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KMID : 1100220100090010021
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Dementia and Neurocognitive Disorders
2010 Volume.9 No. 1 p.21 ~ p.28
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Cardiovascular Autonomic Dysfunction in Dementia
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Kim Sung-Rae
Ji Ki-Hwan
Choi Seong-Hye
Kim So-Hyun
Kim Il-Gon
Choi Yoon-Jae
Song Chang-Seok
Yoon Dae-Hyun
Hong Chang-Gi
Han Im-Tae
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Abstract
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There is a need to identify cardiovascular autonomic dysfunction in patients with dementia in order to ensure appropriate management and reduce risk of falls. The objective of this study is to assess cardiovascular autonomic function in patients with Alzheimer’s disease (AD), dementia with Lewy bodies (DLB) and subcortical ischemic vascular dementia (SIVD). Methods: Twenty-two patients with AD, nine with DLB, seven with SIVD, and 23 healthy elderly controls were recruited for the study. Heart rate responses to standing and deep breathing, Valsalva ratio, change of blood pressure to standing and isometric exercise, and overshoot of systolic blood pressure during phase IV of Valsalva maneuver were assessed with noninvasive beat-to-beat blood pressure monitor, Finometer. Autonomic symptoms were assessed using the Autonomic Symptoms Questionnaire. Results: The prevalence of orthostatic hypotension was highest in the patients with DLB (55.6%, p=0.01). The patients with DLB and SIVD had decreased heart rate response to standing (30:15 ratio, 1.01±0.05 vs. 1.03±0.06 vs. 1.09±0.05 vs. 1.10±0.09, p=0.002) and small overshoot of systolic blood pressure during phase IV of Valsalva maneuver (11.0±14.9 mmHg vs. 5.9±34.1 mmHg vs. 31.8±19.7 mmHg vs. 21.4± 15.3 mmHg, p=0.03) in comparison with the controls and AD group. The prevalence of cardiovascular dysautonomia by Ewing’s classification was significantly high in the patients with DLB, SIVD and AD compared with the controls (77.8% vs. 71.4% vs. 45.5% vs. 17.4%, p=0.01). Atypical dysautonomia with absent or one of the three heart rate tests abnormal and one or both of the blood pressure tests abnormal were frequent in the patient with DLB (55.6%). Conclusions: Cardiovascular autonomic dysfunction is prominent in DLB and SIVD. Cardiovascular sympathetic dysfunction is prevalent in DLB. It is important to identify cardiovascular autonomic dysfunction for reducing risk of falls, especially in DLB.
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KEYWORD
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Autonomic, Dementia, Lewy bodies, Vascular dementia, Alzheimer disease
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