AAN 2026 | Manifestations of autonomic dysfunction in alpha-synucleinopathies
Mitchell Miglis, MD, Stanford Health Care, Stanford, CA, discusses the impact of autonomic dysfunction on movement disorders, particularly those related to alpha-synuclein degeneration. Dr Miglis highlights that orthostatic hypotension is a common autonomic manifestation in these disorders, and notes that identifying autonomic dysfunction can help narrow down the differential diagnosis amongst these conditions. This interview took place at the 78th American Academy of Neurology (AAN) Annual Meeting in Chicago, IL.
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Transcript
So autonomic dysfunction in movement disorders primarily affects the movement disorders of alpha-synuclein degeneration. So that’s primarily Parkinson’s disease, Lewy body dementia, and multiple system atrophy. And amongst those disorders, probably the most common autonomic manifestation we see is orthostatic hypotension, which is characterized by an excessive blood pressure fall on standing...
So autonomic dysfunction in movement disorders primarily affects the movement disorders of alpha-synuclein degeneration. So that’s primarily Parkinson’s disease, Lewy body dementia, and multiple system atrophy. And amongst those disorders, probably the most common autonomic manifestation we see is orthostatic hypotension, which is characterized by an excessive blood pressure fall on standing. In Parkinson’s disease, that’s probably at least 50% of patients. In Lewy body dementia, at least probably 75. In MSA, autonomic dysfunction affects nearly 100% of patients. Yeah, so incredibly important and very easy to do. Once you identify that a patient has, say, neurogenic orthostatic hypotension or they have severe bowel or bladder involvement, that can really help clue you into more of those synuclein disorders, again, PD, DLB, and MSA, versus if they don’t. It’s not completely uncommon in other neurodegenerative disorders like PSP, but autonomic dysfunction is a lot less common in those disorders. It’s very uncommon in, say, Alzheimer’s disease. So it really helps you kind of narrow in the differential amongst those synuclein protein disorders.
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