Autonomic function predicts cognitive decline in mild cognitive impairment: Evidence from power spectral analysis of heart rate variability in a longitudinal study

Abstract

Background: Despite the emerging clinical relevance of heart rate variability (HRV) as a potential biomarker of cognitive decline and as a candidate target for intervention, there is a dearth of research on the prospective relationship between HRV and cognitive change. In particular, no study has addressed this issue in subjects with a diagnosis of cognitive status including cognitive impairment.Objective: To investigate HRV as a predictor of cognitive decline in subjects with normal cognition (NC) or Mild Cognitive Impairment (MCI). Specifically, we tested the literature-based hypothesis that the HRV response to different physical challenges would predict decline in different cognitive domains.Methods: This longitudinal study represents the approximately 3-year followup of a previous cross-sectional study enrolling 80 older outpatients (aged ≥ 65). At baseline, power spectral analysis of HRV was performed on five-minute electrocardiographic recordings at rest and during a sympathetic (active standing) and a parasympathetic (paced breathing) challenge. We focused on normalized HRV measures [normalized low frequency power (LFn) and the low frequency to high frequency power ratio (LF/HF)] and on their dynamic response from rest to challenge ( HRV). Extensive neuropsychological testing was used to diagnose cognitive status at baseline and to evaluate cognitive change over the follow-up via annualized changes in cognitive Z-scores. The association between HRV and cognitive change was explored by means of linear regression, unadjusted and adjusted for potential confounders.

Heart Rate Variability and Cognition: A Narrative Systematic Review of Longitudinal Studies

“…The publication time frame spanned 14 years, from 2008 [ 66 ] to 2022 [ 72 , 73 , 74 , 75 ] with two thirds of studies clustered in the present decade.…”

“…The number of participants ranged from 71 [ 74 ] to 5375 [ 66 ]. However, in two thirds of the studies the sample size was in the order of thousands.…”

Response to "letter to editor" from Nicolini et al. Regarding "Autonomic modulation and the risk of dementia in a middle-aged cohort: A 17-year follow-up study"

“…for offering valuable information and discussion regarding the autonomic regulation and cognitive status. As mentioned in the “letter to the editor”, the authors observed that a higher sympathetic activation was related to cognitive decline whereas a greater parasympathetic HRV response predicted a lesser decline in executive functioning for MCI elderly [ 1 ]. Considering that the presence of cognitive impairment usually precedes the diagnosis of dementia, these results were compatible with our findings [ 2 ].…”

“…The authors further addressed that the central autonomic network (CAN) may be a potential influencer of cognitive decline or dementia through the brain-heart axis [ 1 ]. Previous study has demonstrated that CAN modulates the pathogenesis of essential hypertension or orthostatic hypotension [ 3 ], which were crucial in the occurrence of dementia [ 4 ].…”

Heart rate variability as a predictor of cognitive decline: A possible role for the Central Autonomic Network

“…In particular, there is increasing evidence that different components of the CAN are involved in different cognitive processes and in sympathetic versus parasympathetic autonomic control [ 2 , 4 ]. Accordingly, in a recent longitudinal study, we reported that, in older subjects with mild cognitive impairment, a greater HRV response to a sympathetic challenge predicted a greater decline in episodic memory whereas a greater HRV response to a parasympathetic challenge predicted a lesser decline in executive functioning [ 4 ].…”