VA Morning Report Pearls 7.29 Non-Motor Manifestations of PD

Some choice words about Parkinson’s disease*:
“PD is characterized by deposition of abnormally phosphorylated α-synuclein. The aggregates are typically found in neurons as Lewy bodies. Alongside the hallmark degeneration of the substantia nigra in PD, Lewy bodies and cell loss are detected in: (1) autonomic regulatory areas such as the hypothalamus, parabrachial nucleus, intermediate reticular zone of the medulla, locus coeruleus and raphe; (2) preganglionic parasympathetic regions, such as the Edinger–Westphal nucleus and dorsal vagal motor nuclei; (3) preganglionic sympathetic neurons in the intermediolateral cell column and (4) neurons in paravertebral and paravertebral autonomic ganglia. Histological loss of neurons and Lewy body accumulation in sympathetic ganglia, and cardiac sympathetic denervation in several studies are also evident.”
In other words PD is more than a shuffling gait and a tremor.
So-called non-motor manifestations of Parkinson’s Dx include:
-Anosmia
-Constipation
-Gastroparesis
-Urinary dysfunction
-Abnormal sweating/heat intolerance
-Sexual dysfunction
-Depression
-Sleep disturbances
-Mild cognitive impairment->dementia
-Autonomic dysnfx leading to blood pressure problems
–Orthostatic hypotension
–Supine hypertension
When evaluating similar cases we should consider: differential for Orthostatic Hypotension in the elderly
–Medications that can contribute to OH and falls (alpha blockers, beta blockers, other antihypertensives, sleep meds, pain meds)
-Parkinsonian dysautonomia
-Autonomic insufficiency of the elderly
-also consider hypovolemia, infection, and endocrine causes
Treatments that have been tried for Parkinson’s associated orthostatic hypotension:
-discontinue contributing meds
-florinef?
-droxidopa?
-midodrine?
-yohimbine?
-aggressive hydration
-high salt diet
*Autonomic dysfunction in parkinsonian disorders; assessment and pathophysiology
by Asahina and others J Neurol Neurosurg Psychiatry 2013;84:674-680 doi:10.1136/jnnp-2012-303135
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