautonomia and confirm the comorbidities of depression and RBD in narcolepsy patients. The spectrum, which is comparable to the nonmotor complex in IPD, suggests wide-ranging, clinically detectable dysfunction beyond the narcoleptic core syndrome.

Keyword

autonomic failure; multisystem disorder; narcolepsy; Parkinson's disease

MeSH Terms

Case-Control Studies
Comorbidity
Depression
Humans
Mass Screening
Narcolepsy*
Parkinson Disease
Pennsylvania
Primary Dysautonomias*
Sexuality
Smell
Weights and Measures
Surveys and Questionnaires

Figure

• 

  Fig. 1 Results of the PDNMS questionnaire in 15 patients with narcolepsy and 15 control subjects. apath: apathy, cardio: cardiovascular system, depre: depression, gastro: gastrointestinal system, hallu: hallucinations, misc: miscellaneous, PDNMS: Parkinson's Disease Non-motor Symptoms, sex: sexual system, sleep: sleep disturbances, urin: urinary system.

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