This study aims to investigate the characteristics of autonomic dysfunction in progressive supranuclear palsy (PSP) compared to Parkinson's disease (PD) and multiple system atrophy-parkinsonian type (MSA-P). We retrospectively reviewed 128 patients who underwent multidisciplinary team (MDT) intervention at Peking Union Medical College Hospital between March 31, 2021, and November 22, 2023. A total of 16 PSP, 27 MSA-P, and 11 PD patients were included. Autonomic dysfunction was assessed using the SCOPA-AUT scale and medical record data, analyzed with IBM SPSS Statistics 26. SCOPA-AUT revealed varying degrees of autonomic dysfunction across all groups. The total SCOPA-AUT score was lower in PSP (16.88 ± 6.70) than in MSA-P (23.33 ± 8.80) (p = 0.019), but not significantly different from PD (18.64 ± 9.80). All five SCOPA-AUT subscales were affected in PSP, though significant differences were found only in urinary control (p = 0.006) and urinary storage (p = 0.008) scores between PSP and MSA-P. Orthostatic hypotension was clinically identified in 7.7 % of PSP, 66.7 % of MSA-P, and 27.3 % of PD patients, with a significant difference between PSP and MSA-P (p < 0.001). Residual urine volume in MSA-P (137.5 [75.5-190.25] mL) was significantly higher than in PD (34.5 [1.50-60.00] mL, p < 0.001) and PSP (9.95 [1.13-56.25] mL, p < 0.001). Our findings indicate that PSP presents with various forms of autonomic dysfunction, as assessed by SCOPA-AUT, with similarities to both MSA-P and PD. Objective measures, such as orthostatic blood pressure assessments and residual urine ultrasound, can provide additional insights into autonomic dysfunction in PSP.