Dysautonomia in Parkinson Disease

Abstract

Symptoms of abnormal autonomic-nervous-system function occur commonly in Parkinson’s disease (PD). Orthostatic hypotension in patients with parkinsonism has been thought to be a side-effect of treatment with levodopa, a late stage in the disease progression, or, if prominent and early with respect to disordered movement, an indication of a different disease, such as multiple system atrophy. Instead, patients with PD and orthostatic hypotension have clear evidence for baroreflex failure and loss of sympathetic innervation, most noticeably in the heart. By contrast, patients with multiple system atrophy, which is difficult to distinguish clinically from PD, have intact cardiac sympathetic innervation. Post-mortem studies confirm this distinction. Because PD involves postganglionic sympathetic noradrenergic lesions, the disease seems to be not only a movement disorder with dopamine loss in the nigrostriatal system of the brain, but also a dysautonomia, with norepinephrine loss in the sympathetic nervous system of the heart.

Diagnosis of multiple system atrophy

“…In contrast to patients with PD, in whom cardiac post-ganglionic sympathetic innervation is reduced in virtually all cases, most patients with MSA have preserved post-ganglionic innervation of the heart, as ascertained by normal 18 F-dopamine PET or 123 I-metaiodobenzylguanidine (MIBG) scintigraphy (Braune, 2001; Goldstein, 2014; Kaufmann et al, 2013; Orimo et al, 2002). A meta-analysis showed that reduced cardiac MIBG scintigraphy has high sensitivity and specificity to distinguish PD from other neurodegenerative disorders (Orimo et al, 2012).…”

The potential benefits of Zumba Gold® in people with mild-to-moderate Parkinson’s: Feasibility and effects of dance styles and number of sessions

“…This absence of variation in HR could be explained by dysautonomia commonly observed in PD. 60 Overall, the literature on dance prescription for PD recommends changes in movement speed and length, visual cueing, and alternative shifts in the centre of mass. 61 The main limitations of this study were the relatively small sample size and the fact that only six Zumba Gold ® sessions were undertaken.…”

Decreased dopaminergic treatment of hospitalized Parkinson’s disease patients during infectious diseases is associated with poor outcomes

“…Although the most prominent symptoms are motor disturbances, PD is a multisystem disease with additional multifaceted non-motor symptoms expressing involvement of non-dopaminergic systems [2]. Amongst the non-motor disturbances, autonomic nervous system disturbances, including cardiovascular [3], genitourinary and gastrointestinal [4] symptoms are common. Progressive motor dysfunction leading to dysphagia and immobilization, along with autonomic disturbances (such as orthostatic hypotension, impaired gastric emptying and neurogenic bladder) may increase the risk for pneumonia [5] and urinary tract infections (UTI) [6].…”