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Natural history of pure autonomic failure: A United States prospective cohort

Open access
Kaufmann, Horacio, Norcliffe‐Kaufmann, Lucy, Palma, Jose‐Alberto, Biaggioni, Italo, Low, Phillip A., Singer, Wolfgang, Goldstein, David S., Peltier, Amanda C., Shibao, Cyndia A., Gibbons, Christopher H., Freeman, Roy, Robertson, David, on behalf of the Autonomic Disorders Consortium·2017·Annals of Neurology

Abstract

Objective: To define the clinical features and biomarkers that predict which patients with pure autonomic failure will develop Parkinson disease, dementia with Lewy bodies, or multiple system atrophy. Methods: One hundred patients who presented with pure autonomic failure were recruited at 5 medical centers in the United States. Seventy‐four patients agreed to be followed prospectively. Patients underwent clinical evaluations including neurological rating scales, sleep questionnaires, smell test, and sympathetic and parasympathetic cardiovascular autonomic function tests. Results: At enrollment, patients were 68 ± 12 years old (median ± interquartile range) and had had autonomic failure for 5 ± 7 years. Within 4 years of follow‐up, 25 of 74 subjects (34%) developed dementia with Lewy bodies (n = 13), Parkinson disease (n = 6), or multiple system atrophy (n = 6). The presence of probable rapid eye movement (REM) sleep behavior disorder was strongly associated with the development of a manifest central nervous system (CNS) synucleinopathy (odds ratio = 7.1). Patients who phenoconverted to multiple system atrophy had younger age at onset of autonomic failure, severe bladder/bowel dysfunction, preserved olfaction, and a cardiac chronotropic response upon tilt > 10 beats per minute. Those who phenoconverted to Parkinson disease or dementia with Lewy bodies had decreased olfaction, a lesser chronotropic response to tilt, and a longer duration of illness. The small group of patients retaining the pure autonomic failure phenotype had very low plasma norepinephrine levels, slow resting heart rate, no REM sleep behavior disorder, and preserved smell. Interpretation: Patients presenting with pure autonomic failure are at high risk of phenoconverting to a manifest CNS synucleinopathy. Specific clinical features predict future diagnosis. Ann Neurol 2017;81:287–297

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Metadata

Authors
Kaufmann, H., Norcliffe‐Kaufmann, L., Palma, J., Biaggioni, I., Low, P. A., Singer, W., Goldstein, D. S., Peltier, A. C., Shibao, C. A., Gibbons, C. H., Freeman, R., Robertson, D., & on behalf of the Autonomic Disorders Consortium
Venue
Annals of Neurology
Publisher
Wiley
Published
2017-02
Volume
81
Issue
2
Pages
287-297
ISSN
  • 0364-5134 (ISSN-L)
  • 1531-8249
OpenAlex
W2617170837
Cited by
298
References
8
FWCI
19.52
Type
journal article
Language
en
Open access
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CoChat. (2026). Citation check: Natural history of pure autonomic failure: A United States prospective cohort. https://app.cochat.ai/papers/10.1002/ana.24877
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Kaufmann, H., Norcliffe‐Kaufmann, L., Palma, J., Biaggioni, I., Low, P. A., Singer, W., Goldstein, D. S., Peltier, A. C., Shibao, C. A., Gibbons, C. H., Freeman, R., Robertson, D., & on behalf of the Autonomic Disorders Consortium. (2017). Natural history of pure autonomic failure: A United States prospective cohort. Annals of Neurology. https://doi.org/10.1002/ana.24877

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