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Autonomic dysfunction in Parkinson's disease: Implications for pathophysiology, diagnosis, and treatment

机译：帕金森病的自主功能障碍：对病理生理学，诊断和治疗的影响

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摘要

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 alpha-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.
机译：帕金森病（PD）是一种神经变性疾病，研究历史200年。我们对其临床表型和发病机制的理解仍然有限，但多巴胺能替代疗法具有显着改善的患者结果。自主功能障碍是一种必不可少的非运动表型，最近成为指示PD中的前沿研究的尖端领域。在这篇综述中，我们最初描述了PD中存在的功能自主症状的流行病学。然后，我们对PD中的自主神经功能障碍的病理生理学进行了一丝不苟的分析，并提出了外周自主神经系统可以是从周边到中枢神经系统的α-突触核蛋白病理传播的关键途径。此外，我们建议便秘，异位低血压，尿液功能障碍，勃起功能障碍和纯粹的自主障碍，应在PD预测和诊断中作为前驱性繁琐标志物。最后，我们总结了目前可用于治疗PD的自主功能障碍的策略，并提出了未来高质量，更好设计的随机临床试验。

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