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Current Treatment Options in Neurology
Published in: Current Treatment Options in Neurology 8/2019

Open Access 01-08-2019 | Constipation | Dementia (J Pillai, Section Editor)

Diagnosis and Management of Autonomic Dysfunction in Dementia Syndromes

Author: Louise M. Allan, PhD

Published in: Current Treatment Options in Neurology | Issue 8/2019

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Abstract

Purpose of review

Autonomic dysfunction is common in dementia, particularly in the Lewy body dementias. This review considers the evidence for autonomic dysfunction in dementia, common symptoms and potential management options.

Recent findings

Autonomic dysfunction has been shown in Alzheimer’s disease and Lewy body dementias. Common symptoms include orthostatic dizziness, syncope, falls, urinary tract symptoms and constipation. Non-pharmacological management of orthostatic hypotension should include bolus water drinking. Pharmacological management may include the use of midodrine or droxidopa although the latter is not available in Europe. Atomoxetine is a noradrenaline reuptake inhibitor which may be useful if further clinical trials become available. Management of constipation may include the use o f probiotics, osmotic laxatives such as macrogol and chloride type 2 channel activators such as lubiprostone. Management of urinary tract symptoms may include the use of mirabegron.

Summary

There is a dearth of clinical trials for autonomic dysfunction in dementia and most of the evidence is imputed from trials in Parkinson’s disease. However, pragmatic recommendations may be made. There is a need for controlled clinical trials in people with dementia.
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Metadata
Title
Diagnosis and Management of Autonomic Dysfunction in Dementia Syndromes
Author
Louise M. Allan, PhD
Publication date
01-08-2019
Publisher
Springer US
Published in
Current Treatment Options in Neurology / Issue 8/2019
Print ISSN: 1092-8480
Electronic ISSN: 1534-3138
DOI
https://doi.org/10.1007/s11940-019-0581-2

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