Is There a Characteristic Autonomic Response During Outbursts of Combative Behavior in Dementia Patients?

Curtis K Deutsch, Pooja P Patnaik, Frank A Greco, Curtis K Deutsch, Pooja P Patnaik, Frank A Greco

Abstract

We sought to determine whether skin conductance level could warn of outbursts of combative behavior in dementia patients by using a wristband device. Two outbursts were captured and are reported here. Although no physiologic parameter measured by the wristband gave advance warning, there is a common pattern of parasympathetic withdrawal (increased heart rate) followed approximately 30 seconds later by sympathetic activation (increased skin conductance). In the literature, a similar pattern occurs in psychogenic non-epileptic seizures. We hypothesize that similar autonomic responses reflect similarities in pathophysiology and that physical activity may partially account for the time course of skin conductance.

Keywords: Autonomic nervous system; dementia; galvanic skin response; heart rate; non-epileptic seizures.

Conflict of interest statement

The authors have no conflict of interest to report.

© 2021 – The authors. Published by IOS Press.

Figures

Fig. 1
Fig. 1
Case 1 physiologic measurements. Panel A shows the time course for total acceleration (norm of vector), skin conductance (scale on left axis), and heart rate (scale on right axis). The provocation occurred at the time of the sharp increase of all three measures around 6350 s (marked by vertical line). Panel B is a magnified view of the time around the provocation, with the heart rate tracing shifted downward. The increase in heart rate begins about 35 s before the change in skin conductance. Note that there is no change in skin conductance prior to the onset.
Fig. 2
Fig. 2
Case 2 physiologic measurements. Panel A shows the time course for total acceleration (norm of vector), skin conductance (scale on left axis) and heart rate (scale on right axis). The unprovoked swing occurred at the time of the sharp increase in heart rate and a burst of activity around 8,550 s marked by vertical line); there is a step decrease in skin conductance, indicating a break in the contact between the skin and electrodes. Contact returns about 8,640 s, and the time course of skin conductance is displayed afterwards. Panel B is a magnified view of the time around the swing, with the heart rate tracing shifted downward. To estimate the onset of the increase in skin conductance, the time course before and after the disruption are linearly extrapolated; the increase in skin conductance is estimated to begin 27  s after the change in heart rate. Note that there is no change in skin conductance prior to the onset.

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