An update on the recognition and treatment of autonomic symptoms in Parkinson's disease.

Parkinson's disease (PD) is characterized by motor, autonomic, and neuropsychiatric symptoms. These occur in varying degrees in all stages of the disease. Among the autonomic disorders, cardiovascular, urogenital, gastrointestinal and thermoregulatory disorders are the most relevant. Within cardiovascular disorders drop of blood pressure after orthostasis and non-dipper behavior are very important; but also the influence of cardiovascular medication. Urgency, nocturia, and incontinence are of particular note within the urological problems. Among the gastrointestinal disturbances, swallowing disorders, gastric emptying disorders and constipation are particularly noteworthy. Areas covered: Autonomic symptoms are inherent in PD, in premotor and all other stages of the disease. In this overview, the current status was summarized taking into account original articles and reviews based on relevance to the field and quality of evidence. Expert commentary: The involvement of the autonomic nervous system in Parkinson's disease is still neglected. Because of the significant effects on the quality of life and even the prognosis, appropriate diagnostics and therapy should be performed at all stages of the disease. Despite intensive scientific work the area is still not sufficiently considered and the relevance in pathology is not yet understood.