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Clinical and pathological features affecting cardiac sympathetic denervation in autopsy-confirmed dementia with Lewy

M Takahashi1, T Uchihara2,3, M Yoshida4

  • 1Department of Neurology, Kanto Central Hospital of the Mutual Aid Association of Public-School Teachers, Tokyo, Japan.

European Journal of Neurology
|April 3, 2020
PubMed

Insights

Dementia with Lewy bodies (DLB) patients often have mild cardiac sympathetic nerve (CSN) degeneration. Early psychological symptoms and Alzheimer's pathology may indicate preserved CSN function in DLB.

Area of Science:

  • Neurology
  • Cardiology
  • Pathology

Background:

  • Dementia with Lewy bodies (DLB) is a neurodegenerative disease characterized by Lewy bodies in the brain.
  • Cardiac sympathetic denervation is a common feature in DLB, but factors influencing its severity are not fully understood.

Purpose of the Study:

  • To investigate the clinical and neuropathological features associated with cardiac sympathetic denervation in autopsy-confirmed DLB patients.
  • To identify factors that may predict the degree of residual cardiac sympathetic nerve (CSN) axons in DLB.

Main Methods:

  • Autopsy-confirmed DLB patients (n=54) were analyzed.
  • Cardiac tissue (left ventricular anterior wall) was immunostained for tyrosine hydroxylase to quantify residual CSN axons.
  • Relationships between residual CSN axon levels and clinical/neuropathological features were examined.

Main Results:

  • Nearly all DLB patients exhibited minimal residual CSN axons (<2.0% in 92.6%).
  • Patients with early psychological symptoms had significantly more residual CSN axons (1.50% vs. 0.40%).
  • Preserved CSN axons were associated with shorter disease duration, neocortical Lewy body pathology, and concomitant Alzheimer's disease pathology.

Conclusions:

  • Mild cardiac sympathetic denervation is common in DLB.
  • Early psychological symptoms, shorter disease duration, and co-existing Alzheimer's pathology may be linked to less severe CSN degeneration in DLB.
  • DLB patients with widespread early Lewy body pathology may present with milder cardiac sympathetic nerve degeneration.
Abstract

Keywords:
Alzheimer’s diseaseautonomic nervous systemdementia with Lewy bodies

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