Exploring hyperhidrosis and related thermoregulatory symptoms as a possible clinical identifier for the dysautonomic subtype of Parkinson’s disease

Abstract

<div><h3>Objective</h3><p>To identify associated (non-)motor profiles of Parkinson’s disease (PD) patients with hyperhidrosis as a dominant problem.</p></div><div><h3>Methods</h3><p>This is a cross-sectional, exploratory, analysis of participants enrolled in the Non-motor Longitudinal International Study (NILS; UKCRN No: 10084) at the Parkinson’s Centre at King’s College Hospital (London, UK). Hyperhidrosis scores (yes/no) on question 28 of the Non-Motor Symptom Questionnaire were used to classify patients with normal sweat function (<em>n</em> = 172) and excessive sweating (<em>n</em> = 56) (Analysis 1; <em>n</em> = 228). NMS scale (NMSS) question 30 scores were used to stratify participants based on hyperhidrosis severity (Analysis 2; <em>n</em> = 352) using an arbitrary severity grading: absent score 0 (<em>n</em> = 267), mild 1–4 (<em>n</em> = 49), moderate 5–8 (<em>n</em> = 17), and severe 9–12 (<em>n</em> = 19). NMS burden, as well as PD sleep scale (PDSS) scores were then analysed along with other correlates.</p></div><div><h3>Results</h3><p>No differences were observed in baseline demographics between groups in either analysis. Patients with hyperhidrosis exhibited significantly higher total NMSS burden compared to those without (<em>p</em> < 0.001). Secondary analyses revealed higher dyskinesia scores, worse quality of life and PDSS scores, and higher anxiety and depression levels in hyperhidrosis patients (<em>p</em> < 0.001). Tertiary analyses revealed higher NMSS item scores for fatigue, sleep initiation, restless legs, urinary urgency, and unexplained pain (<em>p</em> < 0.001).</p></div><div><h3>Conclusions</h3><p>Chronic hyperhidrosis appears to be associated with a dysautonomia dominant subtype in PD patients, which is also associated with sleep disorders and a higher rate of dyskinesia (fluctuation-related hyperhidrosis). These data should prompt the concept of hyperhidrosis being used as a simple clinical screening tool to identify PD patients with autonomic symptoms.</p></div>