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Dysautonomia in Parkinson disease
1Clinical Neurocardiology Section, Clinical Neurosciences Program, Division of Intramural Research, National Institute of Neurological Disorders and Stroke, National Institutes of Health, Bethesda, Maryland.
Comprehensive Physiology
|April 10, 2014
Summary
Dysautonomia, or autonomic nervous system dysfunction, is common in Parkinson disease (PD). Cardiovascular autonomic dysfunction, particularly cardiac sympathetic denervation, is a key feature of PD, impacting non-motor symptoms and disease mechanisms.
Area of Science:
- Neurology
- Autonomic Neuroscience
- Pathophysiology
Background:
- Dysautonomias involve autonomic nervous system (ANS) dysfunction impacting health.
- Parkinson disease (PD) frequently presents with dysautonomia, sometimes dominating the clinical picture.
- The ANS comprises sympathetic noradrenergic, parasympathetic, sympathetic cholinergic, sympathetic adrenomedullary, and enteric nervous systems.
Purpose of the Study:
- To review and update knowledge on dysautonomia specifically within Parkinson disease.
- To focus on cardiovascular dysautonomia in PD due to available assessment tools.
- To explore the link between alpha-synucleinopathy and catecholamine neuron loss in PD.
Main Methods:
- Review of existing literature on dysautonomia in Parkinson disease.
- Focus on scientific understanding of cardiovascular autonomic dysfunction in PD.
- Analysis of the relationship between ANS dysfunction, non-motor symptoms, and disease mechanisms.
Main Results:
- Most Parkinson disease patients exhibit symptoms or signs of dysautonomia.
- Cardiovascular dysautonomia is well-understood in PD, with cardiac sympathetic denervation being a key finding.
- Loss of cardiac sympathetic innervation in PD is independent of motor symptom-related dopaminergic loss and links to anosmia, REM sleep behavior disorder, orthostatic hypotension, and dementia.
Conclusions:
- Autonomic dysfunction is a significant aspect of Parkinson disease, affecting clinical management and potentially serving as biomarkers.
- Understanding dysautonomia in PD is crucial for elucidating disease mechanisms, including catecholamine metabolite autotoxicity.
- Future research should prioritize understanding the connection between alpha-synucleinopathy and catecholamine neuron loss in Parkinson disease.
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