Dysautonomia in Alzheimer’s Disease: A Systematic Review
<b>Background</b>: Alzheimer’s disease (AD) is the most common cause of dementia. In addition to cognitive decline, non-cognitive symptoms, including dysautonomia, have been reported, although these symptoms are rarely acknowledged by patients. Dysautonomia in AD is thought to arise from...
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2025-05-01
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| author | Marianna Papadopoulou Maria-Ioanna Stefanou Eleni Bakola Christos Moschovos Athanasia Athanasaki Evdoxia Tsigkaropoulou Ioannis Michopoulos George P. Paraskevas Rossetos Gournellis Georgios Tsivgoulis |
| author_facet | Marianna Papadopoulou Maria-Ioanna Stefanou Eleni Bakola Christos Moschovos Athanasia Athanasaki Evdoxia Tsigkaropoulou Ioannis Michopoulos George P. Paraskevas Rossetos Gournellis Georgios Tsivgoulis |
| author_sort | Marianna Papadopoulou |
| collection | DOAJ |
| description | <b>Background</b>: Alzheimer’s disease (AD) is the most common cause of dementia. In addition to cognitive decline, non-cognitive symptoms, including dysautonomia, have been reported, although these symptoms are rarely acknowledged by patients. Dysautonomia in AD is thought to arise from either cholinergic deficits or hypothalamic involvement. A wide range of tests has been used to investigate the role of the autonomic nervous system; however, the results have been inconsistent. <b>Aim</b>: To systematically review all published research investigating autonomic nervous system (ANS) involvement in patients with AD. A comprehensive literature search was conducted in December 2024 across the following databases: PubMed, Cochrane Library, ScienceDirect, and Scopus. <b>Results</b>: A total of 1422 records were identified, of which 30 studies fulfilled the inclusion criteria and were included in the review. Several autonomic tests were employed, with Heart Rate Variability (HRV) being the most frequently used. Other tests included assessments of orthostatic hypotension (OH), postprandial hypotension (PPH), sympathetic skin response (SSR), the tilt test, 123I-MIBG cardiac scintigraphy, norepinephrine (NE) measurements in serum and cerebrospinal fluid, and baroreflex sensitivity. In most studies, AD patients were compared to either healthy controls or patients with other types of dementia. <b>Discussion</b>: The primary finding of this review is that, although patients with AD rarely report dysautonomic symptoms, they frequently exhibit abnormal results on various autonomic tests. In some cases, these findings were sufficient to differentiate AD patients from healthy controls as well as from patients with Diffuse Lewy Body disease (DLB). The inconsistency in reporting symptoms, along with the variability in test results, suggests that autonomic dysfunction in AD may be under-recognized and warrants further investigation. <b>Conclusions</b>: The heterogeneity of the included studies limits the generalizability of the results. However, given the potential impact of dysautonomia on both quality of life and mortality, it is recommended that AD patients be systematically assessed for autonomic dysfunction. Even in the absence of overt symptoms, appropriate treatment should be considered where indicated to mitigate potential risks. |
| format | Article |
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| institution | DOAJ |
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| publishDate | 2025-05-01 |
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| spelling | doaj-art-9896f6513bb3442fbb1244fe5b9af5132025-08-20T03:14:30ZengMDPI AGBrain Sciences2076-34252025-05-0115550210.3390/brainsci15050502Dysautonomia in Alzheimer’s Disease: A Systematic ReviewMarianna Papadopoulou0Maria-Ioanna Stefanou1Eleni Bakola2Christos Moschovos3Athanasia Athanasaki4Evdoxia Tsigkaropoulou5Ioannis Michopoulos6George P. Paraskevas7Rossetos Gournellis8Georgios Tsivgoulis9Department of Physiotherapy, University of West Attica, 12243 Athens, GreeceSecond Department of Neurology, Attikon University Hospital, School of Medicine, National and Kapodistrian University of Athens, 12462 Athens, GreeceSecond Department of Neurology, Attikon University Hospital, School of Medicine, National and Kapodistrian University of Athens, 12462 Athens, GreeceSecond Department of Neurology, Attikon University Hospital, School of Medicine, National and Kapodistrian University of Athens, 12462 Athens, GreeceSecond Department of Neurology, Attikon University Hospital, School of Medicine, National and Kapodistrian University of Athens, 12462 Athens, GreeceFirst Department of Psychiatry, Eginition University Hospital, School of Medicine, National and Kapodistrian University of Athens, 11528 Athens, GreeceSecond Department of Psychiatry, Attikon University Hospital, School of Medicine, National and Kapodistrian University of Athens, 12462 Athens, GreeceSecond Department of Neurology, Attikon University Hospital, School of Medicine, National and Kapodistrian University of Athens, 12462 Athens, GreeceSecond Department of Psychiatry, Attikon University Hospital, School of Medicine, National and Kapodistrian University of Athens, 12462 Athens, GreeceSecond Department of Neurology, Attikon University Hospital, School of Medicine, National and Kapodistrian University of Athens, 12462 Athens, Greece<b>Background</b>: Alzheimer’s disease (AD) is the most common cause of dementia. In addition to cognitive decline, non-cognitive symptoms, including dysautonomia, have been reported, although these symptoms are rarely acknowledged by patients. Dysautonomia in AD is thought to arise from either cholinergic deficits or hypothalamic involvement. A wide range of tests has been used to investigate the role of the autonomic nervous system; however, the results have been inconsistent. <b>Aim</b>: To systematically review all published research investigating autonomic nervous system (ANS) involvement in patients with AD. A comprehensive literature search was conducted in December 2024 across the following databases: PubMed, Cochrane Library, ScienceDirect, and Scopus. <b>Results</b>: A total of 1422 records were identified, of which 30 studies fulfilled the inclusion criteria and were included in the review. Several autonomic tests were employed, with Heart Rate Variability (HRV) being the most frequently used. Other tests included assessments of orthostatic hypotension (OH), postprandial hypotension (PPH), sympathetic skin response (SSR), the tilt test, 123I-MIBG cardiac scintigraphy, norepinephrine (NE) measurements in serum and cerebrospinal fluid, and baroreflex sensitivity. In most studies, AD patients were compared to either healthy controls or patients with other types of dementia. <b>Discussion</b>: The primary finding of this review is that, although patients with AD rarely report dysautonomic symptoms, they frequently exhibit abnormal results on various autonomic tests. In some cases, these findings were sufficient to differentiate AD patients from healthy controls as well as from patients with Diffuse Lewy Body disease (DLB). The inconsistency in reporting symptoms, along with the variability in test results, suggests that autonomic dysfunction in AD may be under-recognized and warrants further investigation. <b>Conclusions</b>: The heterogeneity of the included studies limits the generalizability of the results. However, given the potential impact of dysautonomia on both quality of life and mortality, it is recommended that AD patients be systematically assessed for autonomic dysfunction. Even in the absence of overt symptoms, appropriate treatment should be considered where indicated to mitigate potential risks.https://www.mdpi.com/2076-3425/15/5/502Alzheimer’s diseasedysautonomiaheart rate variabilityorthostatic hypotensionsympathetic skin response |
| spellingShingle | Marianna Papadopoulou Maria-Ioanna Stefanou Eleni Bakola Christos Moschovos Athanasia Athanasaki Evdoxia Tsigkaropoulou Ioannis Michopoulos George P. Paraskevas Rossetos Gournellis Georgios Tsivgoulis Dysautonomia in Alzheimer’s Disease: A Systematic Review Brain Sciences Alzheimer’s disease dysautonomia heart rate variability orthostatic hypotension sympathetic skin response |
| title | Dysautonomia in Alzheimer’s Disease: A Systematic Review |
| title_full | Dysautonomia in Alzheimer’s Disease: A Systematic Review |
| title_fullStr | Dysautonomia in Alzheimer’s Disease: A Systematic Review |
| title_full_unstemmed | Dysautonomia in Alzheimer’s Disease: A Systematic Review |
| title_short | Dysautonomia in Alzheimer’s Disease: A Systematic Review |
| title_sort | dysautonomia in alzheimer s disease a systematic review |
| topic | Alzheimer’s disease dysautonomia heart rate variability orthostatic hypotension sympathetic skin response |
| url | https://www.mdpi.com/2076-3425/15/5/502 |
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