Alzheimer’s disease is a widely studied disorder with research focusing on
cognitive and functional impairments, behavioral and psychological symptoms, and
on abnormal motor manifestations. Despite the importance of autonomic
dysfunctions they have received less attention in systematic studies. The
underlying neurodegenerative process of AD, mainly affecting cortical areas, has
been studied for more than one century. However, autonomic-related structures
have not been studied neuropathologically with the same intensity. The autonomic
nervous system governs normal visceral functions, and its activity is expressed
in relation to homeostatic needs of the organism’s current physical and mental
activities. The disease process leads to autonomic dysfunction or dysautonomy
possibly linked to increased rates of morbidity and mortality.ObjectiveThe aim of this review was to analyze the cortical, subcortical, and more
caudal autonomic-related regions, and the specific neurodegenerative process
in Alzheimer’s disease that affects these structures.MethodsA search for papers addressing autonomic related-structures affected by
Alzheimer’s degeneration, and under normal condition was performed through
MedLine, PsycInfo and Lilacs, on the bibliographical references of papers of
interest, together with a manual search for classic studies in older
journals and books, spanning over a century of publications.ResultsThe main central autonomic-related structures are described, including
cortical areas, subcortical structures (amygdala, thalamus, hypothalamus,
brainstem, cerebellum) and spinal cord. They constitute autonomic neural
networks that underpin vital functions. These same structures, affected by
specific Alzheimer’s disease neurodegeneration, were also described in
detail. The autonomic-related structures present variable neurodegenerative
changes that develop progressively according to the degenerative stages
described by Braak and Braak.ConclusionThe neural networks constituted by the central autonomic-related structures,
when damaged by progressive neurodegeneration, represent the
neuropathological substrate of autonomic dysfunction. The presence of this
dysfunction and its possible relationship with higher rates of morbidity,
and perhaps of mortality, in affected subjects must be kept in mind when
managing Alzheimer’s patients.