2023 Volume 60 Issue 1 Pages 2-5
Dyautonomia precedes the onset of motor symptoms in patients with Parkinson’s disease (PD). Therefore, it is useful biomarker predicting disease onset. Accumulating evidence suggests sympathetic nervous system may be a key route for α-synuclein pathology propagation as well as vagus nerve. Cardiovascular autonomic failure includes orthostatic hypotension (OH), postprandial hypotension, supine hypertension and nocturnal hypertension. OH is attributed to both peripheral and central sympathetic nervous failure, and is closely related to the development of cognitive impairment in patients with PD. It is necessary to develop a therapeutic strategy for OH in consideration of supine hypertension. Nonpharmacological treatment such as abdominal compression and head-up sleeping is crucial for the treatment of OH and SH. As for pharmacological treatment, combined treatment of OH with L-noradrenaline precursor and cholinesterase inhibitors seems to be clinically useful because cholinesterase inhibitors enhance the function of sympathetic preganglionic nerve fibers.
