Cardiovascular autonomic failure in α-Synucleinopathies: Epidemiological aspects

      Cardiovascular autonomic failure is a frequent non-motor symptom in Parkinson’s disease (PD) and Dementia with Lewy Bodies, as well as a mainstay of multiple system atrophy’s (MSA) and pure autonomic failures’s (PAF) clinical spectrum. In the present symposium an overview of epidemiological aspects of cardiovascular autonomic failure in α-Synucleinopathies will be provided. The main feature of cardiovascular autonomic failure is orthostatic hypotension (OH). Estimated prevalence of OH in PD is 30%, but may rise in advanced or cognitively impaired patients. In MSA, prevalence of OH ranges from 50% to 81% in different epidemiological cohorts. In one study, OH was more frequent and severe in the cerebellar (MSA-C) versus the parkinsonian variant (MSA-P) of the disease. Supine and nocturnal hypertension are attending features of cardiovascular autonomic failure, which need to be considered in the therapeutic management of parkinsonian patients. In a recent retrospective study, we found one third of PD and MSA patients to suffer from mild to severe SH, independently of age, disease duration or disease stage. In PD, cardiovascular comorbidities significantly contributed to the development of SH, while in MSA, SH appeared to reflect cardiovascular autonomic failure. Pathological nocturnal BP profiles have been identified in 50% of PD and MSA patients in 24 h-ABPM studies, but may be even more frequent in subjects with severe cardiovascular autonomic failure or in older and more advanced cases. Post-prandial hypotension as well as carotid sinus hypersensitivity are further aspects of cardiovascular autonomic failure, with relevant clinical and therapeutic implications in α-synucleinopathies.
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