Autonomic dysfunction in Parkinson’s disease: Implications for pathophysiology, diagnosis, and treatment

Chen, Zhichun; Li, Guanglu; Liu, Jun

doi:10.1016/j.nbd.2019.104700

Cited by 191 publications

(164 citation statements)

References 214 publications

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“…The evidence from this investigation definitely extends our current understanding of the etiology of PD that may initiate from the peripheral site due presumably to an unusual metabolism of DA and accumulation of DOPAL, consequently mediating α‐Syn aggregation and causing further dysfunction of central dopaminergic system through toxic effect of DOPAL and α‐Syn on axonal transportation, eventually causing an early autonomic dysfunction of BP regulation. This autonomic failure of BP regulation of PD is strongly supported by recent finding that lower urinary track and gastrointestinal dysfunction are common in early PD 52–54 and these non‐motor deficits of during early PD development such as autonomic dysfunction are well described in a recent review article 55 . The better understanding of early autonomic dysfunction and underlying mechanisms is definitely required to offer better therapeutic options to PD patients 56,57 …”

Section: Discussionmentioning

confidence: 75%

Parkinson‐like early autonomic dysfunction induced by vagal application of DOPAL in rats

Sun

Yan

et al. 2021

CNS Neurosci Ther

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Aim To understand why autonomic failures, a common non‐motor symptom of Parkinson's disease (PD), occur earlier than typical motor disorders. Methods Vagal application of DOPAL (3,4‐dihydroxyphenylacetaldehyde) to simulate PD‐like autonomic dysfunction and understand the connection between PD and cardiovascular dysfunction. Molecular and morphological approaches were employed to test the time‐dependent alternation of α‐synuclein aggregation and the ultrastructure changes in the heart and nodose (NG)/nucleus tractus solitarius (NTS). Results Blood pressure (BP) and baroreflex sensitivity of DOPAL‐treated rats were significantly reduced accompanied with a time‐dependent change in orthostatic BP, consistent with altered echocardiography and cardiomyocyte mitochondrial ultrastructure. Notably, time‐dependent and collaborated changes in Mon‐/Tri‐α‐synuclein were paralleled with morphological alternation in the NG and NTS. Conclusion These all demonstrate that early autonomic dysfunction mediated by vagal application of DOPAL highly suggests the plausible etiology of PD initiated from peripheral, rather than central site. It will provide a scientific basis for the prevention and early diagnosis of PD.

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Section: Discussionmentioning

confidence: 75%

Parkinson‐like early autonomic dysfunction induced by vagal application of DOPAL in rats

Sun

Yan

et al. 2021

CNS Neurosci Ther

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“…Often an early symptom of PD that worsens with disease progression, autonomic dysfunction includes bladder, gastrointestinal (GI), thermoregulation, sexual, and cardiovascular dysfunction (Chen, et al, 2020). As with motor symptoms, hemispheric side of pathology may influence type and severity of autonomic dysfunction: the left hemisphere regulates parasympathetic processes (e.g., lowers blood pressure and heart rate and increases gastric motility for the "rest and digest" state; Guo et al, 2016;Hilz et al, 2001;McCorry, 2007;Oppenheimer et al, 1996;Wittling, 1997) while the right hemisphere regulates sympathetic activity (e.g., increase heart rate, blood pressure, and blood glucose levels in preparation for "flight or fight" responses; Hilz et al, 2001;Julius & Majahalme, 2000;Mancia et al, 2007;Wittling, 1997Wittling, , 1998Oppenheimer et al, 1992Oppenheimer et al, , 1996.…”

Section: Autonomic Dysfunctionmentioning

confidence: 99%

Laterality in Parkinson’s disease: A neuropsychological review

Steinbach

Campbell

DeVore

et al. 2021

Applied Neuropsychology: Adult

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Laterality of motor symptom onset in Parkinson's disease is both well-known and underappreciated. Treatment of disorders that have asymmetric pathological features, such as stroke and epilepsy, demonstrate the importance of incorporating hemispheric lateralization and specialization into therapy and care planning. These practices could theoretically extend to Parkinson's disease, providing increased diagnostic accuracy and improved treatment outcomes; however, laterality in Parkinson's disease has been largely ignored both clinically and in research. Additionally, while motor symptoms have generally received the majority of attention, non-motor features (e.g., autonomic dysfunction) also decrease quality of life and are influenced by asymmetrical neurodegeneration. Due to the laterality of cognitive and behavioral processes in the two brain hemispheres, analysis of hemibody side of onset can potentially give insight into expected symptom profile of the patient and allow for increased predictive accuracy of disease progression and outcome, thus opening the door to personalized and improved therapy in treating Parkinson's disease patients. This review discusses motor and non-motor symptoms (namely autonomic, sensory, visuospatial, language, and emotional dysfunction) of Parkinson's disease in respect to hemispheric lateralization from a theoretical perspective in hopes of providing a framework for future research and personalized treatment.

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“…The primary motor symptoms of PD, include bradykinesia (slowness of movement), hypo-akinesia (reduced frequency of spontaneous movements), resting tremor (involuntary rhythmic movement of a body part), and rigidity (increased muscle tone producing stiffness of the limb) 8 . In addition to motor control disorders, PD is also characterized by non-motor symptoms: neurocognitive impairments 9 , psychiatric disorders 10 , olfactory deficits 11 , and autonomic 12 dysfunctions.…”

Section: Introductionmentioning

confidence: 99%

Human moral decision-making through the lens of Parkinson’s disease

Ponsi

Scattolin

Villa

et al. 2021

npj Parkinsons Dis.

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Parkinson’s disease (PD) is a neurodegenerative disorder characterized by the loss of dopaminergic neurons in the basal ganglia (BG) and thalamocortical circuitry. While defective motor control has long been considered the defining symptom of PD, mounting evidence indicates that the BG are fundamentally important for a multitude of cognitive, emotional, and motivational processes in addition to motor function. Here, we review alterations in moral decision-making in people with PD, specifically in the context of deceptive behavior. We report that PD patients exhibit two opposite behavioral patterns: hyper- and hypo-honesty. The hyper-honest subgroup engages in deception less often than matched controls, even when lying is associated with a monetary payoff. This behavioral pattern seems to be linked to dopaminergic hypo-activity, implying enhanced harm avoidance, risk aversion, non-impulsivity, and reduced reward sensitivity. On the contrary, the hypo-honest subgroup—often characterized by the additional diagnosis of impulse control disorders (ICDs) and dopamine dysregulation syndrome (DDS)—deceives more often than both PD patients without ICDs/DDS and controls. This behavioral pattern appears to be associated with dopaminergic hyperactivity, which underpins enhanced novelty-seeking, risk-proneness, impulsivity, and reward sensitivity. We posit that these two complementary behavioral patterns might be related to dysfunction of the dopaminergic reward system, leading to reduced or enhanced motivation to deceive. Only a few studies have directly investigated moral decision-making in PD and other neurodegenerative disorders affecting the BG, and further research on the causal role of subcortical structures in shaping moral behavior is needed.

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Autonomic dysfunction in Parkinson’s disease: Implications for pathophysiology, diagnosis, and treatment

Cited by 191 publications

References 214 publications

Parkinson‐like early autonomic dysfunction induced by vagal application of DOPAL in rats

Parkinson‐like early autonomic dysfunction induced by vagal application of DOPAL in rats

Laterality in Parkinson’s disease: A neuropsychological review

Human moral decision-making through the lens of Parkinson’s disease

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