Abstract
IntroductionAutonomic dysfunction is a well-known feature in neurodegenerative dementias, especially common in α-synucleinopathies like dementia with Lewy bodies and Parkinson's disease with dementia. The most common symptoms are orthostatic hypotension, incontinence and constipation, but its relevance in clinical practice is poorly understood. There are no earlier studies addressing the influence of autonomic dysfunction on clinical course and survival. The aim of this study was to investigate the frequency of the three most common features of autonomic dysfunction and analyze how it affects survival.MethodsThirty patients with dementia with Lewy bodies and Parkinson's disease with dementia were included in this prospective, longitudinal follow-up study. Presence of incontinence and constipation was recorded at baseline. Blood pressure was measured at baseline, after 3 months and after 6 months according to standardized procedures, with 5 measurements during 10 minutes after rising. Orthostatic hypotension was defined using consensus definitions and persistent orthostatic hypotension was defined as 5 or more measurements with orthostatic hypotension. Difference in survival was analyzed 36 months after baseline.ResultsThere was a high frequency of persistent orthostatic blood pressure (50%), constipation (30%) and incontinence (30%). Patients with persistent orthostatic hypotension had a significantly shorter survival compared to those with no or non-persistent orthostatic hypotension (Log rank x2 = 4.47, p = 0.034). Patients with constipation and/or urinary incontinence, in addition to persistent orthostatic hypotension, had a poorer prognosis compared to those with isolated persistent orthostatic hypotension or no orthostatic hypotension (Log rank x2 = 6.370, p = 0.041).DiscussionAccording to our findings, the identification of autonomic dysfunction seems to be of great importance in clinical practice, not only to avoid falls and other complications, but also as a possible predictor of survival.
Highlights
Autonomic dysfunction is a well-known feature in neurodegenerative dementias, especially common in asynucleinopathies like dementia with Lewy bodies and Parkinson’s disease with dementia
According to our findings, the identification of autonomic dysfunction seems to be of great importance in clinical practice, to avoid falls and other complications, and as a possible predictor of survival
The frequency of symptoms related to autonomic dysfunction in this population is described in figure 3. 25 (83%) of the patients had by definition orthostatic hypotension and 15 (50%) had persistent orthostatic hypotension
Summary
Autonomic dysfunction is a well-known feature in neurodegenerative dementias, especially common in asynucleinopathies like dementia with Lewy bodies and Parkinson’s disease with dementia. Dementia with Lewy bodies (DLB) and dementia associated with Parkinson’s disease (PDD) are neurodegenerative disorders with similar clinical and neuropathological features. Together they account for approximately 15–20% of all clinically diagnosed dementia cases [1,2,3]. They are characterized by widespread a-synuclein-containing intracytoplasmic inclusions called Lewy bodies. Bostrom et al found that increased levels of cerebrospinal total tau were associated with a shorter survival [10]
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