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Pure Autonomic Failure Versus Prodromal Dysautonomia in Parkinson's Disease: Insights from the Bedside
Author(s) -
Merola Aristide,
Espay Alberto J.,
Zibetti Maurizio,
Romagnolo Alberto,
Rosso Michela,
Maule Simona,
Lopiano Leonardo
Publication year - 2016
Publication title -
movement disorders clinical practice
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 0.754
H-Index - 18
ISSN - 2330-1619
DOI - 10.1002/mdc3.12360
Subject(s) - pure autonomic failure , dysautonomia , synucleinopathies , medicine , orthostatic vital signs , atrophy , lewy body , parkinson's disease , autonomic nervous system , cardiology , disease , neuroscience , alpha synuclein , psychology , blood pressure , heart rate
Autonomic failure may include orthostatic hypotension, supine hypertension, bowel and bladder disturbances, impaired thermal regulation, and sexual dysfunction, all of which can be features of Parkinson's disease (PD) and other a‐synucleinopathies. All patients with pure autonomic failure, most patients with multiple system atrophy, and 18% of patients with PD will develop symptomatic orthostatic hypotension. However, the extent of central and peripheral norepinephrine deficiency, parasympathetic nuclei degeneration, and arterial baroreflex failure may be differentially impaired in these disorders. Consequently, clinical features and prognostic implications of autonomic dysfunction in a‐synucleinopathies may be more complex than previously envisioned. The case described in this report highlights the clinical similarities between PD and pure autonomic failure, raising the question of whether pure autonomic failure represents a restricted Lewy body synucleinopathy or an early manifestation of PD.