AbstractBackgroundThe role played by sympathetic and parasympathetic autonomic branches in patients with Parkinson's disease carrying variants in the GBA1 gene (GBA‐PD) is still elusive.ObjectivesTo characterize cardiovascular autonomic function in GBA‐PD and I‐PD patients with early and mid‐stage disease.MethodsThese assessments were performed: cardiovascular autonomic tests, analysis of heart rate and blood pressure variability, cardiac noradrenergic imaging. The frequency and severity of autonomic symptoms were comparatively assessed with the SCOPA‐AUT questionnaire.ResultsCompared to the I‐PD cohort, GBA‐PD patients displayed an increased burden of autonomic symptoms. Autonomic tests revealed worse parasympathetic scores in GBA‐PD while sympathetic indexes and the degree of cardiac sympathetic binding were comparable in the two groups. Heart rate variability indexes also revealed lower vagal modulation in the GBA‐PD group.ConclusionsThe cardiovascular autonomic profile in GBA PD is characterized by a prominent cardiovagal dysfunction compared to I‐PD.