ABSTRACT
Autonomic symptoms in Parkinson's disease (PD) were first reported in 1817 by James Parkinson himself. He described abnormalities of salivation and sweating, and dysfunction of the alimentary tract and urinary bladder. This chapter covers the differential diagnosis of dysautonomia in PD, and explains the investigations used to measure autonomic function in both clinical and research settings. It discusses the clinical implications of dysautonomia in PD and treatment options. Autonomic dysfunction is due to primary and secondary disorders. There are three primary causes of autonomic dysfunction in patients with definite extrapyramidal signs: idiopathic PD with autonomic failure, multiple system atrophy (MSA) and Lewy body dementia. Antiparkinsonian medications and other drugs may interfere with autonomic function. Orthostatic hypotension (OH) is a cardinal feature of autonomic dysfunction. Biochemical and pharmacological investigations are sometimes used in researching dysautonomia in PD, but are rarely required in the clinical setting.
