J Neurol Neurosurg Psychiatry 84:674-680 doi:10.1136/jnnp-2012-303135
  • Movement disorders
  • Review

Autonomic dysfunction in parkinsonian disorders: assessment and pathophysiology

Editor's Choice
  1. Christopher J Mathias2,3
  1. 1Department of Neurology, Chiba University School of Medicine, Chiba, Japan
  2. 2Autonomic and Neurovascular Medicine Unit, Division of Brain Sciences, Faculty of Medicine, Imperial College London at St Mary's Hospital, London, UK
  3. 3Autonomic Unit, National Hospital for Neurology and Neurosurgery, Queen Square/Division of Clinical Neurology, Institute of Neurology, University College London, London, UK
  1. Correspondence to Dr M Asahina, Department of Neurology, Chiba University School of Medicine, 1-3-1 Inohana, Chuo-ku, Chiba 260-8670, Japan; asahina{at}
  1. Contributors MA performed the literature review, and coordinated the conception, authors' writing, revisions and editing, wrote the first draft and finalised the manuscript. EV, DAL and CJM contributed to the literature review, writing of the paper and revisions. VI contributed to revision of the manuscript.

  • Received 18 July 2012
  • Accepted 10 August 2012
  • Published Online First 1 September 2012


Parkinson's disease (PD) is a progressive neurodegenerative disorder characterised by motor dysfunction (parkinsonism) and several non-motor features. Dysautonomia is a significant non-motor feature as well as a neuropsychiatric symptom. Autonomic dysfunction can occur even in the early stages of PD, often preceding the onset of the classic motor symptoms of PD. The patterns of autonomic features in PD are different from other parkinsonian disorders. Detection of autonomic dysfunction may therefore be helpful in diagnosing PD in the early or pre-motor stages, and/or in differentiating it from other parkinsonian disorders, such as multiple system atrophy and progressive supuranuclear palsy. The aim of this review is to describe aspects of autonomic dysfunction, including symptoms, assessment and pathophysiology, resulting from autonomic impairment in PD and other parkinsonian syndromes.


  • Competing interests None.

  • Provenance and peer review Commissioned; externally peer reviewed.

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