On November 22, the American Parkinson Disease Association (APDA) Connecticut Chapter featured Veronica Santini, MD, who presented “Autonomic Dysfunction in Parkinson’s Disease” for the Association’s Summer/Fall 2022 Parkinson’s Education Series. This important webinar shed light on some of the more insidious symptoms of Parkinson’s disease (PD) that often go undetected and undertreated. The pathophysiology, signs and symptoms, and available treatments were comprehensively reviewed for the virtual audience, which included people with PD, caregivers, advocates, and healthcare professionals.
After an introduction by APDA CT Chapter Coordinator Marlane Argianas, Dr. Santini engaged the audience in an explanation of autonomic dysfunction and why it occurs in PD. The peripheral autonomic system was broken down into the sympathetic and parasympathetic divisions, with the functions and structures of each briefly outlined. Dr. Santini explained that this would provide a foundation for understanding the pathophysiology and interrelation of the symptoms being addressed.
Though the constellation of signs and symptoms that can arise from autonomic dysfunction were acknowledged, most of the time was dedicated to neurogenic orthostatic hypotension (nOH), arguably the most problematic of autonomic symptoms. Dr. Santini first outlined the physiology of normal blood pressure regulation and then explained how PD can interfere with this system via changes to the musculature assisting in circulation and a decrease in chemicals that regulate the constriction of blood vessels. Listeners were further advised on the important difference between generalized orthostatic hypotension – which has many causes – and nOH, which is the direct result of autonomic dysfunction.
Dr. Santini also highlighted the lesser-known symptoms of nOH to empower listeners to recognize and name it. These symptoms include falls, imbalance, shortness of breath, a decline in thinking, and tellingly, a “coat hanger headache,” during which pain occurs along the back of the neck and shoulders. Further, the lack of more traditional symptoms like dizziness and fainting was explained by the body’s ability to adapt to a chronic lack of adequate perfusion.
Listeners were encouraged to take control of their symptoms and actively participate in their care. Instructions were given on how to check one’s own orthostatic blood pressure at home, and for anyone diagnosed with nOH, a daily to-do list. A list of things to avoid were also presented. Pharmaceutical options were reviewed, and listeners were apprised of the research surrounding deep brain stimulation (DBS) and its yet inconclusive effects on autonomic dysfunction.
The webinar concluded with a lively Q & A session with Dr. Santini answering several real-time questions from the audience.