대한노인정신의학회

Autonomic dysfunction commonly occurs in patients with dementia and is typically reported in patients with Alzheimer’s dis- ease and Lewy body dementia. The clinical presentation of autonomic dysfunction includes symptoms related to orthostatic hypo- tension (manifested as dizziness, falls, and syncope, etc.), constipation, and urinary tract symptoms. Non-pharmacological manage- ment of orthostatic hypotension should include bolus water drinking. Pharmacological management includes the administration of midodrine (selective α1-adrenoceptor agonist), droxidopa (norepinephrine prodrug), or atomoxetine (selective noradrenaline reup- take inhibitor). Management of constipation includes the administration of probiotics, osmotic laxatives (e.g. macrogol), and type-2 chloride channel activators (e.g. lubiprostone), and management of urinary tract symptoms includes the administration of mirabe- gron (selective β3-adrenergic receptor). Autonomic dysfunction interferes with daily activities and negatively affects patients’ and caregivers’ quality of life. Therefore, early diagnosis of autonomic dysfunction and prompt initiation of optimal treatment are impor- tant to improve patients’ quality of life and prognosis.

Autonomic nervous system; Dementia; Orthostatic hypotension; Lower urinary tract symptoms; Lewy body disease.