Non-motor symptoms of Parkinson’s disease (PD) such as dysautonomia and REM sleep behavior disorder (RBD) are recognized to be important prodromal symptoms that may also indicate clinical subtypes of PD with different pathogenesis. Unbiased clustering analyses showed that subjects with dysautonomia and RBD symptoms, as well as early cognitive dysfunction, have faster progression of the disease. Through analysis of the Parkinson’s Progression Markers Initiative (PPMI) de novo PD cohort, we tested the hypothesis that symptoms of dysautonomia and RBD, which are readily assessed by standard questionnaires in an ambulatory care setting, may help to independently prognosticate disease progression. Although these two symptoms associate closely, dysautonomia symptoms predict severe progression of motor and non-motor symptoms better than RBD symptoms across the 3-year follow-up period. Autonomic system involvement has not received as much attention and may be important to consider for stratification of subjects for clinical trials and for counseling patients.

帕金森病 (PD) 的非运动症状，如自主神经异常和 REM 睡眠行为障碍 (RBD)，被认为是重要的前驱症状，也可能表明具有不同发病机制的 PD 临床亚型。无偏聚类分析表明，患有自主神经功能障碍和 RBD 症状以及早期认知功能障碍的受试者的疾病进展速度更快。通过对帕金森病进展标记计划 (PPMI) 从头 PD 队列的分析，我们检验了自主神经功能障碍和 RBD 的症状可能有助于独立预测疾病进展的假设，这些症状很容易通过门诊护理环境中的标准问卷进行评估。尽管这两种症状密切相关，在 3 年的随访期间，自主神经功能障碍症状比 RBD 症状更能预测运动和非运动症状的严重进展。自主神经系统受累尚未受到足够多的关注，对于临床试验的受试者分层和咨询患者可能很重要。