Potential Interactions between the Autonomic Nervous System and Higher Level Functions in Neurological and Neuropsychiatric Conditions.

Marco Bozzali,Andrea Bassi

doi:10.3389/fneur.2015.00182

Abstract

The autonomic nervous system (ANS) maintains the internal homeostasis by continuously interacting with other brain structures. Its failure is commonly observed in many neurological and neuropsychiatric disorders, including neurodegenerative and vascular brain diseases, spinal cord injury, and peripheral neuropathies. Despite the different underlying pathophysiological mechanisms, ANS failure associates with various forms of higher level dysfunctions, and may also negatively impact on patients’ clinical outcome. In this review, we will discuss potential relationships between ANS and higher level dysfunctions in a selection of neurological and neuropsychiatric disorders. In particular, we will focus on the effect of a documented fall in blood pressure fulfilling the criteria for orthostatic hypotension and/or autonomic-reflex impairment on cognitive performances. Some evidence supports the hypothesis that cardiovascular autonomic failure may play a negative prognostic role in most neurological disorders. Despite a clear causal relationship between ANS involvement and higher level dysfunctions that is still controversial, this might have implications for neuro-rehabilitation strategies aimed at improving patients’ clinical outcome.

Highlights

The autonomic nervous system (ANS) acts as an inside control system, which functions largely below the level of consciousness to regulate and coordinate bodily homeostatic functions and visceral adjustment under physical and mental stress
There are several ways to explore the efficiency of the ANS in vivo. With these concepts in mind, this review aims at exploring the pathophysiological implication of ANS in higher level dysfunctions occurring in patients with neurological and neuropsychiatric diseases
Despite the fact that the exact relationship between cognitive impairment (CI) and autonomic failure (AF) still remains to be fully clarified, it is reasonable to assume that AF may at least contribute in determining cognitive symptoms

Summary

Introduction

The autonomic nervous system (ANS) acts as an inside control system, which functions largely below the level of consciousness to regulate and coordinate bodily homeostatic functions and visceral adjustment under physical and mental stress. Within the diencephalon, the hypothalamus acts as an integrator for several autonomic functions, by linking together the central nervous system (CNS) and the endocrine system through the pituitary gland. It receives inputs from the limbic system supporting a number of higher level functions, including memory, emotion processing, behavior, and motivation [3].

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