Autonomic dysfunction and hypothalamic atrophy in frontotemporal dementia and primary psychiatric disorders

Abstract INTRODUCTION Evidence suggests that autonomic symptoms in frontotemporal dementia (FTD) may relate to hypothalamic pathology. We investigated (1) autonomic symptoms in FTD, primary psychiatric disorders (PPD), and controls; (2) hypothalamic volumes; and (3) their associations. METHODS Autonomic Symptoms Questionnaire (ASQ) data were collected from FTD ( n = 31), PPD ( n = 30), and controls ( n = 30). MRI data from these and additional participants (FTD n = 259, PPD n = 44, controls n = 62) were analyzed using a deep learning approach. RESULTS FTD and PPD groups reported more cardiovascular symptoms than controls ( p = 0.020; p = 0.049). FTD patients showed greater thermodysregulation (vs. PPD p = 0.026; vs. controls p = 0.012) and altered pain perception (FTD 13%, PPD 2%, controls 1%; p < 0.001). FTD showed smaller hypothalamic subregions, except the left inferior‐tubular area. In FTD, autonomic symptoms correlated with subregional hypothalamic volumes. DISCUSSION FTD patients exhibit increased autonomic symptoms across several domains compared to PPD and controls; moreover, FTD is associated with smaller regional hypothalamic volume.