Diagnosis and management of autonomic failure in neurodegenerative disorders

Background: One of the hallmarks of the α-synucleinopathies is the degeneration of the autonomic nervous system. Summary: This review discusses the diagnosis and management of cardiovascular autonomic failure within the context of the α-synucleinopathies. In addition, it outlines the utility of various laboratory assessments including cardiovascular reflex tests for the differential diagnoses of these disorders, as well as general disease management strategies. Key Messages: Laboratory investigations assessing the autonomic control of the cardiovascular system are useful in the differential diagnosis of α-synucleinopathies, especially in early stages of disease. Clinical Implications: The characterization of the different features of AF in patients with α-synucleinopathies is challenging because it might help to improve the accuracy of the differential diagnosis between these diseases at onset. Further cardiovascular AF has been demonstrated to have a negative prognostic role in α-synucleinopathies, therefore an early detection of cardiovascular dysautonomia allows to positively impact the disease course guiding the appropriate therapy