2023年 · 第56卷第10期

autonomic dysfunction (AutD) is the most important non-motor symptom of Parkinson's disease, and it is also one of the core symptoms of prodromal Parkinson's disease. Early appearance of symptoms, wide range of lesions, unknown mechanism of pathological damage and lack of effective treatment are the significant clinical characteristics of AutD. Studies have proved that early AutD is associated with rapid progression of Parkinson's disease and shortened survival. Therefore, revealing the pathological mechanisms of AutD is of great significance for early prediction and diagnosis of Parkinson's disease and timely intervention.

Parkinson's disease is one of the most common neurodegenerative diseases. The pathological deposition and clearance of alpha-synuclein (alpha-syn) is the core pathological process of Parkinson's disease. The glial-lymphatic system is a functional pipeline network in the brain that removes metabolic wastes and deposits proteins. It can realize the drainage of glial lymphatic system between cerebrospinal fluid and intertissue fluid through the perivascular space, and drain the metabolic wastes of the brain from meningeal lymphatic vessels to deep cervical lymph nodes and transport them out of the brain. More and more evidence shows that α-syn is cleared through the glial lymphatic system and hinders the flow of cerebrospinal fluid in the glial lymphatic system, breaking the dynamic balance between the production and clearance of α-syn, which in turn leads to the abnormal aggregation of the latter. Insoluble fibers accumulate in cells, forming Lewy bodies and Lewy neurites, leading to neurotoxicity and apoptosis.