대한치매학회지 (Dementia and Neurocognitive Disorders)

대한치매학회 (Korean Dementia Association)
권호 표지

치매에서 심혈관계 자율신경기능 이상

Cardiovascular Autonomic Dysfunction in Dementia

  • 김성래 (인하대학교 의과대학 신경과학교실) ;
  • 지기환 (인하대학교 의과대학 신경과학교실) ;
  • 김소현 (인하대학교 의과대학 신경과학교실) ;
  • 김일곤 (인하대학교 의과대학 신경과학교실) ;
  • 송창석 (인하대학교 의과대학 신경과학교실) ;
  • 최윤재 (인하대학교 의과대학 신경과학교실) ;
  • 홍창기 (인하대학교 의과대학 신경과학교실) ;
  • 한임태 (인하대학교 의과대학 신경과학교실) ;
  • 윤대현 (서울대학교병원 헬스케어시스템 강남센터 정신과) ;
  • 최성혜 (인하대학교 의과대학 신경과학교실)
  • Kim, Sung-Rae (Department of Neurology, Inha University School of Medicine) ;
  • Ji, Ki-Hwan (Department of Neurology, Inha University School of Medicine) ;
  • Kim, So-Hyun (Department of Neurology, Inha University School of Medicine) ;
  • Kim, Il-Gon (Department of Neurology, Inha University School of Medicine) ;
  • Song, Chang-Seok (Department of Neurology, Inha University School of Medicine) ;
  • Choi, Yoon-Jae (Department of Neurology, Inha University School of Medicine) ;
  • Hong, Chang-Gi (Department of Neurology, Inha University School of Medicine) ;
  • Han, Im-Tae (Department of Neurology, Inha University School of Medicine) ;
  • Yoon, Dae-Hyun (Department of Psychiatry, Seoul National University Hospital Healthcare System Gangnam Center) ;
  • Choi, Seong-Hye (Department of Neurology, Inha University School of Medicine)
  • 발행 : 2010.03.31
⟨ 이전 논문 다음 논문 ⟩

초록

Background: There is a need to identify cardiovascular autonomic dysfunction in patients with dementia in order to ensure appropriate management and reduce risk of falls. The objective of this study is to assess cardiovascular autonomic function in patients with Alzheimer's disease (AD), dementia with Lewy bodies (DLB) and subcortical ischemic vascular dementia (SIVD). Methods: Twenty-two patients with AD, nine with DLB, seven with SIVD, and 23 healthy elderly controls were recruited for the study. Heart rate responses to standing and deep breathing, Valsalva ratio, change of blood pressure to standing and isometric exercise, and overshoot of systolic blood pressure during phase IV of Valsalva maneuver were assessed with noninvasive beat-to-beat blood pressure monitor, Finometer. Autonomic symptoms were assessed using the Autonomic Symptoms Questionnaire. Results: The prevalence of orthostatic hypotension was highest in the patients with DLB (55.6%, p=0.01). The patients with DLB and SIVD had decreased heart rate response to standing $(30:15\;ratio,\;1.01{\pm}0.05\;vs.\;1.03{\pm}0.06\;vs.\;1.09{\pm}0.05\;vs.1.10{\pm}0.09,\;p=0.002)$and small overshoot of systolic blood pressure during phase IV of Valsalva maneuver $(11.0{\pm}14.9\;mmHg\;vs.\;5.9{\pm}34.1\;mmHg\;vs.\;31.8{\pm}19.7\;mmHg\;vs.\;21.4{\pm}15.3\;mmHg,\;p=0.03)$ in comparison with the controls and AD group. The prevalence of cardiovascular dysautonomia by Ewing' classification was significantly high in the patients with DLB, SIVD and AD compared with the controls (77.8% vs. 71.4% vs. 45.5% vs. 17.4%, p=0.01). Atypical dysautonomia with absent or one of the three heart rate tests abnormal and one or both of the blood pressure tests abnormal were frequent in the patient with DLB (55.6%). Conclusions: Cardiovascular autonomic dysfunction is prominent in DLB and SIVD. Cardiovascular sympathetic dysfunction is prevalent in DLB. It is important to identify cardiovascular autonomic dysfunction for reducing risk of falls, especially in DLB.

키워드

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