Crosstalk between bladder-cardiovascular autonomic nervous system in synucleinopathies

Area of Science:

• Neurodegenerative diseases
• Synucleinopathies
• Autonomic dysfunction

Background:

• Parkinson's disease (PD) and multiple system atrophy (MSA) are synucleinopathies characterized by motor and autonomic deficits.
• Lower urinary tract dysfunction (LUTD) and orthostatic hypotension (OH) are common autonomic issues in PD and MSA.
• Limited literature explores the interaction between bladder and cardiovascular autonomic disorders in these conditions.

Purpose of the Study:

• To review the pathophysiology and management of bladder-cardiovascular autonomic disorders in PD and MSA.
• To emphasize the mutual interactions in clinical practice.
• To improve patient outcomes and prevent hospitalizations.

Main Methods:

• Narrative review of PubMed research papers from the past 10 years.
• Inclusion of studies on dementia with Lewy bodies (DLB) due to shared pathology with PD.

Main Results:

• Lower urinary tract dysfunction (LUTD) is often more severe in MSA than PD, with potential for initial presentation as isolated LUTD.
• Orthostatic hypotension (OH) can also present initially as pure autonomic failure (PAF) in PD or MSA.
• Treatment requires careful consideration of drug interactions between urology and cardiology medications to avoid worsening autonomic symptoms like OH or urinary retention.

Conclusions:

• Effective management of autonomic dysfunction in PD and MSA necessitates understanding the interplay between bladder and cardiovascular systems.
• Considering these interactions is crucial for optimizing drug prescriptions and patient care.
• Improved management enhances quality of life and reduces healthcare utilization for PD and MSA patients.