Autonomic dysfunction in dementia with Lewy bodies
John O'Brien, Ian McKeith, David Ames, Edmond Chiu in Dementia with Lewy Bodies and Parkinson's Disease Dementia, 2005
The importance of the ANS is often only appreciated when it is not functioning adequately. Patients with orthostatic intolerance due to generalized autonomic failure have a recognizable pattern of symptoms and aggravating factors that relate to the severity of autonomic failure (Low et al, 1995) (Table 8.1). The commonest symptoms of autonomic failure are orthostatic dizziness, syncope and fatigue. Syncope and falls in older adults are often indistinguishable and in fact are manifestations of similar pathophysiological processes. Up to one-third of cognitively normal older adults have retrograde amnesia for witnessed loss of consciousness (Kenny and Traynor, 1991). Falls in the elderly can therefore be due to unrecognized syncope. Orthostatic hypotension can present with falls alone in the elderly (Ward and Kenny, 1996).
Body Water
Flavia Meyer, Zbigniew Szygula, Boguslaw Wilk in Fluid Balance, Hydration, and Athletic Performance, 2016
Spaceflight promotes a negative body water balance as a result of several different physiological stressors during the take-off: hyper-gravity g-forces, the microgravity environment itself, and the hydration status of the individual along with psychological stress. TBW, ECF volume, and plasma volume have been measured on several NASA flight missions. After the Skylab missions of the 1970s, TBW decreased by an average of 1.7% at landing (Leach and Rambaut 1977). ECF volume was 2% lower than pre-flight levels following the Skylab mission and decreased by 10% after 24 h of spaceflight on the shuttle missions. ECF volume returned to normal values upon landing (Huntoon et al. 1998). Plasma volume has been shown to decrease by up to 17% within 24 h of spaceflight and then seems to stabilize at 10%–15% of pre-flight values after 60 days (Huntoon et al. 1998). In addition, the length of stay in microgravity can have an impact on the physiologic adaptations that take place. Without gravity, fluids from an interstitial space return to the vascular space and shift to the upper body. This increases venous return, atrial stretching, and consequently the release of atrial natriuretic peptide, which increases urine output. The decreased plasma volume and blood volume has consequences on systemic cardiovascular function. Over time, a decreased blood volume can decrease cardiac size. Orthostatic intolerance or the ability to maintain normal blood pressure and reduced blood flow to the brain while standing results from the decrease in blood volume and cardiac size. Upon returning to a gravitational field when landing, individuals are more susceptible to dizziness and fainting.
Autonomic Nervous System Disorders
Philip B. Gorelick, Fernando D. Testai, Graeme J. Hankey, Joanna M. Wardlaw in Hankey's Clinical Neurology, 2020
Acute and subacute autonomic neuropathy: Mainly adrenergic manifesting as predominantly orthostatic intolerance.Predominantly cholinergic resulting in gastrointestinal, pupillary, and sweating disorders.Acute pandysautonomia, (equivalent to Guillain–Barré syndrome restricted to the autonomic nervous system).2
Features that exacerbate fatigue severity in joint hypermobility syndrome/Ehlers–Danlos syndrome – hypermobility type
Published in Disability and Rehabilitation, 2018
Anne Maree Krahe, Roger David Adams, Leslie Lorenda Nicholson
Orthostatic intolerance is a condition related to autonomic nervous system dysfunction and symptoms include dizziness, palpitations and syncope. Episodes are typically precipitated by orthostatic changes and can be exacerbated by physical exertion and heat [33]. Orthostatic intolerance is a significant non-musculoskeletal complaint which has been associated with JHS/EDS-HT and prevalence of symptoms has been reported as up to 78% of individuals with a diagnosis of JHS [34]. Fatigue has previously been linked to postural orthostatic tachycardia syndrome, a form of orthostatic intolerance [35], with 58% of individuals with JHS-related postural orthostatic tachycardia syndrome suffering from clinically significant fatigue [36]. The findings of the current research showed that 22% of participants reported symptoms related to orthostatic intolerance and its contribution to fatigue severity in the multiple regression supports previous research linking orthostatic intolerance to fatigue [36]. A higher frequency of dizziness related to heat, exercise and or postural change was significantly correlated with and a predictor of, fatigue severity. Orthostatic intolerance is a potentially modifiable condition, both pharmacologically and non-pharmacologically [33].
Message from the Guest Editors
Published in Occupational Therapy In Health Care, 2022
The aim of this special edition is to bring awareness of Postural Orthostatic Tachycardia Syndrome (POTS) to the occupational therapy community, platform emerging research in occupational therapy, and most importantly offer clinical guidelines to integrate POTS into occupational therapy practice. POTS is a multisystem autonomic disorder characterized by both cardiac and non-cardiac symptoms that affect overall functioning. Symptoms associated with orthostatic intolerance include tachycardia, palpitations, chest discomfort, and lightheadedness. The diagnostic criteria include an excessive increase in heart rate (≥30 beats per minute in adults or ≥40 bpm for adolescents) within 10 minutes of positional change (standing or upright head tilt) in the absence of meeting criteria for orthostatic hypotension (sustained decrease in blood pressure of ≥20mm Hg systolic or ≥10mm Hg diastolic) or other cause for sinus tachycardia (Vernino et al., 2021). In addition to the symptoms occurring with positional changes, individuals with POTS often experience headaches, fatigue, pre-syncope or syncope, temperature intolerance, sleep disturbance, exercise intolerance neurocognitive impairment, gastrointestinal issues, and bladder dysfunction (Raj et al., 2020).
Autonomic symptoms in patients with moderate and severe chronic obstructive pulmonary disease
Published in Acta Clinica Belgica, 2018
Jibril Mohammed, Eric Derom, Inge De Wandele, Lies Rombaut, Patrick Calders
A major finding of our study was the high rate of orthostatic intolerance and secretomotor symptoms reported in subjects with COPD. This finding is supported by an earlier report, which describes both orthostatic intolerance and secretomotor disorders as the best predictors of autonomic failure in both healthy and diseased populations [11]. This finding is clinically important for a few reasons: orthostatic intolerance is linked to sudden tachycardia and cerebral vasoconstriction [30], and orthostatic intolerance symptoms is a major clinical test that is capable of ascertaining symptoms of cerebral hypo-perfusion (following an upright position) that is secondary to inadequate hemodynamic regulation by the ANS [13,31,32]. It is not surprising that subjects with COPD in our study reported high rates of orthostatic symptoms. Orthostatic intolerance can appear in many forms such as fatigue, diminished concentration, a feeling of absence, brain fog, chest pain, shortness of breath, palpitations, coat-hanger headache and vision disturbances [31]. Moreover, COPD patients who have shortness of breath due to reduced ventilatory capacity, hypercapnia and/or lowered oxygen saturation have been reported to be at more risks of orthostatic symptoms compared to those without these symptoms [33].
Related Knowledge Centers
- Autonomic Nervous System
- Supine Position
- Syndrome
- Dysautonomia
- Chronic Fatigue Syndrome
- Circulatory System
- Fibromyalgia
- Standing
- Stressor
- Neurology