Short communicationHyposialorrhea as an early manifestation of Parkinson disease
Introduction
Reduced salivary secretion is a manifestation of autonomic failure in patients with advanced Parkinson disease (PD) (Proulx et al., 2005, Tumilasci et al., 2006). In PD patients with motor fluctuations, hyposialorrhea is present both on the “off” and “on” conditions and improves with dopaminergic stimulation (Tumilasci et al., 2006). Whereas gastrointestinal motility disorders constitute early autonomic manifestations of PD (Pfeiffer, 2003), whether exocrine secretion, such as salivation, is also affected early in the disease has not yet been explored. We sought to determine whether impaired salivary secretion was an early manifestation of PD, as this could provide insight into the pathodynamics of autonomic involvement in this disorder.
Section snippets
Methods
This study was approved by the Institutional Review Board at the “Hospital de Clinicas”, University of Buenos Aires. Subjects receiving anticholinergic drugs or affected by disorders that may alter autonomic or salivary gland functions, such as diabetes or Sjögren disease were excluded. We studied 20 PD patients (12 women, 8 men, and age 67 ± 11 years, range 40–81) and 11 age- and sex matched controls. In PD patients, disease duration was 8 ± 3 months (range, 4–12) average Hoehn and Yahr stage was
Results
Both basal and reflex salivary secretion were significantly reduced in early PD patients compared to controls (Fig. 1). Basal secretion was 0.0964 ± 0.08 ml/min in PD and 0.293 ± 0.112 ml/min in control subjects (p < 0.001). Citric-acid stimulated salivary flow was 0.263 ± 0.213 ml/min in PD and 0.537 ± 0.313 ml/min in control subjects (p < 0.001). (Fig. 1)
Discussion
Our results indicate that hyposialorrhea is an early autonomic manifestation in PD. Not only basal secretion but also reflex secretion activated by citric acid were affected, suggesting that there is a reduction in neural input to the salivary glands. Unlike previous studies (Proulx et al., 2005, Tumilasci et al., 2006), our study focused on patients with early PD and not receiving dopaminergic medications. This allows excluding effect of disease severity, fluctuations, or dopaminergic receptor
References (14)
- et al.
Gastric alpha-synuclein immunoreactive inclusions in Meissner's and Auerbach's plexuses in cases staged for Parkinson's disease-related brain pathology
Neurosci. Lett.
(2006) - et al.
Chemical coding of enteric neurons
Prog. Brain Res.
(1986) Gastrointestinal dysfunction in Parkinson's disease
Lancet Neurol.
(2003)- et al.
Stanley Fahn Lecture 2005: the staging procedure for the inclusion body pathology associated with sporadic Parkinson's disease reconsidered
Mov. Disord.
(2006) - et al.
Invited article: nervous system pathology in sporadic Parkinson disease
Neurology
(2008) - et al.
Idiopathic Parkinson's disease: possible routes by which vulnerable neuronal types may be subject to neuroinvasion by an unknown pathogen
J. Neural Transm.
(2003) - et al.
Human brainstem preganglionic parasympathetic neurons localized by markers for nitric oxide synthesis
Brain
(1996)
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