Dysautonomia and Aging

Introduction to Dysautonomia

Dysautonomia refers to dysfunction of the autonomic nervous system, which can manifest in various forms, encompassing different types of disorders with fundamentally different underlying mechanisms, according to the European Society of Cardiology 2, 3, 4

The American Geriatrics Society notes that aging is associated with significant changes in autonomic nervous system function, resulting in an impaired ability to adapt to environmental or intrinsic visceral stimuli, and the degree of frailty correlates with deterioration in autonomic function, particularly affecting cardiovascular regulation 1
The European Society of Cardiology states that age-related autonomic changes involve both parasympathetic and sympathetic alterations, leading to a higher incidence of cardiovascular disease morbidity and mortality, although the exact mechanisms are not fully understood 1

The American Heart Association recommends that cardiac function be monitored in older adults, as the ability of the heart to contract deteriorates with age, and when measured against frailty index scores rather than chronological age, a linear relationship emerges where the frailest individuals exhibit the most profound dysfunction 1
The American College of Cardiology notes that electrical conduction, specifically the speed of electrical impulses across the atria, declines with age, an effect clearly evident in individuals with high levels of frailty, providing a substrate for arrhythmias like atrial fibrillation 1

The American Diabetes Association states that the prevalence of CAN increases with age and duration of underlying conditions like diabetes, and CAN is associated with increased risk of myocardial infarction, increased cardiovascular events, and increased mortality 5
The European Society of Cardiology recommends that patients with diabetes be screened for autonomic dysfunction, as it typically progresses from involving the parasympathetic system initially, then the sympathetic system, and finally presenting as orthostatic hypotension in advanced stages 5

The American College of Sports Medicine recommends regular physical exercise as an effective way to prevent deleterious autonomic changes associated with aging, and drugs that inhibit the renin-angiotensin system may reduce frailty scores in aging and potentially improve autonomic function 1