# Parkinson's disease autonomic dysfunction | Symptoms, Causes, Tests and Treatment | OSANG > Approximately 70-80% of Parkinson's disease patients are accompanied by autonomic dysfunction, and some symptoms function as prodromal symptoms that appear before motor… - Official page: https://osns.co.kr/en/encyclopedia/parkinsons-autonomic-dysfunction - Organization: OSANG Neurosurgery ## Page content Neurological Conditions ## Parkinson's disease autonomic dysfunction Autonomic Dysfunction in Parkinson's Disease · G20 Autonomic dysfunction in Parkinson's disease is a non-motor symptom in Parkinson's disease in which Lewy body pathology invades the autonomic nervous system and causes various autonomic symptoms such as orthostatic hypotension, constipation, bladder dysfunction, sweating abnormalities, and cardiac sympathetic denervation. ## At a glance Approximately 70-80% of Parkinson's disease patients are accompanied by autonomic dysfunction, and some symptoms function as prodromal symptoms that appear before motor symptoms. Constipation can appear decades before exercise symptoms, and orthostatic hypotension occurs in approximately 30-58% of cases, increasing the risk of falls and cardiovascular disease. Findings of cardiac sympathetic denervation on cardiac MIBG scan are useful in differentiating it from multiple system atrophy. Autonomic symptoms greatly reduce the quality of life of Parkinson's disease patients and require active evaluation and management. - 01Definition and Overview - 02Mechanism of occurrence - 03Orthostatic hypotension - 04Gastrointestinal autonomic dysfunction - 05bladder dysfunction - 06Sweating and temperature regulation difficulties - 07Cardiac autonomic and MIBG scans - 08Diagnosis and Evaluation - 09treatment ## Definition and Overview Parkinson's disease is a neurodegenerative disease characterized by loss of dopaminergic neurons and accumulation of Lewy bodies in the substantia nigra. Pathological changes in Parkinson's disease are not limited to the substantia nigra, which causes motor symptoms, but also involve a wide range of neural structures, including the autonomic nervous system. Approximately 70-80% of Parkinson's disease patients exhibit various autonomic dysfunction, which accounts for an important part of non-motor symptoms (NMS). Autonomic symptoms have a significant impact on quality of life independently of motor symptoms, and some function as prodromal symptoms that appear before motor symptoms. ## Mechanism of occurrence According to Braak staging, Lewy body pathology in Parkinson's disease first begins in the lower part of the brainstem and peripheral autonomic nerves (especially the enteric nervous system and cardiac sympathetic nerves) and spreads upward. This explains that autonomic symptoms such as constipation and cardiac sympathetic denervation may appear before motor symptoms (substantia nigra involvement). Peripheral autonomic nerve involvement includes cardiac sympathetic denervation and Lewy body involvement in the enteric nervous system. Centrally, damage to the hypothalamus, brainstem autonomic nuclei (nucleus tractus solitarius, dorsal vagal nucleus, etc.), and spinal cord intermediolateral cell column contributes to autonomic dysfunction. Parkinson's disease treatments (especially dopamine agonists and levodopa) can also cause or worsen autonomic symptoms (orthostatic hypotension, nausea, etc.). ## Orthostatic hypotension Orthostatic hypotension is reported in approximately 30-58% of Parkinson's disease patients. When standing, the sympathetic vasoconstrictor response is impaired and blood pressure is not properly maintained. Symptoms include dizziness, headache, blurred vision, presyncope, and fainting. Orthostatic hypotension increases the risk of falls and fractures, and is also associated with decreased cognitive function and increased mortality. Parkinson's disease medications, especially dopamine agonists, can worsen orthostatic hypotension, so medication adjustment is necessary. For treatment, first attempt non-pharmacological methods (sufficient fluid/salt intake, compression stockings, sleep with head elevated), and use fludrocortisone, midodrine, and droxidopa when necessary. ## Gastrointestinal autonomic dysfunction Constipation is one of the most common non-motor symptoms in Parkinson's disease, occurring in approximately 80% of patients. Intestinal motility is reduced due to Lewy body invasion of the enteric nervous system. Constipation is recognized as a prodromal symptom that appears years to decades before motor symptoms, and longitudinal studies have shown that men with constipation have a higher risk of developing Parkinson's disease. Swallowing disorders (dysphagia) occur due to dysfunction of the esophagus and pharynx and are a risk factor for aspiration pneumonia. Saliva hypersecretion (sialorrhea) is a phenomenon in which saliva accumulates due to a decrease in the frequency of swallowing rather than an actual increase in saliva production. ## bladder dysfunction Bladder dysfunction is reported in approximately 70% of Parkinson's disease patients. Overactive bladder is the most common, causing frequent urination, nocturia, and urge incontinence. This is because in Parkinson's disease, the bladder detrusor muscle becomes hyperactive due to the loss of the dopaminergic inhibition mechanism. In some patients, difficulty urinating, residual urine, and urinary tract infections occur repeatedly due to decreased detrusor muscle contraction. ## Sweating and temperature regulation difficulties Abnormal sweating is reported in approximately 64% of Parkinson's disease patients. Symptoms vary and may include generalized or localized hyperhidrosis, night sweats, or anhidrosis. Rapid sweating may occur at peak levodopa doses. ## Cardiac autonomic and MIBG scans In Parkinson's disease, cardiac sympathetic denervation can be confirmed by MIBG (123I-metaiodobenzylguanidine) scan. MIBG is an analogue of norepinephrine and is absorbed into cardiac sympathetic nerve endings. While MIBG uptake is reduced in Parkinson's disease patients, cardiac MIBG uptake is relatively preserved in multiple system atrophy (MSA). This finding is used as an aid in the differential diagnosis of the two diseases. In heart rate variability (HRV) tests, patients with Parkinson's disease show a decrease in overall HRV, with both the high frequency (HF) component (parasympathetic index) and low frequency (LF) component (sympathetic index) decreasing. ## Diagnosis and Evaluation SCOPA-AUT (Scales for Outcomes in Parkinson's disease—Autonomic) is a standard survey tool that quantitatively assesses autonomic symptoms in Parkinson's disease. An objective evaluation is performed using a battery of autonomic function tests, including heart rate variability test, standing tilt test, Valsalva maneuver, and sweating function test (QSART). ## treatment Autonomic symptoms are managed individually for each symptom. Non-pharmacological approaches and drug treatment are combined for each of orthostatic hypotension, bladder dysfunction, constipation, and sweating abnormalities. Because medications used to treat Parkinson's motor symptoms may affect autonomic symptoms, the overall medication plan should be carefully adjusted. ## Frequently asked questions ### Q01Why do autonomic symptoms occur in Parkinson's disease? This is because Lewy bodies, the causative pathology of Parkinson's disease, accumulate not only in the brain but also in the autonomic nervous system. Lewy body pathology also invades the enteric plexus, cardiac sympathetic nerves, and autonomic nerve cells of the spinal cord, deteriorating the autonomic control function of those organs. According to Brach's staging classification, Lewy body pathology begins in the lower brainstem and peripheral autonomic nerves and spreads upward, so autonomic symptoms may appear before motor symptoms. ### Q02What are the most common autonomic symptoms in Parkinson's disease? Constipation is the most common, occurring in approximately 80% of Parkinson's disease patients, and can appear years or decades before motor symptoms appear. Orthostatic hypotension (dizziness and fainting when standing up) occurs in approximately 30-58% of cases. Bladder dysfunction (frequency, nocturia, urge incontinence) is also reported in approximately 70% of cases. Abnormal sweating, excessive salivation, excessive sebum secretion, and difficulty regulating body temperature are also common. ### Q03How is Parkinson's disease orthostatic hypotension treated? Try non-pharmacological methods first. Drinking enough water and salt, wearing compression stockings, sleeping with the head of the bed raised, and not getting up suddenly are effective. Among Parkinson's disease treatments, dopamine agonists may worsen orthostatic hypotension, so medication adjustment is necessary. Drug treatments include droxidopa, midodrine, and fludrocortisone. Regular blood pressure monitoring is important. ### Q04Can I distinguish between Parkinson's disease and another Parkinson's syndrome through an autonomic nervous system test? A cardiac metaiodobenzylguanidine (MIBG) scan is a useful differential tool. In Parkinson's disease, cardiac sympathetic denervation occurs and MIBG uptake is reduced, whereas in multiple system atrophy (MSA), cardiac MIBG uptake is often preserved. This difference helps differentiate Parkinson's disease from MSA. Patterns of autonomic function tests are also useful in distinguishing between the two disorders. ### Q05How do you manage bladder problems in people with Parkinson's disease? Bladder dysfunction in Parkinson's disease mainly manifests as overactive bladder (detrusor overactivity). Frequent urination, nocturia, and urge incontinence are common. Treatment includes bladder training, nighttime fluid restriction, and medications such as anticholinergics or beta-3 agonists (mirabegron). Difficulty passing urine may also occur in some cases, in which case alpha-blockers may be helpful. Collaborative care with urology is effective. ### Q06How much do autonomic symptoms of Parkinson's disease affect quality of life? In a study of Parkinson's disease patients, autonomic symptoms (particularly orthostatic hypotension, constipation, and bladder dysfunction) were strongly associated with decreased quality of life. Orthostatic hypotension increases the risk of falls and fractures, and constipation and bladder symptoms make daily life uncomfortable. Since Parkinson's patients who are known to have autonomic symptoms often do not report them, it is important to actively check for symptoms during regular treatment. ## Related articles - delirium - Cervical radiculopathy - Cervical disc herniation - dystonia This article provides general medical information and does not replace an individual diagnosis or treatment plan. Please seek a medical assessment if symptoms persist. ## Important notice This Markdown alternative helps search and AI tools understand the public page accurately. It provides general health information and does not replace an individual diagnosis or treatment.