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Review
. 2019 Jul 10;21(8):38.
doi: 10.1007/s11940-019-0581-2.

Diagnosis and Management of Autonomic Dysfunction in Dementia Syndromes

Louise M Allan  1
Affiliations
Review

Diagnosis and Management of Autonomic Dysfunction in Dementia Syndromes

Louise M Allan. Curr Treat Options Neurol. .

Abstract

Purpose of review: Autonomic dysfunction is common in dementia, particularly in the Lewy body dementias. This review considers the evidence for autonomic dysfunction in dementia, common symptoms and potential management options.

Recent findings: Autonomic dysfunction has been shown in Alzheimer's disease and Lewy body dementias. Common symptoms include orthostatic dizziness, syncope, falls, urinary tract symptoms and constipation. Non-pharmacological management of orthostatic hypotension should include bolus water drinking. Pharmacological management may include the use of midodrine or droxidopa although the latter is not available in Europe. Atomoxetine is a noradrenaline reuptake inhibitor which may be useful if further clinical trials become available. Management of constipation may include the use o f probiotics, osmotic laxatives such as macrogol and chloride type 2 channel activators such as lubiprostone. Management of urinary tract symptoms may include the use of mirabegron. There is a dearth of clinical trials for autonomic dysfunction in dementia and most of the evidence is imputed from trials in Parkinson's disease. However, pragmatic recommendations may be made. There is a need for controlled clinical trials in people with dementia.

Keywords: Autonomic nervous system; Dementia; Lewy body disease; Orthostatic hypotension; Urinary tract symptoms.

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Conflict of interest statement

Professor Allan reports grant funding from the National Institute of Health Research, the Alzheimer’s Society, Alzheimer’s Research UK and Parkinson’s UK. She has received speaker fees from Healthcare UK Conferences Ltd. outside the submitted work.

References

References and Recommended Reading

Papers of particular interest, published recently, have been highlighted as: • Of importance •• Of major importance
    1. Chu CC, Tranel D, Damasio AR, Van Hoesen GW. The autonomic-related cortex: pathology in Alzheimer’s disease. Cereb Cortex. 1997;7(1):86–95. - PubMed
    1. Palma JA, Kaufmann H. Treatment of autonomic dysfunction in Parkinson disease and other synucleinopathies. Mov Disord. 2018;33(3):372–390. - PMC - PubMed
    1. Perry EK, Marshall E, Perry RH, Irving D, Smith CJ, Blessed G, et al. Cholinergic and dopaminergic activities in senile dementia of Lewy body type. Alzheimer Dis Assoc Disord. 1990;4(2):87–95. - PubMed
    1. Allan L, McKeith I, Ballard C, Kenny RA. The prevalence of autonomic symptoms in dementia and their association with physical activity, activities of daily living and quality of life. Dement Geriatr Cogn Disord. 2006;22(3):230–237. - PubMed
    1. Allan Louise M., Ballard Clive G., Rowan Elise N., Kenny Rose Anne. Incidence and Prediction of Falls in Dementia: A Prospective Study in Older People. PLoS ONE. 2009;4(5):e5521. - PMC - PubMed