Cholinesterase inhibitors (ChEIs), the mainstay treatment for dementia, have systemic actions that can affect
cardiovascular and autonomic nervous system (ANS). Thirty-nine patients with Alzheimer´s disease or mixed dementia
underwent a comprehensive clinical evaluation, prior to and during ChEIs therapy, including orthostatic challenge, electrocardiogram
(EKG) and heart rate variability (HRV) spectral analysis through Holter recordings. ChEIs therapy determined
a decrease in supine diastolic blood pressure (BP) and in both diastolic and systolic BP in orthostatic position (79.8
± 9.0 vs. 76.4 ± 9.3 mmHg, p=0.012; 79.9 ± 11.6 vs. 75.3 ± 9.9, p=0.005 and 144.6 ± 25.8 vs. 137.6 ± 21.1, p=0.020, respectively).
Spectral analysis revealed no difference on static HRV components, but, during orthostatic challenge, an increase
in LF/HF ratio (2.2±2.4 vs. 4.6±5.9, p=0.011) and a reduction in HF component emerged (1604.3 ± 5610.1 vs.
266.1 ± 525.5, p=0.010). ChEIs showed no influence on EKG parameters or on the occurrence of orthostatic hypotension.
Treatment with ChEIs was associated with functional improvement of the ANS behavior and to a decrease in supine DBP
and in both orthostatic SBP and DBP.