Fill a large pot with lightly salted water and bring to a boil. Stir in pasta and return to a boil. Cook pasta uncovered, stirring occasionally, until cooked through but still firm to the bite; drain.
Cook and stir Italian sausage in a large skillet over medium-high heat until the meat is browned, breaking it into crumbles as it cooks, about 10 minutes. Drain excess grease. Stir onion and garlic into sausage and cook until onion is translucent, about 5 minutes.
Stir pumpkin puree, chicken broth, half-and-half, sour cream, nutmeg, cinnamon, salt, and black pepper into the sausage mixture and cook, stirring often, until sauce is creamy and thick, about 5 minutes.
Transfer cooked pasta to a large pot and pour sausage and pumpkin mixture over pasta. Place over medium-high heat and gently stir until pasta mixture is heated through, 4 to 5 minutes. Serve topped with Parmesan cheese.
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