Autonomic Dysfunction in Patients with Mild to Moderate Alzheimer's Disease

Christina Jensen-Dahm; Gunhild Waldemar; Troels Staehelin Jensen; Lasse Malmqvist; Michelle Mai Moeller; Birgitte Bo Andersen; Peter Høgh; Martin Ballegaard

doi:10.3233/JAD-150169

Autonomic Dysfunction in Patients with Mild to Moderate Alzheimer's Disease

Christina Jensen-Dahm, Gunhild Waldemar, Troels Staehelin Jensen, Lasse Malmqvist, Michelle Mai Moeller, Birgitte Bo Andersen, Peter Høgh, Martin Ballegaard

Institut for Klinisk Medicin

15 Citationer (Scopus)

Abstract

Background: Autonomic function has received little attention in Alzheimer's disease (AD).ADpathology has an impact on brain regions which are important for central autonomic control, but it is unclear if AD is associated with disturbance of autonomic function. Objective: To investigate autonomic function using standardized techniques in patients with AD and healthy age-matched controls. Method: Thirty-three patients with mild to moderate AD and 30 age- and gender-matched healthy controls, without symptoms of autonomic dysfunction, underwent standardized autonomic testing with deep breathing, Valsalva maneuver, head-up tilt, and isometric handgrip test. Brachial pressure curve and electrocardiogram were recorded for off-line analysis of blood pressure and beat-to-beat heart rate (HR). Results: AD patients had impaired blood pressure responses to Vasalva maneuver (p < 0.0001) and HR response to isometric contraction (p = 0.0001). A modified composite autonomic scoring scale showed greater degree of autonomic impairment in patients compared to controls (patient: 2.1±1.6; controls: 0.9±1.1, p = 0.001). HR response to deep breathing and Valsalva ratio were similar in the two groups. Conclusion: We identified autonomic impairment ranging from mild to severe in patients with mild to moderate AD, who did not report autonomic symptoms. Autonomic impairment was mainly related to impairment of sympathetic function and evident by impaired blood pressure response to the Vasalva maneuver.Tthe clinical implications of this finding are that AD may be associated with autonomic disturbances, but patients with AD may rarely report symptoms of autonomic dysfunction. Future research should systematically evaluate symptoms of autonomic function and characterize risk factors associated with autonomic dysfunction.

Originalsprog	Engelsk
Tidsskrift	Journal of Alzheimer's Disease
Vol/bind	47
Udgave nummer	3
Sider (fra-til)	681-9
Antal sider	9
ISSN	1387-2877
DOI	https://doi.org/10.3233/JAD-150169
Status	Udgivet - 3 aug. 2015

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10.3233/JAD-150169

Citationsformater

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title = "Autonomic Dysfunction in Patients with Mild to Moderate Alzheimer's Disease",

abstract = "Background: Autonomic function has received little attention in Alzheimer's disease (AD).ADpathology has an impact on brain regions which are important for central autonomic control, but it is unclear if AD is associated with disturbance of autonomic function. Objective: To investigate autonomic function using standardized techniques in patients with AD and healthy age-matched controls. Method: Thirty-three patients with mild to moderate AD and 30 age- and gender-matched healthy controls, without symptoms of autonomic dysfunction, underwent standardized autonomic testing with deep breathing, Valsalva maneuver, head-up tilt, and isometric handgrip test. Brachial pressure curve and electrocardiogram were recorded for off-line analysis of blood pressure and beat-to-beat heart rate (HR). Results: AD patients had impaired blood pressure responses to Vasalva maneuver (p < 0.0001) and HR response to isometric contraction (p = 0.0001). A modified composite autonomic scoring scale showed greater degree of autonomic impairment in patients compared to controls (patient: 2.1±1.6; controls: 0.9±1.1, p = 0.001). HR response to deep breathing and Valsalva ratio were similar in the two groups. Conclusion: We identified autonomic impairment ranging from mild to severe in patients with mild to moderate AD, who did not report autonomic symptoms. Autonomic impairment was mainly related to impairment of sympathetic function and evident by impaired blood pressure response to the Vasalva maneuver.Tthe clinical implications of this finding are that AD may be associated with autonomic disturbances, but patients with AD may rarely report symptoms of autonomic dysfunction. Future research should systematically evaluate symptoms of autonomic function and characterize risk factors associated with autonomic dysfunction.",

author = "Christina Jensen-Dahm and Gunhild Waldemar and {Staehelin Jensen}, Troels and Lasse Malmqvist and Moeller, {Michelle Mai} and Andersen, {Birgitte Bo} and Peter H{\o}gh and Martin Ballegaard",

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doi = "10.3233/JAD-150169",

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AU - Jensen-Dahm, Christina

AU - Waldemar, Gunhild

AU - Staehelin Jensen, Troels

AU - Malmqvist, Lasse

AU - Moeller, Michelle Mai

AU - Andersen, Birgitte Bo

AU - Høgh, Peter

AU - Ballegaard, Martin

PY - 2015/8/3

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N2 - Background: Autonomic function has received little attention in Alzheimer's disease (AD).ADpathology has an impact on brain regions which are important for central autonomic control, but it is unclear if AD is associated with disturbance of autonomic function. Objective: To investigate autonomic function using standardized techniques in patients with AD and healthy age-matched controls. Method: Thirty-three patients with mild to moderate AD and 30 age- and gender-matched healthy controls, without symptoms of autonomic dysfunction, underwent standardized autonomic testing with deep breathing, Valsalva maneuver, head-up tilt, and isometric handgrip test. Brachial pressure curve and electrocardiogram were recorded for off-line analysis of blood pressure and beat-to-beat heart rate (HR). Results: AD patients had impaired blood pressure responses to Vasalva maneuver (p < 0.0001) and HR response to isometric contraction (p = 0.0001). A modified composite autonomic scoring scale showed greater degree of autonomic impairment in patients compared to controls (patient: 2.1±1.6; controls: 0.9±1.1, p = 0.001). HR response to deep breathing and Valsalva ratio were similar in the two groups. Conclusion: We identified autonomic impairment ranging from mild to severe in patients with mild to moderate AD, who did not report autonomic symptoms. Autonomic impairment was mainly related to impairment of sympathetic function and evident by impaired blood pressure response to the Vasalva maneuver.Tthe clinical implications of this finding are that AD may be associated with autonomic disturbances, but patients with AD may rarely report symptoms of autonomic dysfunction. Future research should systematically evaluate symptoms of autonomic function and characterize risk factors associated with autonomic dysfunction.

AB - Background: Autonomic function has received little attention in Alzheimer's disease (AD).ADpathology has an impact on brain regions which are important for central autonomic control, but it is unclear if AD is associated with disturbance of autonomic function. Objective: To investigate autonomic function using standardized techniques in patients with AD and healthy age-matched controls. Method: Thirty-three patients with mild to moderate AD and 30 age- and gender-matched healthy controls, without symptoms of autonomic dysfunction, underwent standardized autonomic testing with deep breathing, Valsalva maneuver, head-up tilt, and isometric handgrip test. Brachial pressure curve and electrocardiogram were recorded for off-line analysis of blood pressure and beat-to-beat heart rate (HR). Results: AD patients had impaired blood pressure responses to Vasalva maneuver (p < 0.0001) and HR response to isometric contraction (p = 0.0001). A modified composite autonomic scoring scale showed greater degree of autonomic impairment in patients compared to controls (patient: 2.1±1.6; controls: 0.9±1.1, p = 0.001). HR response to deep breathing and Valsalva ratio were similar in the two groups. Conclusion: We identified autonomic impairment ranging from mild to severe in patients with mild to moderate AD, who did not report autonomic symptoms. Autonomic impairment was mainly related to impairment of sympathetic function and evident by impaired blood pressure response to the Vasalva maneuver.Tthe clinical implications of this finding are that AD may be associated with autonomic disturbances, but patients with AD may rarely report symptoms of autonomic dysfunction. Future research should systematically evaluate symptoms of autonomic function and characterize risk factors associated with autonomic dysfunction.

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DO - 10.3233/JAD-150169

M3 - Journal article

C2 - 26401703

SN - 1387-2877

VL - 47

SP - 681

EP - 689

JO - Journal of Alzheimer's Disease

JF - Journal of Alzheimer's Disease

IS - 3

ER -

Autonomic Dysfunction in Patients with Mild to Moderate Alzheimer's Disease

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