Recognition and treatment of autonomic disturbances in Parkinson’s disease

Abstract

Symptoms of dysautonomia are common in Parkinson’s disease (PD), and almost all the functional autonomic subsystems can be involved in PD. However, they are still under-recognized in everyday clinical practice. Autonomic dysfunction can be observed in the early stages of PD, affect a substantial proportion of patients, impact quality of life and can also help in differential diagnosis. This review aims to provide an overview of the pathophysiology, clinical manifestations, relevant examination and treatment of cardiovascular, gastrointestinal, urogenital, thermoregulatory and pupil autonomic dysfunctions in Parkinson’s disease.

Keywords:

• autonomic dysfunction
• cardiovascular
• gastrointestinal
• Parkinson’s disease
• pupil
• sexual
• thermoregulatory
• urinary

Financial & competing interests disclosure

The authors have no relevant affiliations or financial involvement with any organization or entity with a financial interest in or financial conflict with the subject matter or materials discussed in the manuscript. This includes employment, consultancies, honoraria, stock ownership or options, expert testimony, grants or patents received or pending, or royalties.

No writing assistance was utilized in the production of this manuscript.

Key issues

• Autonomic dysfunction is prevalent in PD, can present in the early stages, and impact quality of life.

• OH is the main cardiovascular autonomic symptom in PD. A comprehensive cardiovascular autonomic function examination can diagnose, quantify and characterize cardiovascular dysautonomia in PD. Multiple nonpharmacological and medical therapies can relieve OH.

• Gastrointestinal autonomic symptoms include dysphagia and drooling, gastroparesis, constipation and other defecation disturbances. Alimentary tract biopsy for α-synuclein pathology may be a promising biomarker.

• Storage symptoms are predominant in urinary dysfunction, and antimuscarinergics are commonly used. Refractory urinary dysfunctions need collaboration between neurologists and urologists.

• Sexual symptoms are common in PD, and we should bear dopaminergic drug related hypersexuality and paraphilia in mind.

• Thermoregulatory dysfunction should be especially considered when taking care of patients with limited mobility, and dopaminergic drugs can relieve excessive sweating during the off state.

• Pupillary dysfunction is associated with visual disturbances. Pupillary tests may help in differential diagnosis of extrapyramidal diseases.

Notes

Counter maneuver: such as leg crossing, toe raising, thigh contraction, hand grip, and arm tensing. Some of them can be combined. These maneuvers can improve venous return and increase peripheral resistance.

MAO-B: Monoamine oxidase type B; OH: Orthostatic hypotension; PD: Parkinson’s disease.