The current concept of Parkinson disease comprises a group of non-motor symptoms. Among these, dysautonomia is a common problem that deteriorates the quality of life of patients. In this article we review the most common dysautonomic manifestations that are observed in cardiovascular, gastrointestinal, urinary, genital and skin systems. Their possible role as risk factors, premotor symptoms and their implications in the pathogenesis of Parkinson disease are discussed. A general approach to the main syndromes, based in the available evidence and in our experience is also presented.