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Recommendations were drafted based on relevant studies, systematic reviews, meta-analyses and high-quality guidelines identified by the literature search. They were subsequently reviewed, revised, and voted by the Guideline Group in online consensus conferences. The guideline entails: i 10 PICOs and 23 recommendations on the diagnosis and treatment of urogenital, cardiovascular and gastrointestinal autonomic failure; ii four PICOs and four recommendations on the possible types of pain in PD individuals, their diagnosis and treatment; iii 11 PICOs and 11 recommendations on the screening, diagnosis and treatment of sleep disturbances and excessive daytime sleepiness in PD individuals, as well as on their prognostic implications.
Thirty-one out of 38 recommendations achieved a strong consensus. The current German PD guideline provides a practice-oriented and etiology-driven stepwise approach to the diagnosis and treatment of autonomic failure, pain and sleep disturbances in PD individuals. The frequency and severity of PD non-motor symptoms however typically increases with disease duration, and has been associated with morbidity, mortality, more rapid disease progression and overall poorer quality of life of PD individuals and their caregivers [ 15 ].
Lower urinary tract symptoms are a common non-motor symptom in individuals with PD and atypical parkinsonian disorders and are divided into disturbances of the storage phase, mostly due to bladder detrusor hyperactivity, and disturbances of the voiding phase due to detrusor-sphincter dyssynergia or hypocontractile detrusor [ 1 , 88 , ]. Neurogenic bladder dysfunction refers to any disturbance of bladder function due to impaired neural control and needs to be distinguished from non-neurogenic bladder disorders, especially in elderly individuals.
Male erectile dysfunction is defined as the inability to achieve and maintain a penile erection sufficient for a satisfactory sexual intercourse [ 44 ].
