Diagnosis and management of autonomic dysfunction in dementia syndromes

This is the final version. Available on open access from Springer via the DOI in this record.a) Purpose of review: Autonomic dysfunction is common the dementia, particularly in the Lewy body dementias. This review considers the evidence for autonomic dysfunction in dementia, common symptoms and potential management options. b) 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 use of 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. c) 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.National Institute of Health ResearchAlzheimer’s SocietyAlzheimer’s Research UKParkinson’s U