KMID : 0869220210250020057
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Journal of Korean Geriatric Psychiatry 2021 Volume.25 No. 2 p.57 ~ p.64
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Autonomic Dysfunction in Patients With Dementia
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Lee Ji-Min
Chang Sung-Man
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Abstract
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Autonomic dysfunction commonly occurs in patients with dementia and is typically reported in patients with Alzheimer¡¯s disease and Lewy body dementia. The clinical presentation of autonomic dysfunction includes symptoms related to orthostatic hypotension (manifested as dizziness, falls, and syncope, etc.), constipation, and urinary tract symptoms. Non-pharmacological management of orthostatic hypotension should include bolus water drinking. Pharmacological management includes the administration of midodrine (selective ¥á1-adrenoceptor agonist), droxidopa (norepinephrine prodrug), or atomoxetine (selective noradrenaline reuptake inhibitor). Management of constipation includes the administration of probiotics, osmotic laxatives (e.g. macrogol), and type-2 chloride channel activators (e.g. lubiprostone), and management of urinary tract symptoms includes the administration of mirabegron (selective ¥â3-adrenergic receptor). Autonomic dysfunction interferes with daily activities and negatively affects patients¡¯ and caregivers¡¯ quality of life. Therefore, early diagnosis of autonomic dysfunction and prompt initiation of optimal treatment are important to improve patients¡¯ quality of life and prognosis.
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KEYWORD
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Autonomic nervous system, Dementia, Orthostatic hypotension, Lower urinary tract symptoms, Lewy body disease
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