title: The phoenix from the ashes: cardiovascular autonomic dysfunction in behavioral variant of frontotemporal dementia.
abstract: BACKGROUND
  Patients with autonomic failure may experience postural dizziness, syncope, and falls. Identifying symptomatic dysautonomia in dementia is of importance to ensure appropriate management and reduce risk of falls.
  
  
  OBJECTIVE
  The aim of this prospective study is to identify cardiovascular autonomic dysfunction in patients suffering from behavioral variant of frontotemporal dementia (bvFTD), compared to Alzheimer's disease (AD).
  
  
  METHODS
  Patients were prospectively recruited from 2009 until 2013. Clinical autonomic function tests were carried out in an Autonomic Unit according to Ewing's cardiovascular battery. Parasympathetic tests included resting heart rate variability, deep breathing, and Valsalva. Sympathetic function tests compromised blood pressure regulation on valsalva, cutaneous cold stimulation, and 70° head up tilt including of plasma noradrenaline.
  
  
  RESULTS
  26 patients (17 female) with bvFTD and 18 patients (10 female) with AD were examined. Mean age of bvFTD was 69 ± 11 years, AD 74 ± 9 years. History taking was often not conclusive and did not correlate with autonomic signs. In 42% bvFTD patients and 44% AD patients, autonomic dysfunction was demonstrated. Manifest orthostatic hypotension (OH) was present in 19% of bvFTD and 33% AD patients. Frequency of autonomic dysfunction and orthostatic hypotension did not differ between bvFTD and AD, but were significantly higher than in healthy controls. Autonomic dysfunction was associated with an increased risk of falling (assessed with Tinetti Score).
  
  
  CONCLUSIONS
  This is the first prospective study to elucidate autonomic dysfunction in bvFTD patients. There is a considerable higher frequency of cardiovascular dysfunction and OH in bvFTD. History taking may be not conclusive thus cannot exclude cardiovascular dysautonomia.
authors.affiliation: Autonomic Unit, Department of Neurology and Psychiatry, General Hospital of the City of Linz, Linz, Austria.
authors.forename: Walter
authors.initials: W
authors.lastname: Struhal
authors.affiliation: Autonomic Unit, Department of Neurology and Psychiatry, General Hospital of the City of Linz, Linz, Austria.
authors.forename: Andrija
authors.initials: A
authors.lastname: Javor
authors.affiliation: Autonomic Unit, Department of Neurology and Psychiatry, General Hospital of the City of Linz, Linz, Austria.
authors.forename: Cornelia
authors.initials: C
authors.lastname: Brunner
authors.affiliation: Department of Medical Statistics, Vienna Medical University, Vienna, Austria.
authors.forename: Thomas
authors.initials: T
authors.lastname: Benesch
authors.affiliation: Autonomic Unit, Department of Neurology and Psychiatry, General Hospital of the City of Linz, Linz, Austria.
authors.forename: Verena
authors.initials: V
authors.lastname: Schmidt
authors.affiliation: Autonomic Unit, Department of Neurology and Psychiatry, General Hospital of the City of Linz, Linz, Austria.
authors.forename: Milan R
authors.initials: MR
authors.lastname: Vosko
authors.affiliation: Autonomic Unit, Department of Neurology and Psychiatry, General Hospital of the City of Linz, Linz, Austria.
authors.forename: Gerhard
authors.initials: G
authors.lastname: Ransmayr
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D000544:Alzheimer Disease / Q000150:complications; D001342:Autonomic Nervous System Diseases / Q000209:etiology*; D001794:Blood Pressure / Q000502:physiology; D002318:Cardiovascular Diseases / Q000209:etiology*; D003080:Cold Temperature; D057180:Frontotemporal Dementia / Q000150:complications*; D006339:Heart Rate / Q000502:physiology; D006801:Humans; D007024:Hypotension, Orthostatic / Q000209:etiology; D001523:Mental Disorders / Q000209:etiology*; D008875:Middle Aged; D009638:Norepinephrine / Q000097:blood; D012189:Retrospective Studies; D012867:Skin / Q000294:innervation; D014636:Valsalva Maneuver / Q000502:physiology*
chemical_list: D009638:Norepinephrine
keywords: Alzheimer's disease; autonomic dysfunction; autonomic nervous system; dementia; frontotemporal dementia