Autonomic symptoms in dementia with lewy bodies

Abstract

In patients with dementia with Lewy bodies (DLB) as well as Parkinson’s disease, Lewy bodies and Lewy neurites are observed in not only the central nervous system but also the peripheral autonomic nervous system. The peripheral autonomic nervous system innervates various organs such as the esophagus, stomach, intestines, heart, urinary bladder, and skin. Thus, various kinds of symptoms, signs, and abnormal autonomic test findings are observed in patients with DLB. Because of this, Lewy body disease is often viewed as a systemic disorder. Severe autonomic dysfunction is one of the supportive features in the revised diagnostic criteria for DLB. Three of the other supportive features including repeated falls, syncope, and transient loss of consciousness can also be partly attributed to the presence of autonomic dysfunction. Furthermore, reduced cardiac meta-iodobenzylguanidine (MIBG) uptake is also indicative of DLB and represents disturbances of the cardiac sympathetic nerve, implying autonomic dysfunction. Autonomic dysfunction occurs to a lesser extent in Alzheimer disease, vascular dementia, and frontotemporal dementia. Therefore, the presence of autonomic dysfunction is an important feature that differentiates DLB from other dementias.