Although simple questioning can identify the presence of autonomic symptoms and lead to initiation of treatment, diagnostic testing may be helpful in confirming the presence of autonomic involvement. Certain studies can also be useful for discriminating PD from multiple system atrophy (MSA), whereas other studies are not useful in this differential diagnosis.
TABLE 1 Autonomic Features of Parkinson's Disease
Orthostatic hypotension Decreased heart rate variability Decreased MIBG cardiac scintigraphy Cardiac arrhythmias Gastrointestinal
Delayed gastric emptying Urinary bladder Frequency Urgency
Urge incontinence Nocturia Sexual dysfunction Decreased desire Decreased arousal Reduced attainment of orgasm Erectile dysfunction Sexual dissatisfaction Sweating abnormalities Hyperhidrosis Anhydrosis
Abbreviation: MIBG, [123I]metaiodobenzylguanidine.
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