The composite autonomic symptom scale 31 is a useful screening tool for patients with Parkinsonism

Abstract

Differentiation of multiple system atrophy with predominant parkinsonism (MSA-P) and Parkinson's disease (PD) is important, but an effective tool for differentiation has not been identified. We investigated the efficacy of the composite autonomic symptom scale 31 (COMPASS 31) questionnaire as a tool for evaluating autonomic function in parkinsonism patients. In this study, we enrolled drug-naïve patients with MSA-P and PD, and administered the COMPASS-31 and an objective autonomic dysfunction test (AFT). Demographic and clinical data, including parkinsonism and autonomic dysfunction, were compared between the two groups. Additionally, we determined the optimal COMPASS 31 cut-off score to differentiate MSA-P from PD for use as a screening tool. In this study, 27 MSA-P patients and 41 PD patients were recruited. The total COMPASS 31 score was well correlated with the objective AFT results. When we compared the COMPASS 31 score between the two groups, MSA-P patients showed higher total scores and sub-scores in the orthostatic intolerance, gastrointestinal, and bladder domains compared with PD patients. Similarly, MSA-P patients had more abnormalities in expiration to inspiration ratio, Valsalva ratio and pressure recovery time than PD patients in objective AFT. With 13.25 as the cut-off score for diagnosis of MSA-P, the total COMPASS-31 score demonstrated high sensitivity (92.6%) and moderate specificity (51.2%) with an area under the curve of 0.765. Based on our results, the COMPASS 31 is an effective tool for evaluation of autonomic function in patients with parkinsonism. The COMPASS-31 could be used as a sensitive and convenient screening tool, especially for the differentiation between MSA-P and PD.

Conflict of interest statement

Competing Interests: The authors have declared that no competing interests exist.

Figures

Fig 1. Comparison of COMPASS 31 scores among the patients with PD and MSA-P.

The MSA-P patient group had higher total COMPASS 31 scores and higher sub-scores in the orthostatic intolerance, gastrointestinal, and bladder domains compared with PD patients. The error bars represent the standard error of mean. COMPASS 31, composite autonomic symptom scale 31 questionnaire; PD, Parkinson’s disease; MSA-P, multiple system atrophy with predominant parkinsonism. *p-value < 0.05.

Fig 2. ROC curve for COMPASS 31 total score diagnostic performance.

With 13.25 as the cut-off score for differential diagnosis of MSA-P from PD, the total COMPASS 31 score demonstrated high sensitivity (92.6%) and moderate specificity (51.2%) with an area under the curve of 0.765. ROC, receiver operating characteristic; COMPASS 31, composite autonomic symptom scale 31 questionnaire; MSA-P, multiple system atrophy with predominant parkinsonism; PD, Parkinson’s disease.