Clinical and autonomic profile of patients with Alzheimer's disease and mixed dementia

• Published in: Revista da Associação Médica Brasileira 2013-01, Vol.59 (5), p.435-441
• Main Authors: da Costa Dias, Filipi Leles, Lisboa da Silva, Rose Mary Ferreira, de Moraes, Edgar Nunes, Caramelli, Paulo
• Format: Article
• Language: English
• Subjects: Alzheimer's disease; Autonomic nervous system; Doença de Alzheimer; Hipotensão ortostática; Orthostatic hypotension; Sistema nervoso autônomo
• ISSN: 2255-4823; 2255-4823
• DOI: 10.1016/S2255-4823(13)70502-2

To analyze the clinical and autonomic profile of patients with Alzheimer's disease or mixed dementia (MD). Fifty-four patients with indication for cholinesterase inhibitors use were evaluated through clinical examination, rest electrocardiogram, and spectral analysis of heart rate (HR) variability through digital Holter system recordings. Overall, 61.1% of patients were females and were, on average, 77.1 years of age, had 3.3 years of schooling, and scored 16.4 points on the Mini Mental State Examination. The gap between symptom onset and diagnosis was 26.2 months. Almost all patients (90.7%) presented at least one clinical comorbidity, and each patient took, on average, 3.7 drugs to control them. Thirty-one patients had some alteration on the electrocardiogram, and nine (16.6%) had orthostatic hypotension (OH). The latter was associated with the diagnosis of MD (p=0.001), with lower values of low (LF) and high (HF) frequency components of the spectral analysis in the supine position (p=0.000 and p=0.017, respectively), and with lower values of LF in the orthostatic position (p=0.006). Diagnosis of MD was associated with lower values of LF in both positions (p=0.003 and p=0.007). This sample of patients had frequent comorbidities, which resulted in the prescription of multiple drugs. Signs of autonomic dysfunction resulting in OH were found mainly in those with MD. Analisar o perfil clínico e a atividade autonômica de pacientes com diagnóstico de doença de Alzheimer ou demência mista (DM). Foram avaliados 54 pacientes com indicação de uso de inibidores da colinesterase, por meio de exame clínico, eletrocardiograma de repouso e da análise espectral da variabilidade da frequência cardíaca (VFC). A casuística estudada, constituída por 61,1% de mulheres, apresentava média de 77,1 anos de idade, 3,3 anos de escolaridade, pontuação de 16,4 no miniexame do estado mental e intervalo médio de 26,2 meses entre o início dos sintomas e o diagnóstico. A quase totalidade (90,7%) apresentava comorbidades, com o uso, em média, de 3,7 drogas/paciente. Trinta e um (57,4%) pacientes apresentavam alterações eletrocardiográficas e nove (16,6%), hipotensão ortostática (HO). Esta apresentou associação com o diagnóstico de DM (p=0,001) e com valores mais baixos dos componentes de baixa (BF) e de alta (AF) frequência da VFC na posição supina (p=0,000 e p=0,017), além de valores médios menores de BF em ortostatismo (p=0,006). O diagnóstico de DM se associou a menores valores de BF