Crosstalk between bladder-cardiovascular autonomic nervous system in synucleinopathies

Parkinson's disease (PD) and multiple system atrophy (MSA) are major neurogenerative diseases characterized pathologically by abnormal alpha-synuclein aggregation, called synucleinopathy. PD and MSA are clinically characterized by motor disorder and autonomic dysfunction (particularly lower urinary tract dysfunction, LUTD and orthostatic hypotension, OH). However, few literatures are available concerning mutual interaction between bladder-cardiovascular autonomic disorders in PD or MSA.

A narrative review including the past 10-year PubMed research papers on this topic. We also included dementia with Lewy bodies (DLB) that shares pathology with PD.

The LUTD in MSA is more severe than that in PD for large post-void residual (PVR) or urinary retention. These LUTDs presumably reflect the different nervous system pathologies. Of particular importance is that MSA may presents with LUTD alone initially, and some PD or MSA presents with OH alone (called pure autonomic failure, PAF); needs early diagnosis and management. For treating autonomic dysfunction in PD or MSA, mutual interactions between bladder-cardiovascular are worth considering, particularly when we prescribe urology drugs (alpha blockers might worsen OH) or cardiology drugs (antihypertensive drugs might worsen OH, and drugs to treat OH might worsen PVR). Care should also be taken for micturition syncope. This care improves individual's quality of life in PD or MSA; it can also prevent emergency hospitalizations, and early institutionalization.

This review summarizes the pathophysiology and practical management of (mutual) bladder-cardiovascular autonomic disorders in individuals with PD or MSA.