Alzheimer disease neuropathology: understanding autonomic dysfunction

Area of Science:

• Neuropathology
• Neurodegenerative Diseases
• Autonomic Nervous System

Background:

• Alzheimer's disease (AD) research traditionally focuses on cognitive and behavioral symptoms, with less attention to autonomic dysfunctions.
• Autonomic dysfunctions in AD are significant, potentially increasing morbidity and mortality.
• The neuropathological impact of AD on autonomic structures remains understudied.

Purpose of the Study:

• To review the neurodegenerative processes in Alzheimer's disease affecting central autonomic-related regions.
• To analyze cortical, subcortical, and caudal autonomic structures impacted by AD.

Main Methods:

• Comprehensive literature search of MedLine, PsycInfo, and Lilacs databases.
• Inclusion of bibliographical references and manual searches of classic studies.
• Review spanned over a century of AD and autonomic nervous system research.

Main Results:

• Central autonomic structures include cortical and subcortical areas (amygdala, thalamus, hypothalamus, brainstem, cerebellum) and the spinal cord.
• These structures form vital autonomic neural networks.
• Alzheimer's disease neurodegeneration progressively affects these autonomic structures according to Braak staging.

Conclusions:

• Damage to central autonomic neural networks by progressive neurodegeneration is the neuropathological basis of autonomic dysfunction in AD.
• Autonomic dysfunction in AD patients is linked to increased morbidity and potentially mortality.
• Clinicians should consider autonomic dysfunction in the management of Alzheimer's disease patients.