Autonomic Dysfunction in Patients With Dementia

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 α1-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 β3-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