The potential prognostic role of cardiovascular autonomic failure in a-synucleinopathies.pdf

REVIEW ARTICLE The potential prognostic role of cardiovascular autonomic failure in a-synucleinopathies A. Fanciullia,b, S. Stranoc, C. Colosimoa, C. Caltagironed,e, G. Spallettae and F. E. Pontieria,b,e aDepartment of Neurology and Psychiatry, ‘Sapienza’ University of Rome; bMovement Disorder Unit, ‘Sant’Andrea’ Hospital, Rome; cDepartment of Cardiovascular, Respiratory, Nephrologic and Geriatric Sciences, ‘Sapienza’ University of Rome; dDepartment of Neuroscience, ‘Tor Vergata’ University, Rome; and eI.R.C.C.S. ‘Santa Lucia Foundation’, Rome, Italy Keywords: cardiovascular autonomic failure, Lewy body dementia, multiple system atrophy, orthostatic hypotension, Parkinson’s disease Received 14 April 2012 Accepted 12 June 2012 Cardiovascular autonomic failure is the second most common dysautonomic feature of a-synucleinopathies and has significant impact on daily activities and quality of life. Here we provide a systematic review of cardiovascular autonomic failure in a- synucleinopathies, emphasizing its impact on cognitive functions and disease out- comes. Articles spanning the period between January 1985 and April 2012 were identified from the PubMed database using a keyword-based search. Epidemiologi- cal studies highlight the negative prognostic effect of cardiovascular autonomic fail- ure on cardiovascular and cerebrovascular outcomes and overall mortality in all a- synucleinopathies. Altered cerebral perfusion, vascular pressure stress, and related disruption of the blood–brain barrier may also contribute to the white matter hyperintensities and cognitive dysfunction frequently found in patients affected by neurocardiovascular instability. These findings support the hypothesis that cardio- vascular autonomic failure may play a negative prognostic role in a-synucleino- pathies and suggest that precocious screening and therapeutic management of cardiovascular autonomic failure may positively impact disease course. The term a-synucleinopathies refers to a group o