Multi-organ autonomic dysfunction in Parkinson disease

Abstract

Both pathologic and clinical studies of autonomic pathways have expanded the concept of Parkinson disease (PD) from a movement disorder to a multi-level widespread neurodegenerative process with non-motor features spanning several organ systems. This review integrates neuropathologic findings and autonomic physiology in PD as it relates to end organ autonomic function. Symptoms, pathology and physiology of the cardiovascular, skin/sweat gland, urinary, gastrointestinal, pupillary and neuroendocrine systems can be probed by autopsy, biopsy and noninvasive electrophysiological techniques in vivo which assess autonomic anatomy and function. There is mounting evidence that PD affects a chain of neurons in autonomic pathways. Consequently, autonomic physiology may serve as a window into non-motor PD progression and allow the development of mechanistically based treatment strategies for several non-motor features of PD. End-organ physiologic markers may be used to inform a model of PD pathophysiology and non-motor progression.

Plasma levodopa peak delay and impaired gastric emptying in Parkinson's disease

“…Slow gastric transport leads to delayed jejunal absorption, resulting in a delayed plasma levodopa peak. This slow gastric transport can be attributed to myenteric plexus pathology in PD [10], where altered balance of cholinergic/5-HT4 serotonergic excitation and D2 dopaminergic inhibition might occur [11]. Although peripherallyacting dopamine on the bowel motility produced conflicting results [11], centrally-acting levodopa did not worsen colonic transit in PD patients [12].…”

Parkinson's Disease and Parkinsonism: Neuropathology

“…Clearly, the observed distribution of Lewy bodies is dependent on case selection (Parkkinen et al 2001). Although the staging scheme of Braak and co-workers should be considered tentative, it nevertheless, has prompted considerable debate in the field and reawakened recognition of early nonmotor clinical features of PD (Jain 2011). Subsequent iterations of the Braak scheme proposed that autonomic neurons in peripheral nervous system may be affected before involvement of the central nervous system ) and this has prompted recognition that PD is a multiorgan disease process, not merely a disorder of central nervous system (Beach et al 2010).…”

The Clinical and Urodynamic Results of Percutaneous Posterior Tibial Nerve Stimulation on Neurogenic Detrusor Overactivity in Patients With Parkinson's Disease

“…The nonmotor problems of PD are neuropsychiatric disorders, sleep disorders, sensory symptoms, and Page 3 of 14 autonomic disorders. 1 Lower urinary tract symptoms (LUTS) including urgency, increased daytime frequency, nocturia and urge urinary incontinence are the most common autonomic disorder in PD patients. 1,2 Urodynamic abnormalities, including neurogenic detrusor overactivity (NDO), hyporeflexia or areflexia, decreased capacity and abnormalities of external sphincter function have been commonly reported in the patients with PD.…”