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 α-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.

中文翻译：

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帕金森氏病的自主神经功能障碍：对病理生理学，诊断和治疗的意义。

帕金森氏病（PD）是一种具有200年研究历史的神经退行性疾病。尽管多巴胺能替代疗法已大大改善了患者的预后，但我们对其临床表型和发病机理的了解仍然有限。自主神经功能障碍是非运动型表型的重要类别，近来已成为指导PD前沿研究的前沿领域。在这篇综述中，我们最初描述了PD中自主神经症状的流行病学。然后，我们对PD中自主神经功能障碍的病理生理进行了仔细的分析，并提出外周自主神经系统可能是α-突触核蛋白病理学从外周向中枢神经系统传播的关键途径。此外，我们建议便秘，体位性低血压，尿路功能障碍，勃起功能障碍和纯自主神经功能衰竭应被视为PD预测和诊断中的前驱性自主神经功能障碍标志。最后，我们总结了目前可用于治疗PD自主神经功能障碍的策略，并建议将来应进行高质量，设计更好的随机临床试验。