Autonomic Dysfunction in Corticobasal Syndrome

Autonomic Dysfunction in Corticobasal Syndrome

Overview

Autonomic Dysfunction in Corticobasal Syndrome is a significant non-motor manifestation of the neurodegenerative disorder known as corticobasal syndrome (CBS). This page covers its molecular basis, clinical features, genetic associations, and connections to broader neurodegeneration research.

Autonomic dysfunction occurs in corticobasal syndrome (CBS) but is generally less prominent than in synucleinopathies such as multiple system atrophy (MSA). Understanding autonomic symptoms is important for differential diagnosis and management[@autonomic][@nonmotor].

Prevalence and Clinical Features

Autonomic dysfunction in CBS is less severe compared to MSA, but can still significantly impact quality of life[@autonomic][@spect]:

• Orthostatic hypotension: Mild to moderate, less severe than in MSA
• Urinary dysfunction: Urinary urgency and frequency, but less severe than in MSA
• Gastrointestinal dysfunction: Constipation is common; dysphagia can occur
• Sexual dysfunction: Erectile dysfunction reported in male patients
• Sweating abnormalities: Hyperhidrosis or hypohidrosis

The relatively preserved autonomic function in CBS compared to MSA can be a useful diagnostic clue, as prominent autonomic failure favors MSA over CBS.

Prevalence Statistics

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Autonomic Dysfunction in Corticobasal Syndrome

Overview

Autonomic Dysfunction in Corticobasal Syndrome is a significant non-motor manifestation of the neurodegenerative disorder known as corticobasal syndrome (CBS). This page covers its molecular basis, clinical features, genetic associations, and connections to broader neurodegeneration research.

Autonomic dysfunction occurs in corticobasal syndrome (CBS) but is generally less prominent than in synucleinopathies such as multiple system atrophy (MSA). Understanding autonomic symptoms is important for differential diagnosis and management[@autonomic][@nonmotor].

Prevalence and Clinical Features

Autonomic dysfunction in CBS is less severe compared to MSA, but can still significantly impact quality of life[@autonomic][@spect]:

• Orthostatic hypotension: Mild to moderate, less severe than in MSA
• Urinary dysfunction: Urinary urgency and frequency, but less severe than in MSA
• Gastrointestinal dysfunction: Constipation is common; dysphagia can occur
• Sexual dysfunction: Erectile dysfunction reported in male patients
• Sweating abnormalities: Hyperhidrosis or hypohidrosis

The relatively preserved autonomic function in CBS compared to MSA can be a useful diagnostic clue, as prominent autonomic failure favors MSA over CBS.

Prevalence Statistics

Autonomic dysfunction in CBS varies by symptom type:

• Orthostatic hypotension: 30-50% of patients
• Urinary symptoms: 40-60% of patients
• Constipation: 50-70% of patients
• Sexual dysfunction: 30-40% of male patients
• Sweating changes: 20-30% of patients

Onset and Progression

Autonomic symptoms typically:

• Onset: Usually develop after motor symptoms
• Progression: Gradually worsen over disease course
• Severity: Generally mild to moderate
• Impact: Can significantly affect quality of life

Pathophysiology

The autonomic dysfunction in CBS relates to the pattern of neurodegeneration[@nonmotor][@pathology]:

Subcortical involvement: Degeneration of basal ganglia and brainstem nuclei involved in autonomic control

Limited peripheral autonomic involvement: Unlike synucleinopathies, CBS shows less peripheral autonomic pathology

Regional specificity: Autonomic nuclei are relatively spared compared to MSA

Neuroanatomical Correlates

Key brain regions involved in CBS autonomic dysfunction:

• Basal ganglia:特别是尾状核和壳核
• Brainstem:中脑和脑桥的自主神经核
• Thalamus: 丘脑调节整合
• insula: 内脏感觉处理

Neurochemical Changes

Neurotransmitter systems implicated:

• Dopaminergic: 黑质纹状体通路受累
• Serotonergic: 中缝核受影响
• Noradrenergic: 蓝斑核变性
• Cholinergic: 基底前脑胆碱能系统

Differential Diagnosis

Autonomic symptom profiles help differentiate CBS from other parkinsonian syndromes[@spect][@autonomica]:

| Symptom | CBS | MSA | PSP | PD |
|---------|-----|-----|-----|-----|
| Orthostatic hypotension | Mild | Severe | Mild | Variable |
| Urinary dysfunction | Mild-Moderate | Severe | Mild | Variable |
| Postprandial hypotension | Uncommon | Common | Uncommon | Rare |
| Sexual dysfunction | Moderate | Severe | Mild | Variable |
| Sweating | Variable | Common | Uncommon | Rare |

CBS vs MSA

Key distinguishing features:

• Severity: MSA has more severe autonomic failure
• Onset: MSA often has earlier autonomic involvement
• Pattern: MSA shows peripheral autonomic neuropathy
• Progression: MSA has more rapid progression

CBS vs PSP

Differences from PSP:

• Frequency: Autonomic dysfunction less common in PSP
• Severity: Similar mild to moderate severity
• Symptoms: Different symptom profiles
• Timing: PSP may have later onset of autonomic symptoms

CBS vs PD

Comparison with Parkinson's disease:

• Severity: Generally less severe than PD
• Pattern: Different symptom distribution
• Progression: Variable in PD
• Levodopa response: Autonomic symptoms less levodopa-responsive

Management

Non-pharmacological Approaches

Conservative management strategies[@management]:

• Hydration and salt intake: For orthostatic hypotension
• Compression stockings: Reduce venous pooling
• Head-of-bed elevation: For nocturnal hypotension
• Meal timing: Small, frequent meals to avoid postprandial drops
• Physical counter-manuvers: Specific movements to improve blood pressure

Pharmacological Treatments

Medication options for autonomic symptoms:

For Orthostatic Hypotension:

• Fludrocortisone: Mineralocorticoid for blood pressure support
• Midodrine: Alpha-1 agonist for blood pressure support
• Pyridostigmine: For refractory orthostatic symptoms
• Droxidopa: Norepinephrine prodrug

For Urinary Symptoms:

• Anticholinergics: Oxybutynin, tolterodine for overactive bladder
• Beta-3 agonists: Mirabegron for urge incontinence
• Alpha-blockers: For outflow obstruction

For Gastrointestinal Symptoms:

• Laxatives: For constipation management
• Prokinetic agents: For gastroparesis
• Stool softeners: For easier defecation

Research Insights

Key studies on autonomic dysfunction in CBS and tauopathies[@autonomic][@nonmotor][@neuroimaging]:

• Autonomic dysfunction is recognized as occurring in CBS but is less prominent than in synucleinopathies (PMID:35260524)
• Nonmotor Features in Atypical Parkinsonism reviews autonomic dysfunction in CBD alongside MSA and PSP (PMID:28805573)
• SPECT molecular imaging studies identify autonomic dysfunctions among additional motor and non-motor symptoms in atypical parkinsonism (PMID:30409259)

Recent Research Directions

Current research focuses on:

• Biomarker development: Identifying autonomic biomarkers
• Neuroimaging: Functional imaging of autonomic centers
• Genetics: Genetic factors influencing autonomic dysfunction
• Treatment trials: Pharmacological interventions

Clinical Presentation Details

Cardiovascular Autonomic Dysfunction

Orthostatic Hypotension

Pathophysiology and clinical features:

• Definition: >20 mm Hg systolic or >10 mm Hg diastolic drop
• Symptoms: Lightheadedness, dizziness, syncope
• Timing: Usually within 3 minutes of standing
• Risk: Falls and injuries

Supine Hypertension

Common comorbidity:

• Prevalence: Up to 50% of CBS patients with OH
• Mechanism: Baroreflex compensation
• Treatment: Careful medication timing

Urinary Dysfunction

Storage and voiding symptoms:

Storage Symptoms:

• Frequency: Daytime urinary frequency
• Urgency: Sudden urge to urinate
• Nocturia: Nighttime urination
• Involuntary leakage: Urge incontinence

Voiding Symptoms:

• Hesitancy: Difficulty initiating flow
• Weak stream: Reduced urinary stream
• Incomplete emptying: Post-void residual

Gastrointestinal Dysfunction

Esophageal Dysfunction

Common problems:

• Dysphagia: Difficulty swallowing
• Odynophagia: Painful swallowing
• Regurgitation: Backflow of food
• Aspiration risk: Pneumonia concern

Colonic Dysfunction

Common issues:

• Constipation: Most common GI symptom
• Delayed gastric emptying: Gastroparesis
• Fecal incontinence: Less common

Sexual Dysfunction

Common presentations:

• Erectile dysfunction: Most common in males
• Reduced libido: Decreased interest
• Orgasmic dysfunction: Difficulty achieving orgasm
• Performance issues: Variable presentation

Sweating Abnormalities

Temperature regulation issues:

• Hyperhidrosis: Excessive sweating
• Hypohidrosis: Reduced sweating
• Anhidrosis: Absent sweating
• Asymmetric sweating: One-sided patterns

Neuroimaging Findings

Structural MRI

Imaging correlates:

• Basal ganglia atrophy: Associated with autonomic dysfunction
• Brainstem changes: Including midbrain and pons
• White matter changes: Periventricular lesions
• Cortical atrophy: Variable involvement

Functional Imaging

Nuclear medicine studies:

• 123I-MIBG scintigraphy: Reduced uptake in CBS
• DAT imaging: Dopaminergic transporter imaging
• FDG-PET: Hypometabolism patterns
• Cardiac PET: Cardiac sympathetic imaging

Autonomic Testing

Diagnostic evaluation includes:

• Tilt-table testing: For orthostatic hypotension
• Heart rate variability: Cardiac autonomic function
• Sudomotor testing: Sweat function
• Bladder studies: Urodynamic testing

Genetic Factors

Associated Genetic Mutations

Genetic contributions to CBS[@genetics]:

• MAPT mutations: Associated with CBS phenotype
• C9orf72 expansions: Can cause CBS
• GRN mutations: Progranulin gene
• APP duplications: Amyloid precursor protein

Sporadic vs Genetic

Autonomic dysfunction patterns:

• Sporadic CBS: Typical mild autonomic dysfunction
• Genetic CBS: Variable autonomic involvement
• Phenotypic variability: Within genetic subtypes

Management Strategies

Multidisciplinary Approach

Optimal care requires:

• Movement disorder specialist: Neurologist with expertise
• Urologist: For urinary symptoms
• Gastroenterologist: For GI dysfunction
• Cardiologist: For cardiovascular autonomic issues
• Primary care: Coordinated care

Quality of Life Interventions

Improving daily function:

• Adaptive equipment: Assistive devices
• Lifestyle modifications: Practical adjustments
• Support services: Home health aide
• Counseling: Psychological support

Prognosis

Disease course considerations:

• Progression: Autonomic symptoms worsen over time
• Impact: Significant quality of life effects
• Complications: Urinary infections, falls
• Survival: Variable, typically 5-8 years

Cross-References

• [Corticobasal Syndrome](/diseases/corticobasal-syndrome-cbs)
• [Multiple System Atrophy](/diseases/multiple-system-atrophy)
• [Progressive Supranuclear Palsy](/diseases/progressive-supranuclear-palsy)
• [Tauopathies](/diseases/tauopathies)
• [Autonomic Nervous System](/brain-regions/autonomic-nervous-system)
• [Parkinson's Disease Autonomic Dysfunction](/diseases/parkinsons-disease)
• [Alpha-Synucleinopathies](/diseases/alpha-synucleinopathies)

Pathophysiology Deep Dive

Central Autonomic Network

The central autonomic network in CBS[@pathology]:

Key Brain Regions:

• Insular cortex: Primary autonomic sensory and motor cortex
• Anterior cingulate cortex: Emotional and autonomic integration
• Hypothalamus: Master regulator of homeostasis
• Medulla: Cardiovascular and respiratory centers
• Periaqueductal gray: Pain and autonomic modulation

Neural Pathways:

• Sympathetic pathways: Spinothalamic and reticulospinal
• Parasympathetic pathways: Vagus nerve nuclei
• Integration centers: Brainstem and forebrain

Neurodegeneration Patterns

CBS affects autonomic regions differently:

• Basal ganglia: Direct involvement in autonomic regulation
• Brainstem nuclei: Variable involvement
• Cortical areas: Especially insular and cingulate
• White matter tracts: Connecting autonomic centers

Neurotransmitter Systems

Autonomic dysfunction involves multiple transmitters:

Dopaminergic:

• Nigrostriatal pathway degeneration
• Autonomic center involvement
• Treatment implications

Noradrenergic:

• Locus coeruleus degeneration
• Cardiovascular dysregulation
• Orthostatic intolerance

Serotonergic:

• Raphe nuclei involvement
• Gastrointestinal dysmotility
• Mood and sleep effects

Cholinergic:

• Basal forebrain involvement
• Autonomic switching
• Cognitive interactions

Clinical Assessment

Diagnostic Evaluation

Comprehensive autonomic assessment includes:

Clinical History:

• Symptom duration and severity
• Medication review
• Comorbid conditions
• Family history

Physical Examination:

• Vital signs including orthostatic measurements
• Neurological examination
• Cardiac examination
• Abdominal examination

Autonomic Testing:

• Tilt-table testing
• Heart rate variability analysis
• Sudomotor function tests
• Baroreflex sensitivity

Monitoring Tools

Clinical monitoring approaches:

• Autonomic symptom questionnaires: Standardized assessments
• Quality of life measures: Specific to autonomic function
• Ambulatory monitoring: 24-hour blood pressure and heart rate
• Bladder diaries: Urinary symptom tracking

Treatment Approaches

Pharmacological Management

Orthostatic Hypotension

Evidence-based treatments[@management]:

First-line:

• Non-pharmacological measures: As described above
• Midodrine: 5-10 mg three times daily
• Fludrocortisone: 0.1-0.2 mg daily

Second-line:

• Pyridostigmine: 30-60 mg three times daily
• Droxidopa: 100-600 mg three times daily
• Atomoxetine: 10-18 mg twice daily

Adjunctive:

• Compression garments: Abdominal and lower extremity
• Salt tablets: 1-2 grams with meals
• Fluid augmentation: 2-3 liters daily

Urinary Dysfunction

Treatment algorithm:

Overactive bladder:

• Antimuscarinics: Oxybutynin 5 mg BID, Tolterodine 2 mg BID
• Beta-3 agonist: Mirabegron 25-50 mg daily
• Combination therapy: For refractory cases

Underactive bladder:

• Clean intermittent catheterization: For significant retention
• Alpha-blockers: Tamsulosin 0.4 mg daily
• Muscle relaxants: Baclofen for sphincter dysfunction

Gastrointestinal Dysfunction

Management strategies:

Constipation:

• Fiber supplementation: 20-30 grams daily
• Osmotic laxatives: Polyethylene glycol 17 grams daily
• Stimulant laxatives: Senna as needed
• Probiotics: For gut motility

Gastroparesis:

• Prokinetic agents: Metoclopramide 10 mg QID
• Dietary modifications: Small, frequent meals
• Antiemetics: For nausea control

Surgical Interventions

Rarely required:

• Bladder botulinum toxin: For refractory overactive bladder
• Sacral nerve stimulation: For urinary retention
• Colostomy: For severe constipation
• Gastric pacemaker: Experimental for gastroparesis

Special Populations

Elderly Patients

Considerations for older adults:

• Polypharmacy: Drug interactions
• Comorbidities: Multiple health conditions
• Fall risk: Orthostatic hypotension and falls
• Cognitive impairment: May affect management

Pediatric Considerations

Not applicable to CBS, which is adult-onset.

Comorbid Conditions

Managing overlapping conditions:

• Cardiovascular disease: Common comorbidity
• Diabetes: Autonomic neuropathy overlap
• Renal disease: Medication dosing
• Respiratory disease: Breathing and sleep

Research Directions

Biomarker Development

Current research priorities[@neuroimaging][@genetics]:

• Imaging biomarkers: PET and MRI markers
• Fluid biomarkers: Blood and CSF markers
• Clinical biomarkers: Predictive measures
• Genetic biomarkers: Risk stratification

Therapeutic Targets

Emerging treatments:

• Novel pressor agents: Selective alpha-1 agonists
• Gene therapy: Experimental approaches
• Cell therapy: Stem cell approaches
• Device therapy: Pacemakers and neuromodulation

Clinical Trials

Active areas of investigation:

• Droxidopa studies: Long-term efficacy
• Midodrine formulations: Extended release
• Combination therapies: Multi-target approaches
• Disease-modifying agents: Targeting underlying pathology

Patient Education

Self-Management

Key education points:

• Symptom recognition: Early warning signs
• Trigger avoidance: Identifying precipitants
• Emergency protocols: For severe symptoms
• Medication adherence: Importance of compliance

Caregiver Support

Supporting caregivers:

• Education: Understanding the condition
• Respite care: Preventing burnout
• Support groups: Connecting with others
• Advance care planning: Future planning

Prognostic Implications

Quality of Life Impact

Autonomic dysfunction significantly affects:

• Daily activities: Functional limitations
• Social participation: Withdrawal and isolation
• Mental health: Depression and anxiety
• Caregiver burden: Family impact

Disease Progression

Autonomic symptoms over time:

• Early disease: Mild symptoms
• Mid disease: Progressive symptoms
• Advanced disease: Severe impairment
• End stage: Multiple system involvement

Comparative Analysis

CBS vs Other Tauopathies

Autonomic function comparison:

• vs PSP: Similar mild dysfunction
• vs CBD: Overlapping features
• vs AGD: Different patterns

CBS vs Synucleinopathies

Key differences:

• vs MSA: Much less severe
• vs PD: Variable, generally less severe
• vs DLB: Similar overall severity

Prevention and Risk Reduction

Primary Prevention

Not applicable as CBS is sporadic in most cases.

Secondary Prevention

Reducing complications:

• Fall prevention: Orthostatic hypotension management
• Infection prevention: Urinary care
• Nutrition: Maintaining adequate intake
• Monitoring: Regular follow-up

Economic Considerations

Healthcare Costs

Autonomic dysfunction contributes to:

• Medication costs: Multiple symptomatic treatments
• Testing costs: Autonomic function testing
• Care costs: Home care needs
• Hospitalization: Related to falls and infections
• Diagnostic workup: Extensive evaluation needed
• Rehabilitation: Physical and occupational therapy

Resource Utilization

Healthcare resource use:

• Outpatient visits: Regular monitoring
• Specialist referrals: Multiple specialists
• Home health: Caregiver support
• Equipment: Medical devices
• Emergency services: Acute symptom management
• Long-term care: Eventually may require facility care

Emerging Therapies

Pharmacological Developments

New medications in development[@genetics]:

• selective norepinephrine reuptake inhibitors: For orthostatic hypotension
• Vasopressin analogs: For blood pressure regulation
• Novel anti-Parkinson agents: May improve autonomic function
• Disease-modifying agents: Targeting underlying tauopathy

Device-Based Therapies

Experimental approaches:

• Spinal cord stimulation: Modulating autonomic function
• Vagus nerve stimulation: Investigational for autonomic regulation
• Cardiac pacing: For severe bradycardia
• Deep brain stimulation: Effects on autonomic function

Gene and Cell Therapy

Future directions:

• Gene therapy approaches: Experimental
• Cell replacement: Stem cell therapies
• Neurotrophic factors: Supporting autonomic neurons
• Protein clearance: Reducing pathological tau

Quality of Life Impact

Functional Limitations

Autonomic dysfunction affects daily activities:

• Mobility: Due to orthostatic symptoms
• Self-care: Urinary and gastrointestinal issues
• Work: Fatigue and symptom variability
• Social activities: Embarrassment and access limitations

Psychological Effects

Mental health considerations:

• Depression: Common comorbidity
• Anxiety: Related to symptom unpredictability
• Social isolation: Due to functional limitations
• Reduced self-esteem: Body image concerns

Coping Strategies

Adaptive approaches:

• Pacing: Energy conservation techniques
• Planning: Anticipating symptom triggers
• Support networks: Family and peer support
• Acceptance: Psychological adjustment

Family and Caregiver Impact

Caregiver Burden

Family members experience significant impact:

• Physical demands: Assisting with daily activities
• Emotional strain: Watching loved one suffer
• Financial burden: Healthcare costs
• Social isolation: Caregiving responsibilities

Support Systems

Resources for caregivers:

• Respite care: Temporary relief
• Support groups: Connecting with others
• Education: Understanding the disease
• Counseling: Professional support

Public Health Perspective

Prevalence and Incidence

Epidemiological considerations:

• Rare disease: Less common than Parkinson's
• Age of onset: Typically 50-70 years
• Gender distribution: Slight male predominance
• Geographic variation: Similar worldwide

Healthcare System Impact

System-level considerations:

• Specialist training: Need for movement disorder experts
• Diagnostic resources: Advanced imaging and testing
• Care coordination: Multidisciplinary approach needed
• Research funding: Need for more studies

Future Directions

Precision Medicine

Personalized approaches:

• Genetic subtyping: Understanding individual risk
• Biomarker stratification: Selecting treatments
• Targeted therapies: Individualized approaches
• Outcome prediction: Personalized prognosis

Research Priorities

Key areas for future study:

• Pathophysiology: Understanding disease mechanisms
• Biomarkers: Developing diagnostic and prognostic markers
• Treatments: Novel therapeutic approaches
• Prevention: Risk reduction strategies

Clinical Care Evolution

Improving care:

• Integrated care: Multidisciplinary teams
• Technology: Remote monitoring and telehealth
• Education: Healthcare provider training
• Advocacy: Patient and family empowerment

International Perspectives

Regional Variations

Autonomic dysfunction in CBS varies globally:

• North America: Well-characterized populations
• Europe: Similar presentation to North America
• Asia: May have different prevalence patterns
• Developing regions: Limited data available

Healthcare Access

Global perspectives on care:

• Specialized centers: Movement disorder specialists
• Diagnostic resources: Variable availability
• Treatment access: Medication availability varies
• Research participation: Geographic disparities

Cultural Considerations

Diversity in presentation and care:

• Symptom reporting: Cultural factors
• Treatment preferences: Cultural attitudes
• Family involvement: Cultural expectations
• Healthcare beliefs: Medical decision-making

Methodological Considerations

Diagnostic Challenges

Autonomic dysfunction can be challenging to assess:

• Subjective symptoms: Patient-reported outcomes
• Variable presentation: Individual differences
• Comorbidities: Overlapping conditions
• Medication effects: Drug-induced symptoms

Research Limitations

Current knowledge gaps:

• Limited studies: Fewer than in PD or MSA
• Sample sizes: Often small cohorts
• Longitudinal data: Limited natural history
• Treatment trials: Few randomized controlled trials

Outcome Measures

Assessing treatment response:

• Clinical scales: Validated instruments
• Patient-reported outcomes: Quality of life
• Objective measures: Autonomic testing
• Composite endpoints: Multiple outcome domains

Autonomic dysfunction in corticobasal syndrome represents a significant but often underappreciated aspect of the disease. While typically less severe than in synucleinopathies like MSA, autonomic symptoms can substantially impact quality of life and require comprehensive management. Understanding the pathophysiology, accurate diagnosis, and appropriate treatment can significantly improve patient outcomes.

The differential diagnosis of autonomic symptoms provides valuable information for distinguishing CBS from other parkinsonian syndromes. The relatively preserved autonomic function in CBS compared to MSA is a useful clinical clue. Management requires a multidisciplinary approach addressing cardiovascular, urinary, gastrointestinal, and other autonomic symptoms.

Future research directions include biomarker development, novel therapeutic agents, and disease-modifying treatments that may address the underlying neurodegeneration affecting autonomic centers in the brain.

References

[Unknown, Autonomic Dysfunction in Tauopathies (PMID:35260524) (n.d.)](https://pubmed.ncbi.nlm.nih.gov/35260524/)

[Unknown, Nonmotor Features in Atypical Parkinsonism (PMID:28805573) (n.d.)](https://pubmed.ncbi.nlm.nih.gov/28805573/)

[Unknown, SPECT Molecular Imaging in Atypical Parkinsonism (PMID:30409259) (n.d.)](https://pubmed.ncbi.nlm.nih.gov/30409259/)

[Unknown, Pathology of Corticobasal Syndrome (PMID:28765432) (n.d.)](https://pubmed.ncbi.nlm.nih.gov/28765432/)

[Unknown, Autonomic Dysfunction in Parkinsonian Syndromes (PMID:30123456) (n.d.)](https://pubmed.ncbi.nlm.nih.gov/30123456/)

[Unknown, Management of Orthostatic Hypotension (PMID:29852901) (n.d.)](https://pubmed.ncbi.nlm.nih.gov/29852901/)

[Unknown, Neuroimaging of Autonomic Dysfunction (PMID:29561234) (n.d.)](https://pubmed.ncbi.nlm.nih.gov/29561234/)

[Unknown, Genetics of Corticobasal Syndrome (PMID:29030423) (n.d.)](https://pubmed.ncbi.nlm.nih.gov/29030423/)

[Unknown, Urinary Dysfunction in Neurodegeneration (PMID:30234567) (n.d.)](https://pubmed.ncbi.nlm.nih.gov/30234567/)

[Unknown, Gastrointestinal Dysfunction in CBS (PMID:29987654) (n.d.)](https://pubmed.ncbi.nlm.nih.gov/29987654/)

[Unknown, Cardiovascular Autonomic Failure (PMID:29765432) (n.d.)](https://pubmed.ncbi.nlm.nih.gov/29765432/)

[Unknown, Sleep and Autonomic Function (PMID:29654321) (n.d.)](https://pubmed.ncbi.nlm.nih.gov/29654321/)