Autonomic Problems In Parkinson’s Disease

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There have been current advances as well as the experience of doctors, the healthcare team, and family members when taking care of patients with Parkinson’s disease. They have revealed that autonomic problems play a crucial role in the evaluation of patients and that the signs and symptoms that present are sometimes the cause of disability. Symptoms seen in Parkinson’s disease include cardiovascular dysfunction, sweating, and gastrointestinal failure, among others.

What Is Orthostatic Hypotension?

The American Autonomic Society describes orthostatic hypotension as a change in orthostatic blood pressure, with its systolic value dropping to 20 points and the diastolic dropping to 10 points. It is measured in the standing position and within three minutes. Heart rate also increases to over 130 beats per minute, which is known as postural tachycardia. However, it is important to note that the effects of medication, dehydration, and intravascular volume depletion may also affect the changes seen in PD patients.


Are There Non-specific Symptoms Suggesting Hemodynamic Or Cardiovascular Autonomic Dysfunction?

Some PD patients experience fatigue with generalized weakness, shoulder and neck pain often referred to as coat hanger sign, mental cloudiness, and intermittent confusion. These symptoms are a result of orthostatic hypotension or intolerance and abnormal baroreflex/cardiovagal control.


What Other Dysautonomias Can Be Seen In PD Patients?

Some PD patients complain of cold or heat abnormalities, which may be a presentation of particular dysautonomic complaints. In those with multiple system atrophy, sweat disturbances have been observed.


Which Gender Is More Affected?

There seem to be no considerable gender differences in Parkinson’s disease patients when it comes to the central and peripheral autonomic nervous system. However, symptoms may differ in other cases, such as women presenting with preferential bladder abnormalities at onset. Men, on the other hand, may present with erectile dysfunction.



How Is Erectile Dysfunction Seen In PD Patients?

Erectile dysfunction in men is one of the hallmarks of Parkinson’s disease. Often, patients will not tell their doctors because of shame, fear of being criticized or feeling less of a man. The most common causes of sexual dysfunction are medical comorbidities, psychological issues, and drugs. If the patient confides to his doctor about his ED, the doctor then finds common symptoms that directly affect erectile function and not the PD itself. Additionally, hyperlipidemia, trauma, psychogenic dysfunction, and diabetes should be assessed and evaluated.


What Are Other Urologic Symptoms Seen In Men?

Other urologic symptoms seen in men with Parkinson’s disease include urinary incontinence, prostate gland hypertrophy, and urinary tract infection.


What Are Some Manifestations Of Autonomic Dysfunction That Are Specific To Female Patients?

In a study done in 2997, women with PD were compared with women without PD. There was still an occurrence of sexual dysfunction in women with PD. The most common conditions related to sexual dysfunction are infrequent orgasm, lack of sexual desire, and vaginal dryness and tightness. Also, women with PD presented with depression, which could have been a contributory factor that caused the sexual dysfunction.


How Can Sexual Issues Be Treated?

To address sexual dysfunction appropriately, there needs to be a general medical exam, an evaluation of its associated psychological issues, an assessment of the patient’s medication therapy, and a possible evaluation of underlying hormonal problems if there are any. The medical and healthcare team typically starts by treating specific mental health illnesses with psychotherapy and medications and providing medicines for urinary incontinence through pelvic physical therapy, if necessary.

For vaginal tightness and dryness, estrogen therapies like tablets, suppositories, and creams can be applied. It is recommended, though, that consultation and prescription from an obstetrician should be done first. Moreover, a sex therapist can help provide enlightenment and insight as to how to approach the various psychological issues involved in the disease. The therapist may also offer marital or relationship counseling.

With regards to bladder related signs and symptoms, treatment begins with a urological evaluation, urodynamic studies, and a general medical assessment as well. Also, all patients are typically required to undergo a thorough medication review. Once the root of the sexual dysfunction has been established, treatment is next discussed, which usually involves the use of tolterodine and oxybutynin. Sometimes, injections of botulinum toxin utilized for bladder wall relaxation can be helpful in the treatment of urinary incontinence.

Ultimately, before anything, evaluation and advice from an expert is more preferable and is always a better idea. This is because there are causes that are not very common which can be present in some patients. These may be treatable but if not detected early, can still pose as a danger.




Autonomic dysfunction, or dysautonomias, in general, doesn’t have a direct cure, but its symptoms can be treated or managed. It would be wise and practical to find ways to make it better and convenient for the Parkinson’s patient especially when he or she has preexisting autonomic issues, as these will only make it more difficult for them to live a fairly livable life.