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Semin Neurol 2020; 40(05): 492-501
DOI: 10.1055/s-0040-1713844
Review Article

Autonomic Dysfunction in the Synucleinopathies

Elizabeth A. Coon
1   Department of Neurology, Mayo Clinic, Rochester, Minnesota
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Abstract

Autonomic dysfunction is a characteristic feature in the synucleinopathies. Differences in cellular deposition and neuronal populations affected by α-synuclein aggregation influence the manifestations and severity of autonomic failure in the different synucleinopathy disorders. The Lewy body disorders (Parkinson's disease, dementia with Lewy bodies, and pure autonomic failure) have predominantly peripheral involvement, whereas multiple system atrophy chiefly manifests as central autonomic failure. Clinical and laboratory features may be useful in distinguishing the different synucleinopathies based on the pattern and severity of autonomic failure. Treatment recommendations are aimed at the underlying pathophysiology and utilize non-pharmacologic and pharmacologic approaches. This review will focus on pathophysiology, clinical manifestations, and management recommendations for autonomic failure including neurogenic orthostatic hypotension, thermoregulatory dysfunction, genitourinary dysfunction, and gastrointestinal dysfunction in the synucleinopathies.

Keywords

α-synuclein - pure autonomic failure - multiple system atrophy - dementia with Lewy bodies - Parkinson's disease - orthostatic hypotension


Publication History

Article published online:
09 September 2020

© 2020. Thieme. All rights reserved.

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