Heart rate response to orthostatic challenge in patients with dementia with Lewy bodies and Alzheimer's disease

Abstract

Background To elucidate the differences in autonomic dysfunction between dementia with Lewy bodies (DLB) and Alzheimer's disease using a simple and convenient method, we investigated the heart rate response to orthostatic challenge. Methods Ninety‐seven people participated in this cross‐sectional study, and data from 26 DLB patients, 29 Alzheimer's disease patients, and 25 healthy elderly individuals were analysed. Participants underwent postural changes, including 5 min in a supine position, 1 min in a sitting position, and 3 min in an orthostatic position. Their heart rates were continuously recorded. Two heart rate variables were analysed as main outcomes: (i) the difference between heart rate in the sitting position and the peak heart rate within 15 s of orthostasis, defined as the ‘early heart rate increase’; and (ii) the difference between the peak heart rate and the negative peak heart rate after this, defined as ‘early heart rate recovery.’ An early heart rate increase has been considered to reflect parasympathetic and sympathetic functions. Early heart rate recovery is considered to reflect parasympathetic function. We also investigated the frequency domains of resting heart rate variability. Results A significant difference was observed across the three groups in early heart rate increase, and that of the DLB group was lower than that of the healthy control group. Early heart rate recovery also differed significantly across the three groups, and that of the DLB group was less than that of the healthy control group. In addition, the power of the low‐frequency component, which represents both sympathetic and parasympathetic activity, was significantly decreased in the DLB group compared to the Alzheimer's disease group. Conclusions Impaired heart rate response to standing was detected in patients with DLB. Electrocardiogram is a convenient, non‐invasive method that might be useful as a subsidiary marker for DLB diagnosis and differentiation from Alzheimer's disease.

The Clinical Role of Heart Rate Variability Assessment in Cognitively Impaired Patients and Its Applicability in Community Care Settings: A Systematic Review of the Literature

“…We identified 13 cross-sectional studies [2,3,5,10,11,13,24,[38][39][40][41][42], 3 cohort studies [8,9,32], and 1 casecontrol study [4] (Table 1). One of the cohort studies used the raw data gathered as part of a randomized control trial [32].…”

“…One of the cohort studies used the raw data gathered as part of a randomized control trial [32]. Six studies [8,9,32,39,41,42] analyzed data from previous large prospective cohort studies, and 11 gathered primary data [2,3,5,10,11,13,24,38,40,43]. Grouping of cohorts was varied depending on the study objective.…”

“…Grouping of cohorts was varied depending on the study objective. Eight studies grouped participants by cognitive status e.g., controls vs. types of CI (MCI/non-amnesic mild CI (naMCI) and amnesic mild CI (aMCI) [3,4,11,13,24,38,40,43]), four studies by HRV parameters e.g., quartiles of RMSSD [8,32,41,42], and four had no grouping [2,9,10,39]. The remaining study grouped participants based on the presence or absence of white matter lesions on MRI -the extent of which has been found to be independently associated with decreased HRV in both time and frequency domains and is purported to be implicated in the pathogenesis of dementia and HRV decline [5,13,42].…”

Autonomic dysfunction in dementia with Lewy bodies: Focusing on cardiovascular and respiratory dysfunction

“…Orthostatic position also changes heart rate in healthy subjects. Omoya et al 28 reported that the early heart rate increase of a DLB group was lower than that of a healthy control group, and that the early heart rate recovery of the DLB group was also less; however, no significant difference was found between the AD group and healthy controls.…”