期刊
NEUROBIOLOGY OF DISEASE
卷 134, 期 -, 页码 -出版社
ACADEMIC PRESS INC ELSEVIER SCIENCE
DOI: 10.1016/j.nbd.2019.104700
关键词
Autonomic dysfunction; Parkinson's disease; Epidemiology; Pathophysiology; Diagnosis; Treatment
资金
- National Key Research and Development Program [2016YFC1306505]
- National Natural Science Foundation of China [81873778, 81501097]
- Science and Technology Commission of Shanghai Municipality-Basic Key Project [18JC1420300]
- Shanghai Clinical Collaboration Construction Project of Chinese and Western Medicine [ZY(2018-2020)-FWTX-1104]
Parkinson's disease (PD) is a neurodegenerative disease with a 200 year-long research history. Our understanding about its clinical phenotype and pathogenesis remains limited, although dopaminergic replacement therapy has significantly improved patient outcomes. Autonomic dysfunction is an essential category of non-motor phenotypes that has recently become a cutting edge field that directs frontier research in PD. In this review, we initially describe the epidemiology of dysautonomic symptoms in PD. Then, we perform a meticulous analysis of the pathophysiology of autonomic dysfunction in PD and propose that the peripheral autonomic nervous system may be a key route for alpha-synuclein pathology propagation from the periphery to the central nervous system. In addition, we recommend that constipation, orthostatic hypotension, urinary dysfunction, erectile dysfunction, and pure autonomic failure should be viewed as prodromal dysautonomic markers in PD prediction and diagnosis. Finally, we summarize the strategies currently available for the treatment of autonomic dysfunction in PD and suggest that high-quality, better-designed, randomized clinical trials should be conducted in the future.
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