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. 2022 Aug;43(8):4777-4784.
doi: 10.1007/s10072-022-06081-0. Epub 2022 Apr 30.

The path linking excessive daytime sleepiness and activity of daily living in Parkinson's disease: the longitudinal mediation effect of autonomic dysfunction

Ying Huang  1 , Sidan Du  1 , Durong Chen  1 , Yao Qin  1 , Jing Cui  1 , Hongjuan Han  1 , Xiaoyan Ge  1 , Wenlin Bai  1 , Xinnan Zhang  1 , Hongmei Yu  2   3
Affiliations

The path linking excessive daytime sleepiness and activity of daily living in Parkinson's disease: the longitudinal mediation effect of autonomic dysfunction

Ying Huang et al. Neurol Sci. 2022 Aug.

Abstract

Background: Excessive daytime sleepiness (EDS) and autonomic dysfunction have been verified to impair activity of daily living (ADL) in patients with Parkinson's disease (PD). Whether EDS can affect ADL in PD patients through autonomic dysfunction is still unclear. The purpose of this study is to explore the longitudinal mediation effect of autonomic dysfunction between EDS and ADL.

Methods: Data used in this study were from six-follow-up visits of 413 patients with newly diagnosed PD from the Parkinson's Progression Markers Initiative (PPMI). We used latent growth mediation modeling (LGMM) to explore whether the autonomic dysfunction is a longitudinal mediator between EDS and ADL.

Results: The results showed that as the disease progresses, EDS (P < 0.001) and autonomic dysfunction (P < 0.001) gradually worsened and ADL (P < 0.001) gradually decreased in PD patients. In addition, the more severe the patients' EDS symptom, the more worsened the symptoms of autonomic dysfunction, which result in a decrease in ADL. Both the intercept (95% CI: 0.142, 0.308) and the slope (95% CI: 0.083, 0.331) of autonomic dysfunction showed a partial mediating effect, and a longitudinal mediation effect was presented.

Conclusion: Longitudinal changes in EDS affect the ADL of PD patients directly or indirectly by affecting the symptoms of autonomic dysfunction. Controlling the symptoms of autonomic dysfunction may improve the ADL of PD patients with EDS.

Keywords: Activity of daily living; Autonomic dysfunction; Excessive daytime sleepiness; Mediation analysis; Parkinson’s disease.

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