Article type: Narrative Review
Article title: Epidemiology of autonomic dysfunction in Parkinson's disease (Review)
Journal: Medicine International
Year: 2025
Authors: Jamir Pitton Rissardo, Ahmed Farid Gadelmawla, Ibrahim Khalil, Ayah Abdulgadir, Karandeep Singh Bhatti, and Ana LetÃcia Fornari Caprara
E-mail: jamirrissardo@gmail.com
ABSTRACT
Although autonomic dysfunction symptoms are commonly reported by patients with Parkinson's disease (PD) (70‑90%), they are frequently under‑recognized. Dysautonomia often precedes motor symptoms and can affect the quality of life (QoL) of patients with PD. The present review provides a summary of evidence on prevalence patterns, risk factors and clinical presentations from organ systems related to autonomic dysfunction. Cardiovascular symptoms include orthostatic hypotension (30‑50%), supine hypertension (34‑50%) and non‑dipping patterns of blood pressure (83‑88%). Constipation is commonly observed during the prodromal period (60%), and is observed in up to 100% of patients with PD. Genitourinary (89%) and sexual dysfunctions (52‑75%) are common, although under‑reported. An older age, male sex, duration of disease, severity of the disease and akinetic‑rigid phenotype are directly related to overall worse dysautonomia. Genotypic variants have varying degrees of relation with autonomic symptoms; for example, the SNCA gene mutation is associated with cardiac sympathetic denervation, and PARK2 or PARK9 are related to mild effect in autonomic function. Autonomic symptoms are associated with more rapid progression of disease, the attainment of disease milestones, cognitive decline and a poorer QoL. The true prevalence of dysautonomia may be higher due to of the variability of presentation and reporting biases, and current diagnostic definitions may underestimate these non‑motor symptoms. The early detection of autonomic impairment may provide time points for intervention that could modify the natural history of the disease. Future studies are required to be directed towards PD‑related treatment strategies, autonomic‑cognitive relationships, and the development of better animal models covering the complex pathophysiology of PD.
Keywords: dysautonomia; autonomic insufficiency; autonomic dysfunction; autonomic nervous system; premotor phase; predictive biomarker; orthostatic hypotension; gastrointestinal; cardiovascular; sialorrhea.
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DOI
Citation
Rissardo JP, Gadelmawla AF, Khalil I, Abdulgadir A, Bhatti KS, Fornari Caprara AL: Epidemiology of autonomic dysfunction in Parkinson's disease (Review). Med Int 2025;5(68):1–25. https://doi.org/10.3892/mi.2025.267
Figure 1. Epidemiology of autonomic dysfunction in Parkinson's disease.
Figure 2. Radar chart of the epidemiological data of autonomic dysfunction in Parkinson's disease and atypical parkinsonism. The variables analyzed were incidence of the disease, male percentage of patients, percentage of autonomic dysfunction, upper quartile of the disease duration, and lower quartile of the disease onset. CBD, corticobasal degeneration; LBD, Lewy body dementia; LQ, lower quartile (25%); MSA, multiple system atrophy; PD, Parkinson's disease; PSP, progressive supranuclear palsy; UQ, upper quartile (75%). Consider reading supplementary material (Table SII) for specific information regarding percentages.
Figure 3. Heatmap illustrating the prevalence of the most common autonomic symptoms across countries. Data derived from studies using the Non‑Motor Symptoms Questionnaire (NMSQuest). Values represent symptom prevalence percentage. Consider reading the supplementary material (Table SIII) for further details regarding the percentages and references.
Figure 4. Thermography spectrum in Parkinson's disease. Anhidrosis pattern on thermoregulatory sweat test noticed in Parkinson's disease, by Saito et al (319). The pharmacological sweating test is induced by intradermal injection of acetylcholine, and a capacitance hygrometer is used to quantitatively measure the sweating.
Table SI. Summary of autonomic dysfunction features across neurodegenerative disorders [adapted from the study by Niimi et al.].
Table SII. Data of the radar chart.
Table SIII. Prevalence of NMSQuest in different studies from different countries.
Table SIV. Prevalence NMSQuest.
Table SV. Autonomic side-effects of medications for Parkinson’s disease.
Table SVI. Prevalence of cardiovascular dysfunction In Parkinson’s disease.
Table SVII. Detailed overview of autonomic function test findings in Parkinson’s disease across selected studies.
Table SVIII. Prevalence of gastrointestinal dysfunction in Parkinson’s disease.
Table IX. Prevalence of urinary and sexual dysfunctions in Parkinson’s disease.
Table SX. Prevalence of thermoregulatory dysfunction in Parkinson’s disease.
Table SXI. Clinical scales specifically designed for Parkinson’s disease.