Issac Thomas Gregor, Chandra Sadanandavalli Retnaswami, Gupta Neelesh, Rukmani Malligurki Raghurama, Deepika S, Sathyaprabha T N
Department of Clinical Neurosciences, National Institute of Mental Health and Neurosciences, Bengaluru, Karnataka, India.
Department of Neurology, National Institute of Mental Health and Neurosciences, Bengaluru, Karnataka, India.
J Neurosci Rural Pract. 2017 Jan-Mar;8(1):84-88. doi: 10.4103/0976-3147.193545.
In frontotemporal dementia (FTD) and Alzheimer's disease (AD), central autonomic structures get affected early. An insight into autonomic functions in these patients is likely to be of diagnostic importance and thus help in prognosticating and also probably explain unexplained sudden death in some of these patients.
The objective of this study is to identify autonomic dysfunction prevailing in patients. Then, if there is dysfunction, is the pattern same or different in these two conditions. And if different it will serve as an additional biomarker for specific diagnosis.
There were 25 patients and 25 controls and six patients and three controls in AD and FTD groups, respectively. The participants who were recruited were assessed for heart rate variability and conventional cardiac autonomic function testing. The parameters were analyzed using LabChart version 7 software and compared with control population using appropriate statistical methods using SPSS version 22 software.
The mean overall total power was low in the FTD group ( < 0.001), and there was significant reduction in the standard deviation of normal-to-normal intervals and root mean square of successive differences ( < 0.001) with elevated sympathovagal balance in the FTD group ( = 0.04). Patients with AD also showed sympathetic dominance, but there was in addition parasympathetic suppression unlike in the FTD group.
This study reveals autonomic dysfunction in patients with FTD and AD. Both conditions show sympathetic dominance, probably consecutive to the involvement of central autonomic regulatory structures as a shared domain. It remains to be confirmed if these findings are the cause or effect of neurodegeneration and might open up newer territories of research based on the causal role of neurotransmitters in these regions and thus lead to novel therapeutic options such as yoga. The presence of parasympathetic suppression in AD in addition helps differentiate these two conditions.
在额颞叶痴呆（FTD）和阿尔茨海默病（AD）中，中枢自主神经结构早期就会受到影响。深入了解这些患者的自主神经功能可能具有诊断意义，从而有助于预后判断，也可能解释其中一些患者不明原因的猝死。
本研究的目的是确定患者中普遍存在的自主神经功能障碍。然后，如果存在功能障碍，这两种情况下的模式是相同还是不同。如果不同，它将作为特定诊断的额外生物标志物。
AD组和FTD组分别有25例患者和25例对照，以及6例患者和3例对照。对招募的参与者进行心率变异性和传统心脏自主神经功能测试评估。使用LabChart 7版软件分析参数，并使用SPSS 22版软件采用适当的统计方法与对照人群进行比较。
FTD组的平均总体总功率较低（<0.001），正常到正常间隔的标准差和连续差值的均方根显著降低（<0.001），FTD组的交感迷走神经平衡升高（=0.04）。AD患者也表现出交感神经优势，但与FTD组不同的是，还存在副交感神经抑制。
本研究揭示了FTD和AD患者存在自主神经功能障碍。两种情况均表现出交感神经优势，可能是由于中枢自主神经调节结构作为共同区域受累所致。这些发现是神经退行性变的原因还是结果，以及是否可能基于这些区域神经递质的因果作用开辟新的研究领域，从而导致如瑜伽等新的治疗选择，仍有待证实。此外，AD中副交感神经抑制的存在有助于区分这两种情况。
