Publicação
Interoceptive and Autonomic Cross-pathways in Parkinson's Disease
| Resumo: | Introduction: The clinical diagnosis of Parkinson’s disease (PD) remains centred on cardinal motor features. However, non-motor manifestations, particularly autonomic nervous system dysfunction, are prevalent throughout the course of the disease, sometimes preceding motor symptoms by years and significantly impairing quality of life. Interoception refers to the process by which the nervous system senses, integrates, interprets, and regulates signals originating from within the body itself. Preliminary research has demonstrated that patients with Parkinson’s (PwP) exhibit reduced interoceptive accuracy and awareness, which can lead to missed opportunities for early interventions due to a failure to recognise and report these impairments. This study aimed to analyse the association between interoception and autonomic function in PwP.Methods:An observational case-control study was conducted, including PwP recruited from the outpatient clinic of the Neurology department of ULS Coimbra during the third trimester of 2025 and the first trimester of 2026, and age and sex matched healthy controls (HC). Clinical evaluation included demographic and disease-related variables, motor severity assessment using the MDS-UPDRS-III, and levodopa equivalent daily dose (LEDD). Participants completed validated scales evaluating interoception (MAIA, BPQ-AS), non-motor symptoms (NMSS, SCOPA-AUT), cognition (MoCA), mood (HAM, BDI), and quality of life (PDQ-39). Descriptive and comparative analyses were performed between groups and interoceptive dimensions.Results:The PD cohort was in the early disease stage, with a Hoehn & Yahr stage of 1.3 and a mean disease duration of 3.4 years. PwP showed a higher burden of non-motor symptoms (total, gastrointestinal and mix domains) and autonomic dysfunction (total, gastrointestinal, genitourinary and sexual domains) and poorer quality of life compared with HC. There were no significant differences in the MAIA scores between groups. However, the group of PwP showed a correlation between the Noticing and Emotional Awareness subdomains and a higher anxiety score and poorer quality of life. Noticing and Emotional Awareness were also inversely related to motor symptom severity. Additionally, the Attention Regulation subdomain showed a negative correlation with the LEDD. Conclusion:Interoception has an important role in the early non-motor phenotype of PD. PwP show a substantial non-motor, autonomic and cognitive burden, even in early disease stages, which significantly affects their quality of life. While subjective interoceptive awareness remained preserved, patients with hypervigilance towards inner signals present a higher level of psychological distress and reduced quality of life. Awareness declines along the motor disability, possibly paralleling the neurodegeneration of interoceptive hubs. |
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| Autores principais: | Magalhães, Daniela Filipa Rocha |
| Assunto: | Parkinson’s disease Interoception Non-motor symptoms Autonomic dysfunction Doença de Parkinson Interocepção Sintomas não motores Disfunção autonómica |
| Ano: | 2026 |
| País: | Portugal |
| Tipo de documento: | dissertação de mestrado |
| Tipo de acesso: | acesso embargado |
| Instituição associada: | Universidade de Coimbra |
| Idioma: | inglês |
| Origem: | Estudo Geral - Universidade de Coimbra |
| Resumo: | Introduction: The clinical diagnosis of Parkinson’s disease (PD) remains centred on cardinal motor features. However, non-motor manifestations, particularly autonomic nervous system dysfunction, are prevalent throughout the course of the disease, sometimes preceding motor symptoms by years and significantly impairing quality of life. Interoception refers to the process by which the nervous system senses, integrates, interprets, and regulates signals originating from within the body itself. Preliminary research has demonstrated that patients with Parkinson’s (PwP) exhibit reduced interoceptive accuracy and awareness, which can lead to missed opportunities for early interventions due to a failure to recognise and report these impairments. This study aimed to analyse the association between interoception and autonomic function in PwP.Methods:An observational case-control study was conducted, including PwP recruited from the outpatient clinic of the Neurology department of ULS Coimbra during the third trimester of 2025 and the first trimester of 2026, and age and sex matched healthy controls (HC). Clinical evaluation included demographic and disease-related variables, motor severity assessment using the MDS-UPDRS-III, and levodopa equivalent daily dose (LEDD). Participants completed validated scales evaluating interoception (MAIA, BPQ-AS), non-motor symptoms (NMSS, SCOPA-AUT), cognition (MoCA), mood (HAM, BDI), and quality of life (PDQ-39). Descriptive and comparative analyses were performed between groups and interoceptive dimensions.Results:The PD cohort was in the early disease stage, with a Hoehn & Yahr stage of 1.3 and a mean disease duration of 3.4 years. PwP showed a higher burden of non-motor symptoms (total, gastrointestinal and mix domains) and autonomic dysfunction (total, gastrointestinal, genitourinary and sexual domains) and poorer quality of life compared with HC. There were no significant differences in the MAIA scores between groups. However, the group of PwP showed a correlation between the Noticing and Emotional Awareness subdomains and a higher anxiety score and poorer quality of life. Noticing and Emotional Awareness were also inversely related to motor symptom severity. Additionally, the Attention Regulation subdomain showed a negative correlation with the LEDD. Conclusion:Interoception has an important role in the early non-motor phenotype of PD. PwP show a substantial non-motor, autonomic and cognitive burden, even in early disease stages, which significantly affects their quality of life. While subjective interoceptive awareness remained preserved, patients with hypervigilance towards inner signals present a higher level of psychological distress and reduced quality of life. Awareness declines along the motor disability, possibly paralleling the neurodegeneration of interoceptive hubs. |
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