Interoceptive awareness (IA) supports emotional processing and may be affected in people with Parkinson's disease (PwP), where depression and anxiety are common. We examined associations between IA, neuropsychiatric symp...Interoceptive awareness (IA) supports emotional processing and may be affected in people with Parkinson's disease (PwP), where depression and anxiety are common. We examined associations between IA, neuropsychiatric symptoms, cognition, and disease severity in PwP. In a case-control study, 50 PwP and 25 controls completed the MAIA, HDRS, HARS, MoCA, and MDS-UPDRS. IA did not differ between groups. In PwP, lower MAIA Not-Worrying and Self-Regulation scores correlated with depression, anxiety, and disease severity. In addition, lower MAIA Self-Regulation scores correlated with higher orthostatic hypotension symptoms. Reduced interoceptive confidence in PwP is associated with neuropsychiatric burden and perceived autonomic symptom burden.
Lim Z, Chauhan RA, Roper-Jones B
… +5 more, Allen E, Mitcheson J, Clayton RH, Brack KE, Ng GA
Auton Neurosci
· 2026 Jun · PMID 42070447
·
Publisher ↗
INTRODUCTION: Congenital Long QT Syndromes type 1 and 2 (LQT1 and LQT2) are life-threatening conditions that arise from functional impairment of delayed rectifier potassium channels and predispose individuals to ventricu...INTRODUCTION: Congenital Long QT Syndromes type 1 and 2 (LQT1 and LQT2) are life-threatening conditions that arise from functional impairment of delayed rectifier potassium channels and predispose individuals to ventricular arrhythmias (VAs) such as polymorphic ventricular tachycardia and ventricular fibrillation (VF). Sympathetic surges have been associated with VA onset in LQTS, but mechanisms of initiation are not fully understood. It is therefore necessary to investigate the effects of β-adrenergic receptor (β-AR) stimulation on ventricular electrophysiology in LQT1 and LQT2. METHODS: HMR-1556 (0.1 μM, 0.5 μM, 1.0 μM) and E4031 (0.02 μM, 0.05 μM, 0.10 μM) were applied to selectively inhibit the slowly and rapidly activating delayed rectifier potassium currents (IKs and IKr), thereby pharmacologically modelling LQT1 and LQT2, respectively. The effects of β-AR stimulation using isoproterenol (ISO) were investigated on monophasic action potential duration (MAPD), effective refractory period (ERP), MAPD restitution (RT Slope) and VF threshold (VFT). RESULTS: Both HMR and E4031 displayed concentration dependent bradycardic effects and increased MAPD, ERP and VFT. β-AR stimulation on both LQTS models induced tachycardia, and reduced MAPD, ERP and VFT. In LQT1, the presence of ISO caused a greater decrease in VFT and flattening of RT Slope, but in LQT2 RT Slope was steeper. CONCLUSION: The preliminary data suggest that both LQT1 and LQT2 are associated with an increase in VF susceptibility when sympathetic activity is enhanced. However, the dichotomy in the effect on RT slope suggest that each LQT subtype may have different arrhythmogenic mechanisms.
Ortiz PJ, Youssef A, Trujillo P
… +5 more, Sinn DI, Jaradeh S, Paranjape SY, Biaggioni I, Shibao CA
Auton Neurosci
· 2026 Jun · PMID 42068941
·
Publisher ↗
We conducted a retrospective chart review of three patients with brainstem lesions, reporting their clinical features, autonomic function data, and high-resolution brain imaging to identify the site of the lesion in rela...We conducted a retrospective chart review of three patients with brainstem lesions, reporting their clinical features, autonomic function data, and high-resolution brain imaging to identify the site of the lesion in relation to the Nucleus of the Solitary Tract (NST). The first patient experienced neurogenic orthostatic hypotension (NOH) following a brainstem tumor resection with unilateral damage to the NST. The second patient had a giant vascular tumor compressing the brainstem, presenting as afferent baroreflex failure (ABRF). The third patient had a brainstem infiltrating and expanding tumor, exhibiting both presentations: NOH and ABRF. The patient's characteristics, clinical course, and treatment were discussed, along with a review of the literature.
Auton Neurosci
· 2026 Jun · PMID 42030657
·
Publisher ↗
PURPOSE OF REVIEW: Functional neuroimaging, particularly functional MRI (fMRI), has become essential for studying human brain activity, as it provides an indirect measure of this activity. As its technical capabilities e...PURPOSE OF REVIEW: Functional neuroimaging, particularly functional MRI (fMRI), has become essential for studying human brain activity, as it provides an indirect measure of this activity. As its technical capabilities evolve, fMRI continues to offer new insights into the central nervous system. This review summarizes neuroimaging research since 2019 on bladder, pelvic floor, and sexual function in both healthy individuals and those with dysfunction. RECENT FINDINGS: Recent studies examine the central neural control of the lower urinary tract (LUT), highlighting brain regions such as the periaqueductal gray, thalamus, and prefrontal cortex involved in bladder control. fMRI has revealed differences in brain activity between sexes and between healthy individuals and those with overactive bladder (OAB) or neurogenic LUT dysfunction (NLUTD). Research on chronic pelvic pain syndrome (CPPS) suggests abnormal sensory processing and disrupted brain connectivity. Additionally, studies on pelvic floor muscle contraction (PFMC) and micturition identify key brain regions, including the primary motor cortex and cerebellum. Advancements in neuroimaging have also uncovered brain activation patterns linked to sexual dysfunctions such as delayed orgasm, anejaculation, and erectile dysfunction. SUMMARY: This review highlights critical brain regions involved in bladder, pelvic floor, and sexual function, emphasizing the effects of various dysfunctions like OAB, NLUTD, and CPPS. Neuroimaging has revealed alterations in brain activity, paving the way for potential therapeutic approaches. Ongoing research promises to deepen our understanding of these systems and lead to more effective treatments for related disorders.
Smith MD, Portlock GE, Cullen A
… +3 more, Drake MJ, Ben-Shlomo Y, Henderson EJ
Auton Neurosci
· 2026 Jun · PMID 42013781
·
Publisher ↗
Lower-urinary-tract symptoms are common in Parkinson's disease (PD) and are a key autonomic symptom affecting quality of life. We demonstrate that situational triggers of urinary urgency are extremely common in a qualita...Lower-urinary-tract symptoms are common in Parkinson's disease (PD) and are a key autonomic symptom affecting quality of life. We demonstrate that situational triggers of urinary urgency are extremely common in a qualitative study of participants with overactive bladder and PD. 82% reported at least one trigger, and the mean number were 1.6. Running water was a consistent theme, however many were highly specific. This work is important for looking at developing tailored behavioural therapies.
Loufopoulos I, Papaeftstathiou E, Kontos A
… +1 more, Apostolidis A
Auton Neurosci
· 2026 Jun · PMID 42001689
·
Publisher ↗
Lower urinary tract (LUT) function in health, is summarised in urine storage and voluntary voiding. They are mediated through finely coordinated structural signalling mechanisms. The histological structure of the bladder...Lower urinary tract (LUT) function in health, is summarised in urine storage and voluntary voiding. They are mediated through finely coordinated structural signalling mechanisms. The histological structure of the bladder not only preserves a barrier function but also dynamically senses mechanical and chemical stimuli. Urothelial mechano-transduction comprises stretch-activated channels (ENaC, Piezo1/2, TRPV4) and neurotransmitters such as ATP, nitric oxide and acetylcholine to modulate adjacent afferent nerves. Cholinergic signalling through M3 predominantly muscarinic and nicotinic receptors contributes to sensory and contractile responses. Purinergic P2X₃ and P2Y receptors transduce ATP into sensory firing, whereas nitrergic pathways inhibit C-fibre activation to maintain detrusor quiescence. Additional mediators- including transient receptor potential (TRP) vanilloids; neuropetides; endocannabinoids; endothelins; sex hormones and bradykinin - regulate further the excitability and inflammation of the LUT. Urethra, through multi-layered smooth and striated musculature, supported by the pelvic floor, detects flow and pressure via a dense sensory plexus. Similar mechano-transduction pathways, employ urothelial neurotransmitters to coordinate outlet resistance and afferent signalling as rapid adaptation measure to bladder filling. Peripheral neural control, including parasympathetic (pelvic), sympathetic (hypogastric) and somatic (pudendal) pathways, coordinate detrusor contraction and sphincter relaxation during micturition cycle. Spinal and supraspinal centres, integrate afferent input with higher-order modulation of LUT behaviour. The aim of our narrative review is to summarize the current knowledge on the LUT signalling pathways in health involving both the bladder and the urethra, and highlight the integrative neurochemical pathways as future research targets for the management of different urinary disorders.
Auton Neurosci
· 2026 Jun · PMID 41996724
·
Publisher ↗
The autonomic nervous system (ANS) plays a key role in the control of micturition, ensuring an alternation between storage and voiding phases. Any lesion in the neural pathways may be responsible for lower urinary tract...The autonomic nervous system (ANS) plays a key role in the control of micturition, ensuring an alternation between storage and voiding phases. Any lesion in the neural pathways may be responsible for lower urinary tract (LUT) dysfunction, usually associated with bowel and sexual disorders. In individuals with isolated LUT symptoms, dysregulation of the ANS may play a role in the origin of these disorders. This review summarizes the current evidence regarding the association between LUT disorders and ANS dysfunction, explored through a panel of autonomic tests (autonomic cardiovascular testing, heart rate variability, pupillometry, sudomotor tests, etc.). Special focus will be given to the most extensively studied relationship in the literature: ANS dysregulation and overactive bladder, a common syndrome characterized by urinary urgency. The potential of ANS assessment as a predictor of treatment outcomes will be also discusses, as well as the impact of LUT symptom therapies on ANS function.
Janssen J, Van den Ende M, Bou Kheir G
… +2 more, Leue C, Vrijens D
Auton Neurosci
· 2026 Jun · PMID 41996723
·
Publisher ↗
This narrative review explores the complex relationship between lower urinary tract symptoms (LUTS) and mental health disorders, focusing on the influence of anxiety and depression on bladder function. Historical perspec...This narrative review explores the complex relationship between lower urinary tract symptoms (LUTS) and mental health disorders, focusing on the influence of anxiety and depression on bladder function. Historical perspectives highlight early psychoanalytic theories, with renewed research underscoring the link between psychiatric conditions such as anxiety, depression, and obsessive-compulsive disorder (OCD), which is closely related to anxiety and various LUTS, including urinary incontinence (UI), overactive bladder (OAB), voiding dysfunction, and nocturia. Although the exact causal mechanisms remain unclear, the association between LUTS and mental health disorders is complex, involving shared neurological, neurochemical, and inflammatory pathways. The bladder-brain axis (BBA) explains how psychological stressors and physical threats contribute to alarm falsification, enhancing symptom severity and distress. There is a bidirectional relationship between mental health disorders and LUTS which emphasizes the need for a multidisciplinary approach to diagnosis and treatment. Especially because mental health disorders can significantly worsen treatment outcome and treatment adherence. Finally, this review highlights promising directions for future research, including the use of emerging approaches such as artificial intelligence (AI) and ecological momentary assessment (EMA). These tools offer potential for real-time monitoring and personalized treatment, addressing the limitations of retrospective assessment and improving patient care.
Carnevali L, Watanabe DK, Barbetti M
… +4 more, Tyra AT, Williams DP, Ginty AT, Thayer JF
Auton Neurosci
· 2026 Jun · PMID 41990524
·
Publisher ↗
Previous research has demonstrated different associations between ethnicity and resting measures of heart rate variability (HRV), an important proxy of an organism's autonomic regulatory pathways, particularly between no...Previous research has demonstrated different associations between ethnicity and resting measures of heart rate variability (HRV), an important proxy of an organism's autonomic regulatory pathways, particularly between non-Hispanic Black (NHB) and non-Hispanic White (NHW) adults in the United States. The current study aimed to extend the investigation of differences in HRV to four ethnic groups through a social lens, by examining the impact of socioeconomic status (SES) on the relation between ethnicity and HRV. Time- and frequency-domain indexes of HRV were collected during a 10-min period in 944 young adults (n = 175 Asian, n = 77 NHB, n = 208 Hispanic, n = 484 NHW). After adjusting for several covariates, NHB adults had higher resting values of high-frequency HRV compared to the other ethnic groups, specifically at mean and low estimates of SES. In NHB adults only, SES negatively correlated with HRV metrics. Also, Asian adults showed lower resting values of the standard deviation of inter-beat-intervals, and NHW adults had higher resting values of low-frequency HRV compared to the other ethnic groups. These ethnic differences were consistent among women and men. This study provides evidence of specific HRV features and their association with SES in four ethnic groups of young adults residing in the United States, which may have implications for our understanding of the role of social factors in autonomic regulatory processes in individuals of different ethnic groups.
Auton Neurosci
· 2026 Jun · PMID 41967146
·
Publisher ↗
The autonomic nervous system regulates chronic inflammation, with heart rate variability (HRV) reflecting this regulation. We investigated the relationship between HRV and inflammatory markers (IL-6, hs-CRP) in 26 health...The autonomic nervous system regulates chronic inflammation, with heart rate variability (HRV) reflecting this regulation. We investigated the relationship between HRV and inflammatory markers (IL-6, hs-CRP) in 26 healthy young adults (19.9 ± 0.8 years). Participants underwent 24-hour heart rate monitoring, and HRV indices were derived from the median of 5-minute segments. Bayesian correlation analysis was employed to estimate relationships between natural log-transformed (Ln) parameters. LnIL-6 showed substantial positive associations with 24-hour and night-time LnVLF (Bayes factor = 18.61 and 3.24, respectively), with 95% credible intervals entirely above zero. The VLF component is a unique indicator of serum IL-6 in young adults.
Alvarez-Espinoza E, Arévalo-Romero C, Romero M
… +5 more, Corrales V, Gajardo AIJ, Ortiz-Espinoza R, Parada FJ, Cruz G
Auton Neurosci
· 2026 Jun · PMID 41863915
·
Publisher ↗
PURPOSE: To characterize autonomic nervous system alterations in patients with delirium, focusing on cardiovascular, respiratory, ocular, exocrine, and gastrointestinal functions, as well as neurotransmitter levels. This...PURPOSE: To characterize autonomic nervous system alterations in patients with delirium, focusing on cardiovascular, respiratory, ocular, exocrine, and gastrointestinal functions, as well as neurotransmitter levels. This review aims to synthesize current evidence and explore potential clinical implications for monitoring delirium. METHODS: A scoping review was conducted in accordance with PRISMA-ScR guidelines and the Joanna Briggs Institute framework. Searches were performed on the Web of Science, PubMed, Scopus, and EBSCOhost. Eligible studies included experimental, quasi-experimental, observational, or descriptive designs involving hospitalized adults with delirium, diagnosed using standardized tools and accompanied by documented evaluation of the autonomic nervous system. RESULTS: Twenty-seven studies were included. Four domains were identified: cardiovascular activity (18 studies), which addressed heart rate variability, blood pressure variability, and blood flow. Several studies have reported changes in heart rate variability, increased blood pressure variability, and a reduction in mean arterial pressure associated with delirium. Four studies examined ocular changes, reporting reduced pupillary reflex responses in delirium. Gastrointestinal function was assessed in three studies through gut microbiota analysis, showing reduced microbial diversity and increased pathogenic taxa. Two studies examined neurotransmitter levels, reporting elevated norepinephrine in blood and urine associated with delirium. CONCLUSIONS: This scoping review reveals that autonomic alterations are commonly reported in delirium across various domains, including cardiovascular, ocular, gastrointestinal, and neurochemical systems. The evidence is heterogeneous in terms of measures, timing, and study designs, which limits the integration of findings. Autonomic measures may reflect physiological vulnerability, highlighting the need for standardized and longitudinal research.
Furness JB, Marklund U, Czapla BJ
… +2 more, Bornstein JC, Han MN
Auton Neurosci
· 2026 Jun · PMID 41855601
·
Publisher ↗
We provide an account of enteric neuron types and their roles throughout the digestive tract. It is notable that CNS control is essential in the esophagus and has greater importance in the stomach and distal colon than i...We provide an account of enteric neuron types and their roles throughout the digestive tract. It is notable that CNS control is essential in the esophagus and has greater importance in the stomach and distal colon than in the small intestine. CNS control is not essential for the small intestine. Enteric neuron phenotypes and ENS circuits have been determined in detail in the small intestine and colon, but for only two functions, muscle movement and fluid secretion. We discuss neurons controlling other ENS functions, in particular control of neuro-immune interactions and control of nutrient transport. In the small intestine, key neurons include intrinsic primary afferent neurons (IPANs), muscle motor neurons and secretomotor neurons. Neurons for control of acid, enzyme and hormone secretion occur in the stomach, but, except for the muscle motor neurons, gastric neuron types are poorly understood, and information on equivalences of structural and functional types with types defined by expression analysis is lacking. There are substantial gaps in knowledge of esophageal circuitries. IPANS occur in the colon, but whether they occur in the stomach and esophagus is uncertain. We also discuss species differences in organisation of the enteric plexuses and chemical coding of functionally identified neurons. We conclude that there are at least 26 definable enteric neuron types, and several subtypes. There is a need for more in-depth correlated functional and gene expression studies in order to reach a fuller understanding of the physiological roles of the ENS, its constituent neurons and its central connections.
Reis-Silva LL, Tomeo RA, Barreto-de-Souza L
… +4 more, Silva GA, Santos A, Busnardo C, Crestani CC
Auton Neurosci
· 2026 Jun · PMID 41825213
·
Publisher ↗
The present study investigated the contribution of corticotropin-releasing factor (CRF) neurotransmission acting through local CRF₁ receptors in the anterior (aIC), rostral-posterior (rpIC), and caudal-posterior (cpIC) s...The present study investigated the contribution of corticotropin-releasing factor (CRF) neurotransmission acting through local CRF₁ receptors in the anterior (aIC), rostral-posterior (rpIC), and caudal-posterior (cpIC) subregions of the insular cortex (IC) to the modulation of cardiovascular responses during acute and repeated (10th session) restraint stress in rats. To this end, we performed targeted microinjections of the selective CRF receptor antagonist CP376395 or the agonist CRF into the IC subregions; and assessed changes in arterial pressure, heart rate, and tail skin temperature (TST). We observed that microinjection of CP376395 into the aIC reduced tachycardia and enhanced TST drop during acute restraint stress, whereas the same pharmacological approach into the rpIC attenuated the pressor response and enhanced the TST drop. CRF receptor antagonism within the cpIC decreased both pressor and tachycardiac responses during acute restraint stress, without affecting the TST drop. Comparisons between acutely and chronically stressed animals showed that repeated restraint stress altered CRF control of cardiovascular responses in the rpIC and cpIC, but not in the aIC. In chronically stressed animals, these alterations were primarily characterized by an attenuation of the effects observed with CRF₁ receptor antagonism, whereas local CRF administration elicited effects not observed in animals subjected to acute restraint. Repeated restraint stress did not alter CRF₁ receptor expression in any of the IC subregions. These results indicate that CRF neurotransmission in the IC plays a critical role in controlling cardiovascular responses to stress. This control is site-specific across rostrocaudal IC subregions and is affected by previous stress experience.
de Rijk MM, Fernández Chadily S, Knops A
… +2 more, Schoutens Y, Verstegen AMJ
Auton Neurosci
· 2026 Jun · PMID 41819782
·
Publisher ↗
The periaqueductal gray (PAG) in the midbrain is recognized as a critical relay in lower urinary tract control, integrating ascending bladder signals with descending cortical and subcortical inputs, to coordinate micturi...The periaqueductal gray (PAG) in the midbrain is recognized as a critical relay in lower urinary tract control, integrating ascending bladder signals with descending cortical and subcortical inputs, to coordinate micturition regulation. Animal studies reveal that coordinated pathways within the columnar organization of the PAG converge on the pontine micturition center (PMC), initiating or suppressing micturition. The ventrolateral column, in particular, exhibits robust glutamatergic projections to the PMC that facilitate bladder contractions, whereas local gamma-aminobutyric acid (GABA) interneurons likely modulate this excitatory drive. Recent neuroimaging studies in humans demonstrate that PAG activation correlates with bladder filling and intensifies at the transition from storage to voiding, mirroring findings in preclinical models. Humans, and other species, exert top-down modulation over PAG circuits via forebrain regions responsible for emotion, cognition, and social context, highlighting a multilayered regulatory architecture. Disruptions in these connections, whether through direct lesions, neurodegeneration, or functional connectivity alterations, may manifest as urgency, incomplete voiding, or other lower urinary tract symptoms (LUTS). Refined neuroanatomical methods, advanced imaging at ultra-high field strengths, and targeted manipulations in animal models are likely to further elucidate how discrete PAG subdivisions facilitate maintaining continence. By establishing more precise links between PAG function and higher brain oversight, novel therapeutic strategies for LUTS may emerge, optimizing both diagnostic and treatment paradigms.
Rajaei A, Ahmadian M, Foster GE
… +5 more, Van Heusden K, Mueller PJ, Shoemaker JK, Seethaler R, West CR
Auton Neurosci
· 2026 Jun · PMID 41819781
·
Publisher ↗
The sympathetic nervous system is a master regulator of cardiovascular function. Over the last two decades there has been renewed interest in identifying the underlying behavior of post-ganglionic sympathetic nerves. By...The sympathetic nervous system is a master regulator of cardiovascular function. Over the last two decades there has been renewed interest in identifying the underlying behavior of post-ganglionic sympathetic nerves. By using wavelet-based approaches to isolate underlying action potentials (APs) within multi-unit recordings, tremendous progress has been made to better understand the firing characteristics of individual, and clusters of, sympathetic neurons. These studies, however, have applied these approaches within the context of muscle sympathetic nerve activity recorded from humans, limiting the depth of experimentation into mechanisms that determine sympathetic action potential behaviours and patterns. Here, we extended and refined this wavelet-based approach and uniquely apply it to the measurement of sympathetic nerve activity directed towards the critical splanchnic vascular bed in rodents (i.e., splanchnic sympathetic nerve activity; sSNA). We subsequently quantified AP occurrence within and across bursts and employed k-means clustering on the amplitude of APs and bursts. We first demonstrate that a wavelet-based approach is feasible to implement in rodent recordings. We subsequently show that there is a significant increase in the proportion of large APs and decrease in the proportion of small APs as burst size increases (p < 0.001). Analysis of AP amplitude and latency demonstrated a significant negative association (p < 0.001), indicating that larger APs exhibit shorter latencies. Finally, we demonstrate good agreement between a group-averaged mother wavelet and individual animal mother wavelets. This methodological advance sets the stage for rodent-based mechanistic studies to further understand communication strategies employed by the sympathetic nervous system.
The pathophysiological biomarkers underlying the progression of autonomic dysfunction in Parkinson's disease (PD) are not fully understood. We conducted a cohort analysis of 116 sporadic PD patients to determine whether...The pathophysiological biomarkers underlying the progression of autonomic dysfunction in Parkinson's disease (PD) are not fully understood. We conducted a cohort analysis of 116 sporadic PD patients to determine whether CSF concentrations of total LRRK2 protein and its phosphorylated substrate p-Rab10 predict the trajectories of SCOPA-AUT scores over five years. CSF LRRK2 and p-Rab10 were similarly elevated in sporadic PD and LRRK2 mutation carriers compared with controls. In linear mixed-effects models, higher baseline CSF LRRK2 levels were associated with attenuated annual SCOPA-AUT progression (Ln LRRK2 * time interaction: β = -0.714 points/year; p = 0.003), whereas the interaction between Ln p-Rab10 and time was not significant. These findings indicate that CSF LRRK2 may serve as a biomarker for the progression of autonomic dysfunction in sporadic PD.
PURPOSE: Temperature intolerance is a common and often debilitating symptom of postural tachycardia syndrome (POTS), however treatment options are limited. In this open-label pilot study, we examined the use of a novel w...PURPOSE: Temperature intolerance is a common and often debilitating symptom of postural tachycardia syndrome (POTS), however treatment options are limited. In this open-label pilot study, we examined the use of a novel wearable thermal watch (Embr Wave2™) on thermoregulatory and other autonomic symptoms in POTS. METHODS: Participants with POTS and temperature intolerance were recruited from the Stanford autonomic disorders clinic. All patients completed an online battery of autonomic and sleep questionnaires including the composite autonomic symptom score-31 (COMPASS-31), the Delphi interoceptive scale, the temperature disturbance index scale (TDIS), and a 10-minute active stand testing at baseline and after 4 weeks of wearable use. RESULTS: Twenty-two POTS participants with severe temperature intolerance were included in the final analysis. At baseline, 55% noted a moderate to severe impact of temperature intolerance on quality of life (QoL). After 4 weeks of wearable use, sustained reductions were seen across multiple TDIS domains, including work, leisure activities, and enjoyment of life (p ≤0.05). No significant changes were seen in COMPASS-31 scores (53.98 [43.36-56.62] vs. 53.04 [44.66-60.30], p = 0.34) or orthostatic tachycardia on stand testing (31.5 [24.8-45.5] bpm vs.31.0 [21.0-40.5] bpm, p = 0.56). CONCLUSIONS: Temperature intolerance is common and directly correlated with QoL in patients with POTS. Use of a non-invasive thermal wearable led to improvement in temperature related QoL measures, however global autonomic symptom scores and orthostatic tachycardia remained unchanged. This study highlights the need for other treatment studies with more specific patient reported outcomes measures in POTS patients with temperature intolerance.
This exploratory analysis of a pilot randomized controlled trial investigated the effects of cycling exercise on autonomic symptoms in early Parkinson's disease (PD). Thirty patients were assigned to a cycling group, whi...This exploratory analysis of a pilot randomized controlled trial investigated the effects of cycling exercise on autonomic symptoms in early Parkinson's disease (PD). Thirty patients were assigned to a cycling group, which performed three 40-60-min sessions per week for 24 weeks, or to a control group. Autonomic symptoms were assessed using the SCOPA-AUT scale. After 24 weeks, urinary symptoms increased significantly less in the cycling group compared with controls, whereas no differences were observed in other autonomic domains. Among urinary subitems, only urinary frequency improved significantly. These results suggest cycling may selectively benefit urinary function in early PD and warrant further confirmation in large-scale trials.
Baker JR, Ranada SI, Incognito AV
… +5 more, Sheldon RS, Morillo CA, Wilson RJA, Phillips AA, Raj SR
Auton Neurosci
· 2026 Apr · PMID 41734601
·
Full text
PURPOSE: Neurogenic orthostatic hypotension (nOH) causes profound drops in blood pressure (≥20/10 mmHg). We previously showed that carbon dioxide (CO) inhalation powerfully elevates standing blood pressure in patients. R...PURPOSE: Neurogenic orthostatic hypotension (nOH) causes profound drops in blood pressure (≥20/10 mmHg). We previously showed that carbon dioxide (CO) inhalation powerfully elevates standing blood pressure in patients. Rebreathe devices elevate CO and lower O and may offer a simple, cost-effective way to raise standing blood pressure. We tested the acute efficacy of high CO + low O (i.e., simulated rebreathing) to raise standing blood pressure. Additionally, we compared simulated rebreathing to high CO (+CO) alone. METHODS: In this exploratory sub-study, ten patients with nOH (F = 3; 69 ± 9 years) performed two sit-to-stand tests while breathing either room air or simulated rebreathing. Continuous blood pressure, heart rate, respiration, stroke volume, cardiac output, and systemic vascular resistance were recorded. Hemodynamics were averaged over the final minute of stand for each condition. Tolerability was defined as completing the full 5-minute stand without aborting due to breathing discomfort. RESULTS: Compared to room air, simulated rebreathing increased standing systolic blood pressure (p = 0.02), stroke volume (p = 0.03), cardiac output (p = 0.02), and reduced hypotensive time (p = 0.02). Hemodynamic responses and hypotensive time during simulated rebreathing did not differ from +CO₂ alone (all p > 0.1). Tolerability was lower with only 2/10 patients completing the simulated rebreathing protocol, primarily due to shortness of breath, whereas 9/10 completed +CO₂ alone (p = 0.014). CONCLUSIONS: Simulated rebreathing improves standing blood pressure in nOH but is poorly tolerated. High CO₂ alone appears equally effective and better tolerated. CO₂ delivery systems that elevate CO₂ while maintaining oxygen may offer a more feasible therapeutic strategy. CLINICAL TRIAL NO: NCT05295810 https://clinicaltrials.gov/study/NCT05295810.