Cardiovascular dysfunction in parkinsonian disorders.

Parkinsonian disorders comprise a variety of diseases, with differing pathology, natural history and prognosis. Although the most common is idiopathic (classical) Parkinson’s disease (PD), there is increasing recognition of ‘atypical’ parkinsonian disorders, such as multiple system atrophy (MSA), progressive supranuclear palsy (PSP) and Lewy body disease (LBD) (1) (Fig. 1, see over). In some parkinsonian patients, and in particular in MSA, autonomic failure characterised by cardiovascular disturbances is a prominent feature. However, the majority of patients with parkinsonism are over the age of 50, when there is an increasing incidence of cardiovascular disease; this may create diagnostic difficulties and also compound problems with management. This review will focus on cardiovascular autonomic dysfunction, especially in MSA, and will deal predominantly with blood pressure and heart rate control together with newer information on cardiac sympathetic innervation in parkinsonian patients.