UC San Diego

Autonomic dysfunction (AD) is present in nearly all people with Parkinson disease (PD), contributing to tremendous morbidity and mortality. Highly variable presentations including cardiovascular, gastrointestinal, urogenital, and thermoregulatory dysfunction can substantially affect daily function, safety, medication tolerance, and quality of life. Although autonomic symptoms are frequently encountered in neurologic practice, their management frequently extends beyond the traditional scope of neurologic care and may require input from multiple disciplines. Despite the increasing complexity of PD care and the need for coordinated multidisciplinary involvement, there are currently limited practical frameworks to guide specialist collaboration. Consequently, people with PD and their caregivers are often left to navigate fragmented care systems, conflicting recommendations, and uncertainty regarding which clinician should guide management. To help address these gaps, we provide a framework for the possible indications for specialist referrals and the potential roles of different healthcare practitioners in evaluating and treating AD. The manuscript also discusses the intersection between autonomic and neuropsychiatric manifestations in PD and offers practical clinical guidance for addressing this overlap. By providing a framework informed by coauthors in movement disorders, autonomic disorders, cardiology, nephrology, gastroenterology, physical therapy, and psychiatry, we hope to encourage neurologists – who often serve as the central point of contact – to collaborate closely and actively engage multidisciplinary team members in the management of these complex patients.