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Attreed A, Morand LR, Pond DC, Sturmberg JP. 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. Cureus 2024; 16:e61703. [PMID: 38975380 PMCID: PMC11226213 DOI: 10.7759/cureus.61703] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 06/05/2024] [Indexed: 07/09/2024] Open
Abstract
Heart rate variability (HRV) correlates well with a person's overall physiological function. Clinically, HRV is successfully used in acute care to identify impending infections, but little is known about its potential in the management of chronic diseases like cognitive decline/dementia. The aim of this study was to identify the best available knowledge about HRV in cognitively impaired populations that might be applied to improve clinical practice in community settings. We conducted a systematic literature search in PubMed, Embase, and Cochrane databases published from January 2009 to August 2022. Eligible studies were selected using Covidence and each study underwent qualitative assessment using the Mixed Method Appraisal Tool. At each stage of selection, each study was reviewed independently by two members of the team, and any disputes were discussed along the way. The literature identified that the brain regions controlling HRV are also those affected by dementias of Alzheimer's type (AD) and Lewy body types (DLB). HRV was impaired in both types, with DLB showing greater impairment in all HRV parameters compared to AD. No studies explored the temporal changes of HRV or its use in the clinical management of people with cognitive impairment (CI). The current lack of standardization of HRV recording and analysis limits its use in clinical practice. HRV may emerge as a potentially useful tool to identify people with early/preclinical memory impairment and help to differentiate AD from DLB. Longitudinal HRV measurement is emerging as a useful way to monitor disease progression and treatment response, and continuous HRV measurement may prove useful in the early identification of sepsis and its complications in patients no longer able to communicate their illness experiences.
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Affiliation(s)
- Amanda Attreed
- General Medicine, Central Coast Local Health District, Gosford, AUS
| | - Louisa R Morand
- General Medicine, Royal Brisbane and Women's Hospital, Brisbane, AUS
| | - Dimity C Pond
- General Practice, Wicking Dementia Research and Training Centre, Hobart, AUS
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Bahameish M, Stockman T. Short-Term Effects of Heart Rate Variability Biofeedback on Working Memory. Appl Psychophysiol Biofeedback 2024; 49:219-231. [PMID: 38366274 PMCID: PMC11101506 DOI: 10.1007/s10484-024-09624-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 01/31/2024] [Indexed: 02/18/2024]
Abstract
Drawing upon the well-documented impact of long-term heart rate variability biofeedback (HRVB) on psychophysiological responses, this study seeks to explore the short-term effects arising from a single HRVB session during and after paced breathing exercise. The research aligns with the neurovisceral integration model, emphasizing the link between heart rate variability (HRV) levels and cognitive performance. Therefore, a randomized controlled trial employing a between-subjects design was conducted with 38 participants. Each participant was assigned to either the paced breathing intervention group or the spontaneous breathing control group. The study assessed various parameters such as cardiac vagal tone, evaluated through vagally mediated HRV measures, and working memory, measured using the N-back task. Additionally, participants' affective states were assessed through self-reported questionnaires, specifically targeting attentiveness, fatigue, and serenity. The results notably reveal enhancements in the working memory task and an elevated state of relaxation and attention following the HRVB session, as evidenced by higher averages of correct responses, serenity and attentiveness scores. However, the findings suggest that this observed improvement is not influenced by changes in cardiac vagal tone, as assessed using a simple mediation analysis. In conclusion, this study presents promising insights into the impact of a single HRVB session, laying the foundation for future research advancements in this domain.
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Affiliation(s)
- Mariam Bahameish
- College of Science and Engineering, Hamad Bin Khalifa University, Doha, Qatar.
| | - Tony Stockman
- School of Electronics Engineering and Computer Science, Queen Mary University of London, London, UK
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3
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Nicolini P, Malfatto G, Lucchi T. Heart Rate Variability and Cognition: A Narrative Systematic Review of Longitudinal Studies. J Clin Med 2024; 13:280. [PMID: 38202287 PMCID: PMC10780278 DOI: 10.3390/jcm13010280] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/05/2023] [Revised: 12/23/2023] [Accepted: 12/27/2023] [Indexed: 01/12/2024] Open
Abstract
BACKGROUND Heart rate variability (HRV) is a reliable and convenient method to assess autonomic function. Cross-sectional studies have established a link between HRV and cognition. Longitudinal studies are an emerging area of research with important clinical implications in terms of the predictive value of HRV for future cognition and in terms of the potential causal relationship between HRV and cognition. However, they have not yet been the objective of a systematic review. Therefore, the aim of this systematic review was to investigate the association between HRV and cognition in longitudinal studies. METHODS The review was conducted according to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines. The Embase, PsycINFO and PubMed databases were searched from the earliest available date to 26 June 2023. Studies were included if they involved adult human subjects and evaluated the longitudinal association between HRV and cognition. The risk of bias was assessed with the Newcastle-Ottawa Scale for Cohort Studies. The results were presented narratively. RESULTS Of 14,359 records screened, 12 studies were included in this systematic review, with a total of 24,390 participants. Two thirds of the studies were published from 2020 onwards. All studies found a longitudinal relationship between HRV and cognition. There was a consistent association between higher parasympathetic nervous system (PNS) activity and better cognition, and some association between higher sympathetic nervous system activity and worse cognition. Also, higher PNS activity persistently predicted better executive functioning, while data on episodic memory and language were more scant and/or controversial. CONCLUSIONS Our results support the role of HRV as a biomarker of future cognition and, potentially, as a therapeutic target to improve cognition. They will need confirmation by further, more comprehensive studies also including unequivocal non-HRV sympathetic measures and meta-analyses.
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Affiliation(s)
- Paola Nicolini
- Fondazione IRCCS Ca’ Granda Ospedale Maggiore Policlinico, Geriatric Unit, Internal Medicine Department, 20122 Milan, Italy;
| | - Gabriella Malfatto
- Istituto Auxologico Italiano IRCCS, Department of Cardiovascular, Neural and Metabolic Sciences, Ospedale San Luca, 20149 Milan, Italy;
| | - Tiziano Lucchi
- Fondazione IRCCS Ca’ Granda Ospedale Maggiore Policlinico, Geriatric Unit, Internal Medicine Department, 20122 Milan, Italy;
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Wecht JM, Weir JP, Peters CG, Weber E, Wylie GR, Chiaravalloti NC. Autonomic Cardiovascular Control, Psychological Well-Being, and Cognitive Performance in People With Spinal Cord Injury. J Neurotrauma 2023; 40:2610-2620. [PMID: 37212256 DOI: 10.1089/neu.2022.0445] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/23/2023] Open
Abstract
PURPOSE To examine associations between parameters of psychological well-being, injury characteristics, cardiovascular autonomic nervous system (ANS) control, and cognitive performance in persons with spinal cord injury (SCI) compared with age-matched uninjured controls. This is an observational, cross-sectional study including a total of 94 participants (52 with SCI and 42 uninjured controls: UIC). Cardiovascular ANS responses were continuously monitored at rest and during administration of the Paced Auditory Serial Addition Test (PASAT). Self-report scores on the SCI-Quality of Life questionnaires are reported for depression, anxiety, fatigue, resilience, and positive affect. Participants with SCI performed significantly more poorly on the PASAT compared with the uninjured controls. Although not statistically significant, participants with SCI tended to report more psychological distress and less well-being than the uninjured controls. In addition, when compared with uninjured controls, the cardiovascular ANS responses to testing were significantly altered in participants with SCI; however, these responses to testing did not predict PASAT performance. Self-reported levels of anxiety were significantly related to PASAT score in the SCI group, but there was no significant relationship between PASAT and the other indices of SCI-Quality of Life. Future investigations should more closely examine the relationship among cardiovascular ANS impairments, psychological disorders, and cognitive dysfunction to better elucidate the underpinnings of these deficits and to guide interventions aimed at improving physiological, psychological, and cognitive health after SCI. Tetraplegia, paraplegia, blood pressure variability, cognitive, mood.
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Affiliation(s)
- Jill M Wecht
- James J Peters VA Medical Center, Bronx, New York, USA
- Bronx Veterans Medical Research Foundation, Bronx, New York, USA
- Department of Medicine, the Icahn School of Medicine, Mount Sinai, New York, New York, USA
- Department of Rehabilitation and Human Performance, the Icahn School of Medicine, Mount Sinai, New York, New York, USA
| | - Joseph P Weir
- Department of Health, Sport, and Exercise Science, University of Kansas, Lawrence, Kansas, USA
| | - Caitlyn G Peters
- James J Peters VA Medical Center, Bronx, New York, USA
- Kessler Foundation, West Orange, New Jersey, USA
| | - Erica Weber
- Kessler Foundation, West Orange, New Jersey, USA
- Rutgers-NJ Medical School, Department of Physical Medicine and Rehabilitation, Newark, New Jersey, USA
| | - Glenn R Wylie
- Kessler Foundation, West Orange, New Jersey, USA
- Rutgers-NJ Medical School, Department of Physical Medicine and Rehabilitation, Newark, New Jersey, USA
| | - Nancy C Chiaravalloti
- Kessler Foundation, West Orange, New Jersey, USA
- Rutgers-NJ Medical School, Department of Physical Medicine and Rehabilitation, Newark, New Jersey, USA
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Ramachandran M, Priyadarsini N, Kar M, Behera KK. Impact of Cardiac Autonomic Dysfunction on Cognitive Event-Related Potential in Type 2 Diabetes Mellitus Patients: A Cross-Sectional Study. Indian J Endocrinol Metab 2023; 27:506-512. [PMID: 38371187 PMCID: PMC10871012 DOI: 10.4103/ijem.ijem_368_22] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/19/2022] [Revised: 02/10/2023] [Accepted: 03/23/2023] [Indexed: 02/20/2024] Open
Abstract
Introduction Type 2 diabetes mellitus (T2DM) is a chronic metabolic condition that is responsible for various long-term complications. Cognitive impairment is one of the most common complications, but the underlying mechanisms are still undetermined. The autonomic imbalance is a major cause for CVS morbidity in T2DM which could also potentially affect cognition. But there is sparse data available in the literature to prove the association between autonomic dysfunction and cognitive impairment. Methodology We recruited 40 T2DM patients and 40 healthy controls. The assessment of cognitive functions was done by cognitive P300 event-related potential (ERP) and MoCA. Heart rate variability (HRV) was done to assess autonomic function. Results The P300 ERP latency in Fz, Cz and Pz sites was significantly prolonged in T2DM patients (P < 0.001). We found moderate correlation is present between P300 latency and total power (r = -0.466, P < 0.01) and LFnu (r = -0.423, P < 0.01) in T2DM patients. The total power and HbA1C show independent association with P300 latency after adjustment for confounding factors like age and duration of diabetes (P < 0.05). Conclusion As the incidence of Alzheimer's disease is rising among T2DM patients increasing their dependency, making necessary lifestyle measures at earliest to improve autonomic balance may prevent or delay the onset of cognitive decline and alleviate its consequences and improve the quality of life in T2DM patients.
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Affiliation(s)
- Madumathy Ramachandran
- Department of Physiology, Saveetha Medical College and Hospital, Chennai, Tamil Nadu, India
| | - Nibedita Priyadarsini
- Department of Physiology, All India Institute of Medical Sciences, Bhubaneswar, Odisha, India
| | - Manisha Kar
- Department of Physiology, All India Institute of Medical Sciences, Bhubaneswar, Odisha, India
| | - Kishore Kumar Behera
- Department of Endocrinology, All India Institute of Medical Sciences, Bhubaneswar, Odisha, India
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Liu KY, Whitsel EA, Heiss G, Palta P, Reeves S, Lin FV, Mather M, Roiser JP, Howard R. Heart rate variability and risk of agitation in Alzheimer's disease: the Atherosclerosis Risk in Communities Study. Brain Commun 2023; 5:fcad269. [PMID: 37946792 PMCID: PMC10631859 DOI: 10.1093/braincomms/fcad269] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/21/2022] [Revised: 07/24/2023] [Accepted: 10/11/2023] [Indexed: 11/12/2023] Open
Abstract
Agitation in Alzheimer's disease is common and may be related to impaired emotion regulation capacity. Heart rate variability, a proposed index of autonomic and emotion regulation neural network integrity, could be associated with agitation propensity in Alzheimer's disease. We used the Atherosclerosis Risk in Communities Study cohort data, collected over seven visits spanning over two decades, to investigate whether heart rate variability (change) was associated with agitation risk in individuals clinically diagnosed with dementia due to Alzheimer's disease. Agitation (absence/presence) at Visit 5, the primary outcome, was based on the Neuropsychiatric Inventory agitation/aggression subscale, or a composite score comprising the total number of agitation/aggression, irritability, disinhibition and aberrant motor behaviour subscales present. Visit 1-5 heart rate variability measures were the log-transformed root mean square of successive differences in R-R intervals and standard deviation of normal-to-normal R-R intervals obtained from resting, supine, standard 12-lead ECGs. To aid interpretability, heart rate variability data were scaled such that model outputs were expressed for each 0.05 log-unit change in heart rate variability (which approximated to the observed difference in heart rate variability with every 5 years of age). Among 456 participants who had dementia, 120 were clinically classified to have dementia solely attributable to Alzheimer's disease. This group showed a positive relationship between heart rate variability and agitation risk in regression models, which was strongest for measures of (potentially vagally mediated) heart rate variability change over the preceding two decades. Here, a 0.05 log-unit of heart rate variability change was associated with an up to 10-fold increase in the odds of agitation and around a half-unit increase in the composite agitation score. Associations persisted after controlling for participants' cognitive status, heart rate (change), sociodemographic factors, co-morbidities and medications with autonomic effects. Further confirmatory studies, incorporating measures of emotion regulation, are needed to support heart rate variability indices as potential agitation propensity markers in Alzheimer's disease and to explore underlying mechanisms as targets for treatment development.
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Affiliation(s)
- Kathy Y Liu
- Division of Psychiatry, University College London, London W1T 7NF, UK
| | - Eric A Whitsel
- Department of Epidemiology, Gillings School of Global Public Health, University of North Carolina at Chapel Hill, Chapel Hill, NC 27599, USA
- Department of Medicine, School of Medicine, University of North Carolina at Chapel Hill, Chapel Hill, NC 27599, USA
| | - Gerardo Heiss
- Department of Epidemiology, Gillings School of Global Public Health, University of North Carolina at Chapel Hill, Chapel Hill, NC 27599, USA
| | - Priya Palta
- Department of Medicine, Columbia University Irving Medical Center, New York, NY 10032, USA
- Department of Epidemiology, Columbia University Irving Medical Center, New York, NY 10032, USA
| | - Suzanne Reeves
- Division of Psychiatry, University College London, London W1T 7NF, UK
| | - Feng V Lin
- Department of Psychiatry and Behavioral Sciences, Stanford University, Stanford, CA 94305, USA
| | - Mara Mather
- Davis School of Gerontology, University of Southern California, Los Angeles, CA 90089, USA
| | - Jonathan P Roiser
- Institute of Cognitive Neuroscience, University College London, London WC1N 3AZ, UK
| | - Robert Howard
- Division of Psychiatry, University College London, London W1T 7NF, UK
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Wang R, Muresanu D, Hösl K, Hilz MJ. Cardiovascular autonomic regulation correlates with cognitive performance in patients with a history of traumatic brain injury. Neurol Sci 2023; 44:3535-3544. [PMID: 37227563 PMCID: PMC10495484 DOI: 10.1007/s10072-023-06857-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/06/2023] [Accepted: 05/14/2023] [Indexed: 05/26/2023]
Abstract
BACKGROUND AND OBJECTIVE Traumatic brain injury (TBI) may afflict brain areas contributing to both cardiovascular autonomic regulation and cognitive performance. To evaluate possible associations between both functions in patients with a history of TBI (post-TBI-patients), we determined correlations between cardiovascular autonomic regulation and cognitive function in post-TBI-patients. METHODS In 86 post-TBI-patients (33.1 ± 10.8 years old, 22 women, 36.8 ± 28.9 months after injury), we monitored RR intervals (RRI), systolic and diastolic blood pressures (BPsys, BPdia), and respiration (RESP) at rest. We calculated parameters of total cardiovascular autonomic modulation (RRI-standard-deviation (RRI-SD), RRI-coefficient-of-variation (RRI-CV), RRI-total-powers), sympathetic (RRI-low-frequency-powers (RRI-LF), normalized (nu) RRI-LF-powers, BPsys-LF-powers) and parasympathetic modulation (root-mean-square-of-successive-RRI-differences (RMSSD), RRI-high-frequency-powers (RRI-HF), RRI-HFnu-powers), sympathetic-parasympathetic balance (RRI-LF/HF-ratios), and baroreflex sensitivity (BRS). We used the Mini-Mental State Examination and Clock Drawing Test (CDT) to screen the general global and visuospatial cognitive function, and applied the standardized Trail Making Test (TMT)-A assessing visuospatial abilities and TMT-B assessing executive function. We calculated correlations between autonomic and cognitive parameters (Spearman's rank correlation test; significance: P < 0.05). RESULTS CDT values positively correlated with age (P = 0.013). TMT-A values inversely correlated with RRI-HF-powers (P = 0.033) and BRS (P = 0.043), TMT-B values positively correlated with RRI-LFnu-powers (P = 0.015), RRI-LF/HF-ratios (P = 0.036), and BPsys-LF-powers (P = 0.030), but negatively with RRI-HFnu-powers (P = 0.015). CONCLUSIONS In patients with a history of TBI, there is an association between decreased visuospatial and executive cognitive performance and reduced parasympathetic cardiac modulation and baroreflex sensitivity with relatively increased sympathetic activity. Altered autonomic control bears an increased cardiovascular risk; cognitive impairment compromises quality of life and living conditions. Thus, both functions should be monitored in post-TBI-patients.
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Affiliation(s)
- Ruihao Wang
- Department of Neurology, University of Erlangen-Nuremberg, Schwabachanlage 6, 91054, Erlangen, Germany
| | - Dafin Muresanu
- Department of Neurosciences, Iuliu Hatieganu University of Medicine and Pharmacy, Cluj-Napoca-Napoca, Romania
- RoNeuro Institute for Neurological Research and Diagnostic, Cluj-Napoca-Napoca, Romania
| | - Katharina Hösl
- Department of Psychiatry and Psychotherapy, Paracelsus Medical University, Nuremberg, Germany
| | - Max J Hilz
- Department of Neurology, University of Erlangen-Nuremberg, Schwabachanlage 6, 91054, Erlangen, Germany.
- Department of Neurology, Icahn School of Medicine at Mount Sinai, New York, NY, USA.
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Rocha ASL, de Barros Siqueira V, Maduro PA, Batista LDSP, Neves VR, Gambassi BB, Schwingel PA. Do older people with poor sleep quality have worse cardiac autonomic control? Can Geriatr J 2023; 26:276-282. [PMID: 37265984 PMCID: PMC10198679 DOI: 10.5770/cgj.26.658] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/03/2023] Open
Abstract
Objective To identify the differences in cardiac autonomic control between older people with good and poor sleep quality. Material and Methods This is a cross-sectional study with 40 older people aged ≥ 60 years, registered at a community health center in Petrolina, Pernambuco, Brazil. The sleep quality was assessed with the Pittsburgh Sleep Quality Index (PSQI). To assess heart rate variability (HRV), the RR intervals (RRI) were recorded for 10 min with a validated smartphone app and a wireless transmitter Polar H7 positioned on the patient's chest. The HRV parameters were calculated with Kubios HRV, and the data were analyzed in SPSS. Subjects with good and poor sleep quality (PSQI >5) were compared with the Mann-Whitney U test. Results A total of 31 older people were included in the final analysis, with 18 (58.1%) of them having poor sleep quality. Older people with good sleep quality have similar cardiac autonomic control to those with poor sleep quality. The medians of time (mean RRI, pNN50, SDNN, and RMSSD) and frequency-domain HRV parameters (LFms2, LFnu, HFms2, HFnu, and LF/HF ratio) were statistically similar (p > .05) in older people with good and poor sleep quality. According to the effect size, the HRV indicators were slightly better among those with good sleep quality. Conclusion There were no statistical differences in cardiac autonomic control between older people with good and poor sleep quality.
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Affiliation(s)
- Alaine S L Rocha
- Departamento de Fisioterapia, Universidade Federal do Ceará, Fortaleza
- Programa de Pós-Graduação em Ciências da Saúde, Universidade de Pernambuco, Recife
- Laboratório de Pesquisas em Desempenho Humano, Universidade de Pernambuco Campus Petrolina, Petrolina
| | | | - Paula A Maduro
- Programa de Pós-Graduação em Ciências da Saúde, Universidade de Pernambuco, Recife
- Laboratório de Pesquisas em Desempenho Humano, Universidade de Pernambuco Campus Petrolina, Petrolina
| | | | - Victor R Neves
- Laboratório de Pesquisas em Desempenho Humano, Universidade de Pernambuco Campus Petrolina, Petrolina
- Programa de Pós-Graduação em Reabilitação e Desempenho Funcional, Universidade de Pernambuco Campus Petrolina, Petrolina
| | - Bruno B Gambassi
- Laboratório de Pesquisas em Desempenho Humano, Universidade de Pernambuco Campus Petrolina, Petrolina
- Programa de Mestrado em Gestão de Programas e Serviços de Saúde, Universidade Ceuma, São Luís, Brazil
| | - Paulo A Schwingel
- Programa de Pós-Graduação em Ciências da Saúde, Universidade de Pernambuco, Recife
- Laboratório de Pesquisas em Desempenho Humano, Universidade de Pernambuco Campus Petrolina, Petrolina
- Programa de Pós-Graduação em Reabilitação e Desempenho Funcional, Universidade de Pernambuco Campus Petrolina, Petrolina
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Hung WC, Yu TH, Wu CC, Lee TL, Tsai IT, Hsuan CF, Chen CY, Chung FM, Lee YJ, Tang WH. FABP3, FABP4, and heart rate variability among patients with chronic schizophrenia. Front Endocrinol (Lausanne) 2023; 14:1165621. [PMID: 37255976 PMCID: PMC10225495 DOI: 10.3389/fendo.2023.1165621] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/22/2023] [Accepted: 05/04/2023] [Indexed: 06/01/2023] Open
Abstract
Introduction The prevalence of cardiovascular disease (CVD) and CVD-related deaths in patients with schizophrenia is high. An elevated risk of CVD has been associated with low heart rate variability (HRV). There is increasing evidence that fatty acid-binding protein (FABP)3 and FABP4 play roles in the development and progression of CVD. This study aimed to explore the association of circulating FABP3/FABP4 levels with HRV in patients with chronic schizophrenia. Methods We included 265 consecutive patients with chronic schizophrenia who attended a disease management program. We used an enzyme-linked immunosorbent assay for the measurement of plasma concentrations of FABP3 and FABP4. Standard HRV was recorded at baseline following a standard protocol. Mean high- and low-frequency (HF/LF) HRV values were analyzed by tertile of FABP3 and FABP4 using one-way analysis of variance, and linear regression analysis was performed to assess trends. Results A positive association between FABP3 and creatinine was found in multiple regression analysis. In addition, negative associations between levels of hematocrit, hemoglobin, HF HRV, and estimated glomerular filtration rate (eGFR) with FABP3 were also found. Moreover, positive associations between FABP4 with body mass index, diabetes mellitus, hypertension, systolic blood pressure, low-density lipoprotein-cholesterol, triglycerides, creatinine, and FABP3 were found. Furthermore, negative associations between levels of high-density lipoprotein-cholesterol, eGFR, and HF HRV with FABP4 were found. We also found a significant inverse association between FABP3 and HF HRV (p for trend = 0.008), and significant inverse associations between FABP4 with HF and LF HRV (p for trend = 0.007 and 0.017, respectively). Discussion Together, this suggests that elevated levels of FABP3 and FABP4 may be linked to health problems related to CVD in patients with chronic schizophrenia.
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Affiliation(s)
- Wei-Chin Hung
- Division of Cardiology, Department of Internal Medicine, E-Da Hospital, I-Shou University, Kaohsiung, Taiwan
- School of Medicine, College of Medicine, I-Shou University, Kaohsiung, Taiwan
| | - Teng-Hung Yu
- Division of Cardiology, Department of Internal Medicine, E-Da Hospital, I-Shou University, Kaohsiung, Taiwan
- School of Medicine, College of Medicine, I-Shou University, Kaohsiung, Taiwan
| | - Cheng-Ching Wu
- Division of Cardiology, Department of Internal Medicine, E-Da Hospital, I-Shou University, Kaohsiung, Taiwan
- School of Medicine, College of Medicine, I-Shou University, Kaohsiung, Taiwan
- Division of Cardiology, Department of Internal Medicine, E-Da Cancer Hospital, I-Shou University, Kaohsiung, Taiwan
| | - Thung-Lip Lee
- Division of Cardiology, Department of Internal Medicine, E-Da Hospital, I-Shou University, Kaohsiung, Taiwan
- School of Medicine for International Students, College of Medicine, I-Shou University, Kaohsiung, Taiwan
| | - I-Ting Tsai
- School of Medicine, College of Medicine, I-Shou University, Kaohsiung, Taiwan
- Department of Emergency, E-Da Hospital, I-Shou University, Kaohsiung, Taiwan
| | - Chin-Feng Hsuan
- Division of Cardiology, Department of Internal Medicine, E-Da Hospital, I-Shou University, Kaohsiung, Taiwan
- School of Medicine, College of Medicine, I-Shou University, Kaohsiung, Taiwan
- Division of Cardiology, Department of Internal Medicine, E-Da Dachang Hospital, I-Shou University, Kaohsiung, Taiwan
| | - Chun-Yu Chen
- Division of General Neurology, Neurological Institute, Taipei Veterans General Hospital, Taipei, Taiwan
| | - Fu-Mei Chung
- Division of Cardiology, Department of Internal Medicine, E-Da Hospital, I-Shou University, Kaohsiung, Taiwan
| | - Yau-Jiunn Lee
- Department Head, Lee’s Endocrinologic Clinic, Pingtung, Taiwan
| | - Wei-Hua Tang
- Division of Cardiology, Department of Internal Medicine, Taipei Veterans General Hospital, Yuli Branch, Hualien, Taiwan
- Faculty of Medicine, School of Medicine, National Yang Ming Chiao Tung University, Taipei, Taiwan
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Nashiro K, Yoo HJ, Cho C, Min J, Feng T, Nasseri P, Bachman SL, Lehrer P, Thayer JF, Mather M. Effects of a Randomised Trial of 5-Week Heart Rate Variability Biofeedback Intervention on Cognitive Function: Possible Benefits for Inhibitory Control. Appl Psychophysiol Biofeedback 2023; 48:35-48. [PMID: 36030457 PMCID: PMC9420180 DOI: 10.1007/s10484-022-09558-y] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 08/01/2022] [Indexed: 12/01/2022]
Abstract
Previous research suggests that higher heart rate variability (HRV) is associated with better cognitive function. However, since most previous findings on the relationship between HRV and cognitive function were correlational in nature, it is unclear whether individual differences in HRV play a causal role in cognitive performance. To investigate whether there are causal relationships, we used a simple breathing manipulation that increases HRV through a 5-week HRV biofeedback intervention and examined whether this manipulation improves cognitive performance in younger and older adults (N = 165). The 5-week HRV biofeedback intervention did not significantly improve inhibitory control, working memory and processing speed across age groups. However, improvement in the Flanker score (a measure of inhibition) was associated with the amplitude of heart rate oscillations during practice sessions in the younger and older intervention groups. Our results suggest that daily practice to increase heart rate oscillations may improve inhibitory control, but future studies using longer intervention periods are warranted to replicate the present finding.
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Affiliation(s)
- Kaoru Nashiro
- University of Southern California, 3715 McClintock Avenue, Los Angeles, CA, 90089, USA.
| | - Hyun Joo Yoo
- University of Southern California, 3715 McClintock Avenue, Los Angeles, CA, 90089, USA
| | - Christine Cho
- University of Southern California, 3715 McClintock Avenue, Los Angeles, CA, 90089, USA
| | - Jungwon Min
- University of Southern California, 3715 McClintock Avenue, Los Angeles, CA, 90089, USA
| | - Tiantian Feng
- University of Southern California, 3715 McClintock Avenue, Los Angeles, CA, 90089, USA
| | - Padideh Nasseri
- University of Southern California, 3715 McClintock Avenue, Los Angeles, CA, 90089, USA
| | - Shelby L Bachman
- University of Southern California, 3715 McClintock Avenue, Los Angeles, CA, 90089, USA
| | | | | | - Mara Mather
- University of Southern California, 3715 McClintock Avenue, Los Angeles, CA, 90089, USA
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11
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Zeng J, Meng J, Wang C, Leng W, Zhong X, Gong A, Bo S, Jiang C. High vagally mediated resting-state heart rate variability is associated with superior working memory function. Front Neurosci 2023; 17:1119405. [PMID: 36891458 PMCID: PMC9986304 DOI: 10.3389/fnins.2023.1119405] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/09/2022] [Accepted: 01/30/2023] [Indexed: 02/22/2023] Open
Abstract
Background Heart rate variability (HRV), a cardiac vagal tone indicator, has been proven to predict performance on some cognitive tasks that rely on the prefrontal cortex. However, the relationship between vagal tone and working memory remains understudied. This study explores the link between vagal tone and working memory function, combined with behavioral tasks and functional near-infrared spectroscopy (fNIRS). Methods A total of 42 undergraduate students were tested for 5-min resting-state HRV to obtain the root mean square of successive differences (rMSSD) data, and then divided into high and low vagal tone groups according to the median of rMSSD data. The two groups underwent the n-back test, and fNIRS was used to measure the neural activity in the test state. ANOVA and the independent sample t-test were performed to compare group mean differences, and the Pearson correlation coefficient was used for correlation analysis. Results The high vagal tone group had a shorter reaction time, higher accuracy, lower inverse efficiency score, and lower oxy-Hb concentration in the bilateral prefrontal cortex in the working memory tasks state. Furthermore, there were associations between behavioral performance, oxy-Hb concentration, and resting-state rMSSD. Conclusion Our findings suggest that high vagally mediated resting-state HRV is associated with working memory performance. High vagal tone means a higher efficiency of neural resources, beneficial to presenting a better working memory function.
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Affiliation(s)
- Jia Zeng
- The Center of Neuroscience and Sports, Capital University of Physical Education and Sports, Beijing, China
| | - Jiao Meng
- The Center of Neuroscience and Sports, Capital University of Physical Education and Sports, Beijing, China
| | - Chen Wang
- The Center of Neuroscience and Sports, Capital University of Physical Education and Sports, Beijing, China
| | - Wenwu Leng
- The Center of Neuroscience and Sports, Capital University of Physical Education and Sports, Beijing, China
| | - Xiaoke Zhong
- The Center of Neuroscience and Sports, Capital University of Physical Education and Sports, Beijing, China
| | - Anmin Gong
- School of Information Engineering, Engineering University of People's Armed Police, Xi'an, China
| | - Shumin Bo
- School of Kinesiology and Health, Capital University of Physical Education and Sports, Beijing, China
| | - Changhao Jiang
- The Center of Neuroscience and Sports, Capital University of Physical Education and Sports, Beijing, China.,School of Kinesiology and Health, Capital University of Physical Education and Sports, Beijing, China
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12
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Noda Y, Knyahnytska Y, Zomorrodi R, Downar J, Rajji TK, Daskalakis ZJ, Blumberger DM. Vagally Mediated Heart Rate Variability Is Associated With Executive Function Changes in Patients With Treatment-Resistant Depression Following Magnetic Seizure Therapy. Neuromodulation 2022; 25:1378-1386. [PMID: 32870549 DOI: 10.1111/ner.13262] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/24/2020] [Revised: 07/03/2020] [Accepted: 07/25/2020] [Indexed: 12/14/2022]
Abstract
OBJECTIVES Magnetic seizure therapy (MST) is a novel investigational brain stimulation modality for patients with treatment-resistant depression (TRD). MST is a potential alternative seizure-based treatment to electroconvulsive therapy (ECT), given that it may offer equivalent antidepressant efficacy, yet with a relative sparing of cognitive functioning. Heart rate variability (HRV) is a marker of central autonomic functioning. We aimed to explore the relationships among baseline HRV, age, clinical outcome, and executive function following MST, in patients with TRD. MATERIALS AND METHODS Eighty-eight TRD patients (55 females; 18-70 years) were enrolled and 48 patients completed a course of MST in an open-label study. Patients received MST treatments two to three times per week, using one of three stimulation frequencies (ie, 100 Hz, 50 Hz, or 25 Hz) at 100% stimulator output. Root mean square of the successive R-R differences (RMSSD), an index of HRV, was computed from a baseline electrocardiogram (ECG) recording. Clinical symptoms were assessed using the Hamilton Depression Rating Scale (HAM-D24) and the Quick Inventory of Depressive Symptomatology (QIDS16). Executive function was assessed using the Trail Making Test and the Mazes Test from the MATRICS battery. RESULTS Baseline RMSSD was correlated with baseline HAM-D24 (r = -0.340, p = 0.001) and baseline Mazes Test (r = 0.417, p = 0.0007) but not with baseline Trail Making Test. Furthermore, baseline RMSSD was not correlated with changes on the HAM-D24, QIDS16, or total scores on the Trail Making Test. However, there was a significant correlation between baseline RMSSD and improvement on the Mazes Test following MST (r = 0.502, p = 0.0004). CONCLUSIONS Since this is an open-label trial, the influence of the placebo effect cannot be excluded. However, our results suggest that baseline RMSSD may be a state-biomarker of depression and executive function impairment. Additionally, while baseline vagally mediated resting cardiac activity did not predict the outcome of depression, it may mediate executive function improvements following MST.
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Affiliation(s)
- Yoshihiro Noda
- Temerty Centre for Therapeutic Brain Intervention, Centre for Addiction and Mental Health, Toronto, ON, Canada; Department of Psychiatry, University of Toronto, Toronto, ON, Canada; Department of Neuropsychiatry, Keio University School of Medicine, Tokyo, Japan
| | - Yuliya Knyahnytska
- Temerty Centre for Therapeutic Brain Intervention, Centre for Addiction and Mental Health, Toronto, ON, Canada; Department of Psychiatry, University of Toronto, Toronto, ON, Canada
| | - Reza Zomorrodi
- Temerty Centre for Therapeutic Brain Intervention, Centre for Addiction and Mental Health, Toronto, ON, Canada
| | - Jonathan Downar
- Department of Psychiatry, University of Toronto, Toronto, ON, Canada; MRI-Guided rTMS Clinic, University Health Network, Toronto, ON, Canada
| | - Tarek K Rajji
- Temerty Centre for Therapeutic Brain Intervention, Centre for Addiction and Mental Health, Toronto, ON, Canada; Department of Psychiatry, University of Toronto, Toronto, ON, Canada; Campbell Family Mental Health Research Institute, Centre for Addiction and Mental Health, Toronto, ON, Canada
| | - Zafiris J Daskalakis
- Temerty Centre for Therapeutic Brain Intervention, Centre for Addiction and Mental Health, Toronto, ON, Canada; Department of Psychiatry, University of Toronto, Toronto, ON, Canada; Campbell Family Mental Health Research Institute, Centre for Addiction and Mental Health, Toronto, ON, Canada
| | - Daniel M Blumberger
- Temerty Centre for Therapeutic Brain Intervention, Centre for Addiction and Mental Health, Toronto, ON, Canada; Department of Psychiatry, University of Toronto, Toronto, ON, Canada; Campbell Family Mental Health Research Institute, Centre for Addiction and Mental Health, Toronto, ON, Canada.
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13
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Imahori Y, Vetrano DL, Xia X, Grande G, Ljungman P, Fratiglioni L, Qiu C. Association of resting heart rate with cognitive decline and dementia in older adults: A population-based cohort study. Alzheimers Dement 2022; 18:1779-1787. [PMID: 34859936 DOI: 10.1002/alz.12495] [Citation(s) in RCA: 16] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/25/2021] [Revised: 09/09/2021] [Accepted: 09/15/2021] [Indexed: 01/28/2023]
Abstract
INTRODUCTION Resting heart rate (RHR) predicts future risk for cardiovascular disease (CVD). However, longitudinal studies investigating the relationship of RHR with cognitive decline are scarce. METHODS This population-based cohort study included 2147 participants (age≥60) in SNAC-K who were free of dementia and regularly followed from 2001-2004 to 2013-2016. RHR was assessed with electrocardiogram. Dementia was diagnosed following the Diagnostic and Statistical Manual of Mental Disorders 4th Revision criteria. Global cognitive function was assessed using Mini-Mental State Examination (MMSE). Data were analyzed using Cox and linear mixed-effects models. RESULTS RHR≥80 (vs. 60-69) bpm was associated with a multi-adjusted hazard ratio of 1.55 (95% confidence interval 1.06-2.27) for dementia. The association remained significant after excluding participants with prevalent and incident CVDs. Similarly, RHR≥80 bpm was associated with a multi-adjusted β-coefficient of -0.13 (-0.21 to -0.04) for MMSE score. DISCUSSION Higher RHR is associated with increased risk for dementia and faster cognitive decline independent of CVDs in a general population of elderly people.
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Affiliation(s)
- Yume Imahori
- Aging Research Center, Department of Neurobiology, Care Sciences and Society, Karolinska Institutet and Stockholm University, Stockholm, Sweden
| | - Davide L Vetrano
- Aging Research Center, Department of Neurobiology, Care Sciences and Society, Karolinska Institutet and Stockholm University, Stockholm, Sweden.,Centro Medicina dell'Invecchiamento, Fondazione Policlinico "A- Gemelli" IRCCS and Catholic University of Rome, Rome, Italy
| | - Xin Xia
- Aging Research Center, Department of Neurobiology, Care Sciences and Society, Karolinska Institutet and Stockholm University, Stockholm, Sweden
| | - Giulia Grande
- Aging Research Center, Department of Neurobiology, Care Sciences and Society, Karolinska Institutet and Stockholm University, Stockholm, Sweden
| | - Petter Ljungman
- Institute of Environmental Medicine, Karolinska Institute, Stockholm, Sweden.,Department of Cardiology, Danderyd Hospital, Stockholm, Sweden
| | - Laura Fratiglioni
- Aging Research Center, Department of Neurobiology, Care Sciences and Society, Karolinska Institutet and Stockholm University, Stockholm, Sweden.,Stockholm Gerontology Research Center, Stockholm, Sweden
| | - Chengxuan Qiu
- Aging Research Center, Department of Neurobiology, Care Sciences and Society, Karolinska Institutet and Stockholm University, Stockholm, Sweden
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14
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Nicolini P, Lucchi T, Abbate C, Inglese S, Tomasini E, Mari D, Rossi PD, Vicenzi M. Autonomic function predicts cognitive decline in mild cognitive impairment: Evidence from power spectral analysis of heart rate variability in a longitudinal study. Front Aging Neurosci 2022; 14:886023. [PMID: 36185491 PMCID: PMC9520613 DOI: 10.3389/fnagi.2022.886023] [Citation(s) in RCA: 7] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/28/2022] [Accepted: 08/25/2022] [Indexed: 11/13/2022] Open
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 follow-up 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 (Δ 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 Δ HRV and cognitive change was explored by means of linear regression, unadjusted and adjusted for potential confounders. Results In subjects diagnosed with MCI at baseline a greater response to a sympathetic challenge predicted a greater decline in episodic memory [adjusted model: Δ LFn, standardized regression coefficient (β) = −0.528, p = 0.019; Δ LF/HF, β = −0.643, p = 0.001] whereas a greater response to a parasympathetic challenge predicted a lesser decline in executive functioning (adjusted model: Δ LFn, β = −0.716, p < 0.001; Δ LF/HF, β = −0.935, p < 0.001). Conclusion Our findings provide novel insight into the link between HRV and cognition in MCI. They contribute to a better understanding of the heart-brain connection, but will require replication in larger cohorts.
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Affiliation(s)
- Paola Nicolini
- Geriatric Unit, Internal Medicine Department, Fondazione IRCCS Ca’ Granda Ospedale Maggiore Policlinico, Milan, Italy
- *Correspondence: Paola Nicolini,
| | - Tiziano Lucchi
- Geriatric Unit, Internal Medicine Department, Fondazione IRCCS Ca’ Granda Ospedale Maggiore Policlinico, Milan, Italy
| | - Carlo Abbate
- Geriatric Unit, Internal Medicine Department, Fondazione IRCCS Ca’ Granda Ospedale Maggiore Policlinico, Milan, Italy
- IRCCS Fondazione Don Carlo Gnocchi, Milan, Italy
| | - Silvia Inglese
- Geriatric Unit, Internal Medicine Department, Fondazione IRCCS Ca’ Granda Ospedale Maggiore Policlinico, Milan, Italy
| | - Emanuele Tomasini
- Geriatric Unit, Internal Medicine Department, Fondazione IRCCS Ca’ Granda Ospedale Maggiore Policlinico, Milan, Italy
- IRCCS Fondazione Don Carlo Gnocchi, Milan, Italy
| | - Daniela Mari
- Department of Clinical Sciences and Community Health, University of Milan, Milan, Italy
| | - Paolo D. Rossi
- Geriatric Unit, Internal Medicine Department, Fondazione IRCCS Ca’ Granda Ospedale Maggiore Policlinico, Milan, Italy
| | - Marco Vicenzi
- Dyspnea Lab, Department of Clinical Sciences and Community Health, University of Milan, Milan, Italy
- Cardiovascular Disease Unit, Internal Medicine Department, Fondazione IRCCS Ca’ Granda Ospedale Maggiore Policlinico, Milan, Italy
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15
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Khoshnoud S, Alvarez Igarzábal F, Wittmann M. Brain–Heart Interaction and the Experience of Flow While Playing a Video Game. Front Hum Neurosci 2022; 16:819834. [PMID: 35572002 PMCID: PMC9096496 DOI: 10.3389/fnhum.2022.819834] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/22/2021] [Accepted: 04/06/2022] [Indexed: 11/13/2022] Open
Abstract
The flow state – an experience of complete absorption in an activity – is linked with less self-referential processing and increased arousal. We used the heart-evoked potential (HEP), an index representing brain–heart interaction, as well as indices of peripheral physiology to assess the state of flow in individuals playing a video game. 22 gamers and 21 non-gamers played the video game Thumper for 25 min while their brain and cardiorespiratory signals were simultaneously recorded. The more participants were absorbed in the game, the less they thought about time and the faster time passed subjectively. On the cortical level, the fronto-central HEP amplitude was significantly lower while playing the game compared to resting states before and after the game, reflecting less self-referential processing while playing. This HEP effect corresponded with lower activity during gameplay in brain regions contributing to interoceptive processing. The HEP amplitude predicted the level of absorption in the game. While the HEP amplitude was overall lower during the gaming session than during the resting states, within the gaming session the amplitude of HEP was positively associated with absorption. Since higher absorption was related to higher performance in the game, the higher HEP in more absorbed individuals reflects more efficient brain–heart interaction, which is necessary for efficient game play. On the physiological level, a higher level of flow was associated with increased overall sympathetic activity and less inhibited parasympathetic activity toward the end of the game. These results are building blocks for future neurophysiological assessments of flow.
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Affiliation(s)
- Shiva Khoshnoud
- Institute for Frontier Areas of Psychology and Mental Health, Freiburg, Germany
- Department of Neurosurgery and Neurotechnology, Institute for Neuromodulation and Neurotechnology, University of Tübingen, Tübingen, Germany
- *Correspondence: Shiva Khoshnoud,
| | | | - Marc Wittmann
- Institute for Frontier Areas of Psychology and Mental Health, Freiburg, Germany
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16
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Analysis of Heart Rate Variability and Game Performance in Normal and Cognitively Impaired Elderly Subjects Using Serious Games. APPLIED SCIENCES-BASEL 2022. [DOI: 10.3390/app12094164] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/04/2022]
Abstract
Cognitive decline is one of the primary concerns in the elderly population. Serious games have been used for different purposes related to elderly care, such as physical therapy, cognitive training and mood management. There has been scientific evidence regarding the relationship between cognition and the autonomic nervous system (ANS) through heart rate variability (HRV). This paper explores the changes in the ANS among elderly people of normal and impaired cognition through measured HRV. Forty-eight subjects were classified into two groups: normal cognition (NC) (n = 24) and mild cognitive impairment (MCI) (n = 24). The subjects went through the following experiment flow: rest for 3 min (Rest 1), play a cognitive aptitude game (Game 1), rest for another 3 min (Rest 2), then play two reaction-time games (Game 2&3). Ten HRV features were extracted from measured electrocardiography (ECG) signals. Based on statistical analysis, there was no significant difference on the HRV between the two groups, but the experiment sessions do have a significant effect. There was no significant interaction between sessions and cognitive status. This implies that the HRV between the two groups have no significant difference, and they will experience similar changes in their HRV regardless of their cognitive status. Based on the game performance, there was a significant difference between the two groups of elderly people. Tree-based pipeline optimization tool (TPOT) was used for generating a machine learning pipeline for classification. Classification accuracy of 68.75% was achieved using HRV features, but higher accuracies of 83.33% and 81.20% were achieved using game performance or both HRV and game performance features, respectively. These results show that HRV has the potential to be used for detection of mild cognition impairment, but game performance can yield better accuracy. Thus, serious games have the potential to be used for assessing cognitive decline among the elderly.
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17
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Kang J, Chang Y, Kim Y, Shin H, Ryu S. Ten-Second Heart Rate Variability, Its Changes Over Time, and the Development of Hypertension. Hypertension 2022; 79:1308-1318. [PMID: 35317608 DOI: 10.1161/hypertensionaha.121.18589] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
BACKGROUND The role of ultrashort-term heart rate variability (HRV) and its temporal changes in incident hypertension are unknown. We aimed to investigate the association between 10-second HRV, its changes, and incident hypertension in adults aged <40 years and older. METHODS This cohort study included 232 587 Koreans (mean age 37.6 years) without hypertension. Hypertension was defined according to the 2017 American College of Cardiology and American Heart Association hypertension guidelines. HRV, including the root mean square of successive RR interval differences and the SD of normal-to-normal RR intervals, was estimated using standard 12-lead, 10-second electrocardiography. RESULTS During a median follow-up of 3.8 years, 40 268 hypertension cases were identified (incidence rates: 36.1 and 67.9 per 1000 person-years for young and older participants, respectively). An inverse association was observed between HRV and hypertension risk, in a dose-dependent manner. The multivariable-adjusted hazard ratios (95% CIs) for hypertension comparing the first to the fifth quintiles of root mean square of successive RR interval difference and SD of normal-to-normal RR interval were 1.58 (1.52-1.63) and 1.35 (1.30-1.39), respectively. These associations were stronger in young adults than in older adults. In a subsample of 150 301 participants, compared with stable HRV, an increase in HRV over time was also inversely associated with incident hypertension. CONCLUSIONS A higher HRV and its increase over time on a 10-second electrocardiography were associated with a lower risk of hypertension. Our findings indicate that autonomic function, estimated using 10-second standard electrocardiography, plays a role in predicting hypertension, with a stronger effect in young adults.
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Affiliation(s)
- Jeonggyu Kang
- Total Healthcare Center, Sungkyunkwan University, Seoul, South Korea. (J.K., H.S.).,Center for Cohort Studies, Total Healthcare Center, Sungkyunkwan University, Seoul, South Korea. (J.K., Y.C., Y.K., S.R.)
| | - Yoosoo Chang
- Center for Cohort Studies, Total Healthcare Center, Sungkyunkwan University, Seoul, South Korea. (J.K., Y.C., Y.K., S.R.).,Department of Occupational and Environmental Medicine, Sungkyunkwan University, Seoul, South Korea. (Y.C., S.R.).,Kangbuk Samsung Hospital, School of Medicine and Department of Clinical Research Design and Evaluation, SAIHST, Sungkyunkwan University, Seoul, South Korea. (Y.C., S.R.)
| | - Yejin Kim
- Center for Cohort Studies, Total Healthcare Center, Sungkyunkwan University, Seoul, South Korea. (J.K., Y.C., Y.K., S.R.)
| | - Hocheol Shin
- Total Healthcare Center, Sungkyunkwan University, Seoul, South Korea. (J.K., H.S.).,Department of Family Medicine, Sungkyunkwan University, Seoul, South Korea. (H.S.)
| | - Seungho Ryu
- Center for Cohort Studies, Total Healthcare Center, Sungkyunkwan University, Seoul, South Korea. (J.K., Y.C., Y.K., S.R.).,Department of Occupational and Environmental Medicine, Sungkyunkwan University, Seoul, South Korea. (Y.C., S.R.).,Kangbuk Samsung Hospital, School of Medicine and Department of Clinical Research Design and Evaluation, SAIHST, Sungkyunkwan University, Seoul, South Korea. (Y.C., S.R.)
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18
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Geng D, Wang Y, Gao Z, Wang J, Liu X, Pang G. Effects of Alzheimer's disease of varying severity on cardiac and autonomic function. Braz J Med Biol Res 2022; 55:e11504. [PMID: 35019033 PMCID: PMC8851908 DOI: 10.1590/1414-431x2021e11504] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/28/2021] [Accepted: 10/08/2021] [Indexed: 11/30/2022] Open
Abstract
Alzheimer’s disease (AD) is one of the most common neurodegenerative diseases in the elderly. The aim of this study was to explore the effects of AD on cardiac function and autonomic nervous function, and the feasibility of electrocardiogram (ECG) in monitoring the development of AD. APP/PS1 double transgenic mice were used in the Morris water maze (MWM) experiment to evaluate the changes of cognitive ability of AD mice, then the non-invasive ECG acquisition system was used and the changes of ECG intervals and heart rate variability (HRV) were analyzed. AD mice already had cognitive dysfunction at the age of 5 months, reaching the level of mild dementia, and the degree of dementia increased with the course of disease. There were no significant changes in ECG intervals in the AD group at each month. The mean square of successive RR interval differences, percentage of intervals >6 ms different from preceding interval, and normalized high frequency power component in the AD group were decreased and low-to-high frequency power ratio and normalized low frequency power component were increased. Combined with the results of the MWM, it was shown that the regulation mechanism of sympathetic and parasympathetic nerves in mice was already imbalanced in early stage AD, which was manifested as the increase of excessive activity of sympathetic nerves and the inhibition of parasympathetic activities. Therefore, ECG-based analysis of HRV may become a means of daily monitoring of AD and provide an auxiliary basis for clinical diagnosis.
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Affiliation(s)
- Duyan Geng
- State Key Laboratory of Reliability and Intelligence of Electrical Equipment, School of Electrical Engineering, Hebei University of Technology, Tianjin, China.,Key Laboratory of Electromagnetic Field and Electrical Apparatus Reliability of Hebei Province, School of Electrical Engineering, Hebei University of Technology, Tianjin, China
| | - Yan Wang
- Key Laboratory of Electromagnetic Field and Electrical Apparatus Reliability of Hebei Province, School of Electrical Engineering, Hebei University of Technology, Tianjin, China
| | - Zeyu Gao
- Key Laboratory of Electromagnetic Field and Electrical Apparatus Reliability of Hebei Province, School of Electrical Engineering, Hebei University of Technology, Tianjin, China
| | - Jiaxing Wang
- Key Laboratory of Electromagnetic Field and Electrical Apparatus Reliability of Hebei Province, School of Electrical Engineering, Hebei University of Technology, Tianjin, China
| | - Xuanyu Liu
- Key Laboratory of Electromagnetic Field and Electrical Apparatus Reliability of Hebei Province, School of Electrical Engineering, Hebei University of Technology, Tianjin, China
| | - Geng Pang
- Key Laboratory of Electromagnetic Field and Electrical Apparatus Reliability of Hebei Province, School of Electrical Engineering, Hebei University of Technology, Tianjin, China
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19
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Zonneveld MH, Abbel D, le Cessie S, Jukema JW, Noordam R, Trompet S. Cardiac Troponin, Cognitive Function, and Dementia: A Systematic Review. Aging Dis 2022; 14:386-397. [PMID: 37008066 PMCID: PMC10017151 DOI: 10.14336/ad.2022.0818] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/21/2022] [Accepted: 08/18/2022] [Indexed: 11/18/2022] Open
Abstract
Elevated cardiac troponin, a biomarker of myocardial injury, has been found in individuals with brain damage and lower cognitive function. We conducted a systematic review to examine the association of troponin with cognitive function, incidence of dementia and dementia-related outcomes. PubMed, Web of Science and EMBASE were searched from inception to August 2022. Inclusion criteria were: (i) population-based cohort studies; (ii) troponin measured as determinant; and (iii) cognitive function in any metric or diagnosis of any type of dementia or dementia-related measures as outcomes. Fourteen studies were identified and included, with a combined total of 38,286 participants. Of these studies, four examined dementia-related outcomes, eight studies examined cognitive function, and two studies examined both dementia-related outcomes and cognitive function. Studies report higher troponin to be associated with higher prevalence of cognitive impairment (n=1), incident dementia (n=1), increased risk of dementia hospitalization (specifically due to vascular dementia) (n=1), but not with incident Alzheimer's Disease (n=2). Majority of studies on cognitive function found elevated troponin also associated with worse global cognitive function (n=3), attention (n=2), reaction time (n=1) and visuomotor speed (n=1), both cross-sectionally and prospectively. Evidence regarding the association between higher troponin and memory, executive function, processing speed, language and visuospatial function was mixed. This was the first systematic review on the association between troponin, cognitive function, and dementia. Higher troponin is associated with subclinical cerebrovascular damage and might act as a risk-marker of cognitive vulnerability.
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Affiliation(s)
- Michelle H Zonneveld
- Department of Internal Medicine, Section of Gerontology and Geriatrics, Leiden University Medical Center, 2333 ZA Leiden, the Netherlands.
- Department of Cardiology, Leiden University Medical Center, 2333 ZA Leiden, the Netherlands.
- Correspondence should be addressed to: Michelle Zonneveld, M.S., Department of Internal Medicine, Section of Gerontology and Geriatrics, Leiden University Medical Center, 2300 RC Leiden, The Netherlands.
| | - Denise Abbel
- Department of Internal Medicine, Section of Gerontology and Geriatrics, Leiden University Medical Center, 2333 ZA Leiden, the Netherlands.
| | - Saskia le Cessie
- Department of Clinical Epidemiology, Leiden University Medical Center, 2333 ZA Leiden, the Netherlands.
- Department of Biomedical Data Sciences, Leiden University Medical Center, 2333 ZA Leiden, the Netherlands.
| | - J. Wouter Jukema
- Department of Cardiology, Leiden University Medical Center, 2333 ZA Leiden, the Netherlands.
- Netherlands Heart Institute, Utrecht, the Netherlands
| | - Raymond Noordam
- Department of Internal Medicine, Section of Gerontology and Geriatrics, Leiden University Medical Center, 2333 ZA Leiden, the Netherlands.
| | - Stella Trompet
- Department of Internal Medicine, Section of Gerontology and Geriatrics, Leiden University Medical Center, 2333 ZA Leiden, the Netherlands.
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20
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Costa MD, Redline S, Hughes TM, Heckbert SR, Goldberger AL. Prediction of Cognitive Decline Using Heart Rate Fragmentation Analysis: The Multi-Ethnic Study of Atherosclerosis. Front Aging Neurosci 2021; 13:708130. [PMID: 34512310 PMCID: PMC8428192 DOI: 10.3389/fnagi.2021.708130] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/11/2021] [Accepted: 07/06/2021] [Indexed: 12/24/2022] Open
Abstract
Background: Heart rate fragmentation (HRF), a new non-invasive metric quantifying cardiac neuroautonomic function, is associated with increasing age and cardiovascular disease. Since these are risk factors for cognitive decline and dementia, in the Multi-Ethnic Study of Atherosclerosis (MESA), we investigated whether disrupted cardiac neuroautonomic function, evidenced by increased HRF, would be associated with worse cognitive function assessed concurrently and at a later examination, and with greater cognitive decline. Methods: HRF was derived from the ECG channel of the polysomnographic recordings obtained in an ancillary study (n = 1,897) conducted in conjunction with MESA exam 5 (2010–2012). Cognitive function was assessed at exam 5 and 6.4 ± 0.5 years later at exam 6 (2016–2018) with tests of global cognitive performance (the Cognitive Abilities Screening Instrument, CASI), processing speed (Digit Symbol Coding, DSC) and working memory (Digit Span). Multivariable regression models were used to quantify the associations between HRF indices and cognitive scores. Results: The participants’ mean age was 68 ± 9 years (54% female). Higher HRF at baseline was independently associated with lower cognitive scores at both exams 5 and 6. Specifically, in cross-sectional analyses, a one-standard deviation (SD) (13.7%) increase in HRF was associated with a 0.51 (95% CI: 0.17–0.86) points reduction in CASI and a 1.12 (0.34–1.90) points reduction in DSC. Quantitatively similar effects were obtained in longitudinal analyses. A one-SD increase in HRF was associated with a 0.44 (0.03–0.86) and a 1.04 (0.28–1.81) points reduction in CASI and DSC from exams 5 to 6, respectively. HRF added predictive value to the Cardiovascular Risk Factors, Aging, and Incidence of Dementia (CAIDE-APOE-ε4) risk score and to models adjusted for serum concentration of NT-proBNP, an analyte associated with cognitive impairment and dementia. Conclusion: Increased HRF assessed during sleep was independently associated with diminished cognitive performance (concurrent and future) and with greater cognitive decline. These findings lend support to the links between cardiac neuroautonomic regulation and cognitive function. As a non-invasive, repeatable and inexpensive probe, HRF technology may be useful in monitoring cognitive status, predicting risk of dementia and assessing therapeutic interventions.
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Affiliation(s)
- Madalena D Costa
- Margret and H. A. Rey Institute for Non-linear Dynamics in Medicine, Department of Medicine, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA, United States
| | - Susan Redline
- Division of Sleep and Circadian Disorders, Department of Medicine and Neurology, Brigham and Women's Hospital, Boston, MA, United States.,Department of Medicine, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA, United States
| | - Timothy M Hughes
- Section on Gerontology and Geriatric Medicine, Department of Internal Medicine, Wake Forest School of Medicine, Winston-Salem, NC, United States.,Department of Epidemiology and Prevention, Wake Forest School of Medicine, Winston-Salem, NC, United States
| | - Susan R Heckbert
- Department of Epidemiology, University of Washington, Seattle, WA, United States
| | - Ary L Goldberger
- Margret and H. A. Rey Institute for Non-linear Dynamics in Medicine, Department of Medicine, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA, United States
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21
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Tinello D, Kliegel M, Zuber S. Does Heart Rate Variability Biofeedback Enhance Executive Functions Across the Lifespan? A Systematic Review. JOURNAL OF COGNITIVE ENHANCEMENT 2021; 6:126-142. [PMID: 35299845 PMCID: PMC8901517 DOI: 10.1007/s41465-021-00218-3] [Citation(s) in RCA: 13] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/19/2021] [Accepted: 05/25/2021] [Indexed: 12/26/2022]
Abstract
The scope of this systematic review was to summarize the existing literature on the effects of heart rate variability biofeedback (HRV-BF) on executive functions (EFs) across the lifespan. Specifically, it aimed to investigate the factors that may affect the efficacy of HRV-BF interventions, such as the study population, duration and intensity of the intervention, or the technical equipment. This review was conducted according to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines. Studies that measured and presented at least one EF were included. We included controlled and uncontrolled trials involving clinical and general populations. From the initial list of 137 papers, 16 final studies were reviewed, with 777 participants. Fifty-six percent of the studies included in this review reported significant positive effects of HRV-BF intervention on at least one EF. Attention was the domain that most often benefited from the intervention. The majority of EF improvements (78%) occurred in studies that addressed patient populations or individuals that may present particular profiles: individuals exposed to stress, professional athletes, war veterans, children and adults with ADHD, and clinical older patients. The remaining studies (22%) that reported significant improvements focused on the general population. Efficacy was neither related to the duration or intensity of the intervention nor related to the technical equipment. Overall, our review shows that HRV-BF may be beneficial (a) to increase attentional skills, inhibition, and working memory and (b) when targeting more vulnerable individuals or individuals with particular profiles. However, further development of standardized, controlled protocols and consistent reporting of effect sizes may contribute to establishing the relevance of HRV-BF biofeedback interventions within the field of cognitive enhancement.
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Affiliation(s)
- Doriana Tinello
- Department of Psychology, Faculty of Psychology and Sciences of Education, University of Geneva, 28 Boulevard du Pont d’Arve, 1205 Geneva, Switzerland
- Swiss National Centre of Competence in Research LIVES Overcoming Vulnerability: Life Course Perspectives, Lausanne and Geneva, Geneva, Switzerland
- Centre for the Interdisciplinary Study of Gerontology and Vulnerability, University of Geneva, Geneva, Switzerland
| | - Matthias Kliegel
- Department of Psychology, Faculty of Psychology and Sciences of Education, University of Geneva, 28 Boulevard du Pont d’Arve, 1205 Geneva, Switzerland
- Swiss National Centre of Competence in Research LIVES Overcoming Vulnerability: Life Course Perspectives, Lausanne and Geneva, Geneva, Switzerland
- Centre for the Interdisciplinary Study of Gerontology and Vulnerability, University of Geneva, Geneva, Switzerland
| | - Sascha Zuber
- Department of Psychology, Faculty of Psychology and Sciences of Education, University of Geneva, 28 Boulevard du Pont d’Arve, 1205 Geneva, Switzerland
- Swiss National Centre of Competence in Research LIVES Overcoming Vulnerability: Life Course Perspectives, Lausanne and Geneva, Geneva, Switzerland
- Centre for the Interdisciplinary Study of Gerontology and Vulnerability, University of Geneva, Geneva, Switzerland
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22
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Hämmerle P, Aeschbacher S, Springer A, Eken C, Coslovsky M, Dutilh G, Moschovitis G, Rodondi N, Chocano P, Conen D, Osswald S, Kühne M, Zuern CS. Cardiac autonomic function and cognitive performance in patients with atrial fibrillation. Clin Res Cardiol 2021; 111:60-69. [PMID: 34156525 PMCID: PMC8766386 DOI: 10.1007/s00392-021-01900-4] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/13/2021] [Accepted: 06/16/2021] [Indexed: 12/14/2022]
Abstract
Background Atrial fibrillation (AF) is associated with loss of cognition and dementia. Cardiac autonomic dysfunction has been linked to cognitive decline. We aimed to investigate if reduced cardiac autonomic function (CAF) is associated with cognitive impairment in AF patients. Methods Patients with paroxysmal, persistent and permanent AF were enrolled from a multicenter cohort study if they had AF (“AF group”) or sinus rhythm (“SR group”) on a baseline 5 min ECG recording. Parameters quantifying CAF (heart rate variability triangular index (HRVI), mean heart rate (MHR), RMSSD, SDNN, total power and power in the VLF, LF, HF ranges) were calculated. We used the Montreal Cognitive Assessment (MoCA) to assess global cognitive function. Results 1685 AF patients with a mean age of 73 ± 8 years, 29% females, were included. MoCA score was 24.5 ± 3.2 in the AF group (N = 710 patients) and 25.4 ± 3.2 in the SR group (N = 975 patients). After adjusting for multiple confounders, lower HRVI was associated with lower MoCA scores, both in the SR group [β = 0.049; 95% confidence interval (CI) 0.016–0.081; p = 0.003] and in the AF group (β = 0.068; 95% CI 0.020–0.116; p = 0.006). In the AF group, higher MHR was associated with a poorer performance in the MoCA (β = − 0.008; 95% CI − 0.014 to − 0.002; p = 0.014). We found no convincing evidence of association for other CAF parameters with cognition. Conclusion Our data suggest that impaired CAF is associated with worse cognitive performance in patients with AF. Among standard HRV parameters, HRVI might be the most promising ECG index. Trial registration ClinicalTrials.gov Identifier: NCT02105844. Graphic abstract ![]()
Supplementary Information The online version contains supplementary material available at 10.1007/s00392-021-01900-4.
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Affiliation(s)
- Peter Hämmerle
- Department of Cardiology, Cardiovascular Research Institute Basel, University Hospital Basel, Basel, Switzerland
| | - Stefanie Aeschbacher
- Department of Cardiology, Cardiovascular Research Institute Basel, University Hospital Basel, Basel, Switzerland
| | - Anne Springer
- Department of Cardiology, Cardiovascular Research Institute Basel, University Hospital Basel, Basel, Switzerland
| | - Ceylan Eken
- Department of Cardiology, Cardiovascular Research Institute Basel, University Hospital Basel, Basel, Switzerland
| | - Michael Coslovsky
- Department of Cardiology, Cardiovascular Research Institute Basel, University Hospital Basel, Basel, Switzerland
- Department Clinical Research, University of Basel, Basel, Switzerland
| | - Gilles Dutilh
- Department Clinical Research, University of Basel, Basel, Switzerland
| | - Giorgio Moschovitis
- Department of Cardiology, Hospedale Regionale Di Lugano, Lugano, Switzerland
| | - Nicolas Rodondi
- Institute of Primary Health Care (BIHAM), University of Bern, Bern, Switzerland
- Department of General Internal Medicine, Inselspital, Bern University Hospital, Bern, Switzerland
| | - Patricia Chocano
- Institute of Primary Health Care (BIHAM), University of Bern, Bern, Switzerland
| | - David Conen
- Population Health Research Institute, McMaster University and Hamilton Health Sciences, Hamilton, Canada
| | - Stefan Osswald
- Department of Cardiology, Cardiovascular Research Institute Basel, University Hospital Basel, Basel, Switzerland
- Department of Cardiology, University Hospital Basel, Basel, Switzerland
| | - Michael Kühne
- Department of Cardiology, Cardiovascular Research Institute Basel, University Hospital Basel, Basel, Switzerland
- Department of Cardiology, University Hospital Basel, Basel, Switzerland
| | - Christine S Zuern
- Department of Cardiology, Cardiovascular Research Institute Basel, University Hospital Basel, Basel, Switzerland.
- Department of Cardiology, University Hospital Basel, Basel, Switzerland.
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23
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Association between nocturnal activity of the sympathetic nervous system and cognitive dysfunction in obstructive sleep apnoea. Sci Rep 2021; 11:11990. [PMID: 34099794 PMCID: PMC8184757 DOI: 10.1038/s41598-021-91329-6] [Citation(s) in RCA: 12] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/24/2020] [Accepted: 05/24/2021] [Indexed: 01/12/2023] Open
Abstract
Obstructive sleep apnoea (OSA) is associated with repetitive breathing obstructions during sleep. These episodes of hypoxia and associated arousals from sleep induce physiological stress and nocturnal over-activation of the sympathetic nervous system (SNS). One consequence of OSA is impairment in a range of cognitive domains. Previous research into cognitive impairment in OSA have focussed on intermittent hypoxia and disrupted sleep, but not nocturnal over-activation of the SNS. Therefore, we investigated whether nocturnal over-activity of the SNS was associated with cognitive impairments in OSA. The extent of nocturnal SNS activation was estimated from heart rate variability (HRV), pulse wave amplitude (PWA) and stress response biomarkers (cortisol and glucose levels). OSA severity was significantly associated with PWA indices and the HRV low frequency/ high frequency ratio (p < 0.05). Morning blood glucose levels were significantly associated with the duration of a blood oxygen saturation (SaO2) < 90% (p < 0.01). PWA and HRV were significantly associated with the time taken to perform a task involving visuospatial functioning (p < 0.05), but not with impairments in sustained attention, reaction time or autobiographical memory. These results suggest that the visuospatial dysfunction observed in people with OSA is associated with increased nocturnal activity of the SNS.
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24
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Scarsoglio S, Ridolfi L. Different Impact of Heart Rate Variability in the Deep Cerebral and Central Hemodynamics at Rest: An in silico Investigation. Front Neurosci 2021; 15:600574. [PMID: 34079433 PMCID: PMC8165247 DOI: 10.3389/fnins.2021.600574] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/30/2020] [Accepted: 04/19/2021] [Indexed: 11/18/2022] Open
Abstract
Background: Heart rate variability (HRV), defined as the variability between consecutive heartbeats, is a surrogate measure of cardiac vagal tone. It is widely accepted that a decreased HRV is associated to several risk factors and cardiovascular diseases. However, a possible association between HRV and altered cerebral hemodynamics is still debated, suffering from HRV short-term measures and the paucity of high-resolution deep cerebral data. We propose a computational approach to evaluate the deep cerebral and central hemodynamics subject to physiological alterations of HRV in an ideal young healthy patient at rest. Methods: The cardiovascular-cerebral model is composed by electrical components able to reproduce the response of the different cardiovascular regions and their features. The model was validated over more than thirty studies and recently exploited to understand the hemodynamic mechanisms between cardiac arrythmia and cognitive deficit. Three configurations (baseline, increased HRV, and decreased HRV) are built based on the standard deviation (SDNN) of RR beats. For each configuration, 5,000 RR beats are simulated to investigate the occurrence of extreme values, alteration of the regular hemodynamics pattern, and variation of mean perfusion/pressure levels. Results: In the cerebral circulation, our results show that HRV has overall a stronger impact on pressure than flow rate mean values but similarly alters pressure and flow rate in terms of extreme events. By comparing reduced and increased HRV, this latter induces a higher probability of altered mean and extreme values, and is therefore more detrimental at distal cerebral level. On the contrary, at central level a decreased HRV induces a higher cardiac effort without improving the mechano-contractile performance, thus overall reducing the heart efficiency. Conclusions: Present results suggest that: (i) the increase of HRV per se does not seem to be sufficient to trigger a better cerebral hemodynamic response; (ii) by accounting for both central and cerebral circulations, the optimal HRV configuration is found at baseline. Given the relation inversely linking HRV and HR, the presence of this optimal condition can contribute to explain why the mean HR of the general population settles around the baseline value (70 bpm).
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Affiliation(s)
- Stefania Scarsoglio
- Department of Mechanical and Aerospace Engineering, Politecnico di Torino, Torino, Italy
| | - Luca Ridolfi
- Department of Environmental, Land and Infrastructure Engineering, Politecnico di Torino, Torino, Italy
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25
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Hilgarter K, Schmid-Zalaudek K, Csanády-Leitner R, Mörtl M, Rössler A, Lackner HK. Phasic heart rate variability and the association with cognitive performance: A cross-sectional study in a healthy population setting. PLoS One 2021; 16:e0246968. [PMID: 33647023 PMCID: PMC7920382 DOI: 10.1371/journal.pone.0246968] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/12/2020] [Accepted: 01/28/2021] [Indexed: 12/18/2022] Open
Abstract
Introduction Sympathovagal balance measured by heart rate variability is a core component of psychophysiological research. Through the close link of physiological and psychological aspects, often a reduced heart rate variability is associated with impaired cognitive function. A better understanding of the associations between cognitive and cardiovascular dysfunctions is necessary to prevent the manifestation of diseases. Therefore, this study investigated phasic heart rate variability using rest, anticipatory, stress, and recovery periods and the association with high and low cognitive performance in a generally healthy population setting. Methods 114 healthy individuals (40 males, 74 females) aged 20 to 70 participated in the cross-sectional study. The heart rate variability based on standard deviation of NN intervals (SDNN), and the root means square of successive differences (RMSSD), low frequency (LF), high frequency (HF) and LF/HF ratio and its association with high and low cognitive performance measured by the California Verbal Learning Task II were examined. Results The results of this study indicate that the paradigm was successful in producing stress and showed a significant association between phasic heart rate variability (SDNN) and verbal episodic memory performance, irrespective of age and sex. Discussion The results of this study suggest that a reduced heart rate variability is associated with reduced cognitive function regardless of age and sex and seem to be an early indicator of sympathovagal disbalance. Conclusion This leads to the conclusion that differences between high and low cognitive performance might show differences in heart rate variability at an early stage, where no diseases are yet manifest.
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Affiliation(s)
- Kathrin Hilgarter
- Division of Physiology, Otto Loewi Research Centre, Medical University of Graz, Graz, Austria
- * E-mail:
| | - Karin Schmid-Zalaudek
- Division of Physiology, Otto Loewi Research Centre, Medical University of Graz, Graz, Austria
| | - Regina Csanády-Leitner
- Division of Physiology, Otto Loewi Research Centre, Medical University of Graz, Graz, Austria
| | - Manfred Mörtl
- Department of Obstetrics and Gynecology, Clinical Centre Klagenfurt, Klagenfurt, Austria
| | - Andreas Rössler
- Division of Physiology, Otto Loewi Research Centre, Medical University of Graz, Graz, Austria
| | - Helmut Karl Lackner
- Division of Physiology, Otto Loewi Research Centre, Medical University of Graz, Graz, Austria
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26
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Haigh SM, Walford TP, Brosseau P. Heart Rate Variability in Schizophrenia and Autism. Front Psychiatry 2021; 12:760396. [PMID: 34899423 PMCID: PMC8656307 DOI: 10.3389/fpsyt.2021.760396] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/18/2021] [Accepted: 11/01/2021] [Indexed: 11/23/2022] Open
Abstract
Suppressed heart rate variability (HRV) has been found in a number of psychiatric conditions, including schizophrenia and autism. HRV is a potential biomarker of altered autonomic functioning that can predict future physiological and cognitive health. Understanding the HRV profiles that are unique to each condition will assist in generating predictive models of health. In the current study, we directly compared 12 adults with schizophrenia, 25 adults with autism, and 27 neurotypical controls on their HRV profiles. HRV was measured using an electrocardiogram (ECG) channel as part of a larger electroencephalography (EEG) study. All participants also completed the UCLA Loneliness Questionnaire as a measure of social stress. We found that the adults with schizophrenia exhibited reduced variability in R-R peaks and lower low frequency power in the ECG trace compared to controls. The HRV in adults with autism was slightly suppressed compared to controls but not significantly so. Interestingly, the autism group reported feeling lonelier than the schizophrenia group, and HRV did not correlate with feelings of loneliness for any of the three groups. However, suppressed HRV was related to worse performance on neuropsychological tests of cognition in the schizophrenia group. Together, this suggests that autonomic functioning is more abnormal in schizophrenia than in autism and could be reflecting health factors that are unique to schizophrenia.
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Affiliation(s)
- Sarah M Haigh
- Department of Psychology and Center for the Neural Basis of Cognition, Carnegie Mellon University, Pittsburgh, PA, United States.,Department of Psychology and Center for Integrative Neuroscience, University of Nevada, Reno, Reno, NV, United States
| | - Tabatha P Walford
- Department of Psychology and Center for Integrative Neuroscience, University of Nevada, Reno, Reno, NV, United States
| | - Pat Brosseau
- Department of Psychology and Center for the Neural Basis of Cognition, Carnegie Mellon University, Pittsburgh, PA, United States
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27
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Vrinceanu T, Lagacé-Lavoie G, Kaushal N, Esmail A, Vu TTM, Berryman N, Nigam A, Bherer L. Mind the Rhythm: ECG QT Dispersion and Cognition in Healthy Older Adults. Front Psychol 2020; 11:566341. [PMID: 33117235 PMCID: PMC7561416 DOI: 10.3389/fpsyg.2020.566341] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/28/2020] [Accepted: 09/14/2020] [Indexed: 12/19/2022] Open
Abstract
Background Autonomic function has been linked to cognitive abilities in aging. Even in non-clinical states, a certain variability in heart rhythm regulation can be measured with QT dispersion (QTcD), an ECG marker of ventricular repolarization which has been linked to autonomic function and cardiovascular health. QTcD has been shown to be higher in individuals with mild cognitive impairment, and the highest in individuals with Alzheimer’s disease. The goal of this study was to see if QTcD is associated with cognitive performance in healthy individuals. Methods Sixty-three healthy inactive older adults (> 60 years) completed an extensive cognitive assessment (including inhibition, divided attention, updating, working memory, and processing speed), a physical fitness assessment, and underwent a resting ECG. Results After controlling for age, sex, and education, QTcD significantly predicted global cognition (MoCA) scores (R2 = 0.17, F(4.58) = 3.00, p < 0.03, β = −0.36). Exploratory analysis on the MoCA subcomponents revealed a significant association between the visual/executive subcomponent and QTcD (R2 = 0.12, F(1.61) = 7.99, p < 0.01, β = −0.34). In individuals with high QTcD, QTcD values were linked to executive functions (R2 = 0.37), processing speed (R2 = 0.34), and dual-task performances (R2 = 0.47). No significant associations were found within the low QTcD group. Conclusion This study shows an association between ventricular repolarization (QTcD) and cognitive performance, in particular speed and executive functions, in healthy older adults. The results provide further support for linking autonomic heart regulation and age-related cognitive changes, and suggest that deviations on ECG, even within-normal range, could help detect early cognitive deficits.
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Affiliation(s)
- Tudor Vrinceanu
- Department of Medicine, Université de Montréal, Montreal, QC, Canada.,Research Centre, Montreal Heart Institute, Montreal, QC, Canada.,Research Centre, Institut Universitaire de Gériatrie de Montréal, Montreal, QC, Canada
| | | | - Navin Kaushal
- Department of Health Sciences, School of Health & Human Sciences, Indiana University, Indianapolis, IN, United States
| | - Alida Esmail
- École de Réadaptation, Faculté de Médecine, Université de Montréal, Montreal, QC, Canada
| | - T T Minh Vu
- Department of Medicine, Université de Montréal, Montreal, QC, Canada.,Centre Hospitalier de l'Université de Montréal, Montreal, QC, Canada.,Centre de Recherché du CHUM, Montreal, QC, Canada
| | - Nicolas Berryman
- Research Centre, Institut Universitaire de Gériatrie de Montréal, Montreal, QC, Canada.,Département des Sciences de l'Activité Physique, Université du Québec à Montréal, Montreal, QC, Canada
| | - Anil Nigam
- Department of Medicine, Université de Montréal, Montreal, QC, Canada.,Research Centre, Montreal Heart Institute, Montreal, QC, Canada
| | - Louis Bherer
- Department of Medicine, Université de Montréal, Montreal, QC, Canada.,Research Centre, Montreal Heart Institute, Montreal, QC, Canada.,Research Centre, Institut Universitaire de Gériatrie de Montréal, Montreal, QC, Canada
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28
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Nussinovitch U. Reliability of ultra-short indices for autonomic dysfunction in dyslipidemia. Clin Physiol Funct Imaging 2020; 40:423-433. [PMID: 32886849 DOI: 10.1111/cpf.12661] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/02/2020] [Revised: 08/21/2020] [Accepted: 08/26/2020] [Indexed: 11/28/2022]
Abstract
Dyslipidemia is associated with autonomic nervous system (ANS) dysfunction. Heart rate variability (HRV) is a powerful tool for evaluating the ANS and for cardiovascular risk stratification. Yet, the methodologies used are impractical in most clinical settings and therefore, are usually not applied. The current study aimed to evaluate the reliability of ultra-short HRV parameters, which are easily calculated from any standard ECG, as a practical method for ANS study, with a focus on patients with dyslipidemia. Fifty-nine volunteers with dyslipidemia underwent HRV study of parametric and power spectral indices according to accepted methods. Correlations were calculated between ultra-short HRV indices (five 1-min and five 10-s segments) and standard 5-min recordings. Correlations were found between 10-s and 1-min RMSSD and 5-min recordings (mean Pearson ρ correlation coefficients of 0.913 and 0.944, respectively, and mean concordance correlation coefficients of 0.855 and 0.938, respectively). Associations were found between other ultra-short HRV parameters (SDNN, maximum RR, minimum RR, pNN50, ln(RMSSD) and 5-min recordings. In addition, average RR, HRV-TI, NN50, TP, LF/HF, ln(SDNN), ln(HRV-TI), ln(TP) and ln(LF/HF) from 1-min recordings were associated with 5-min values. In conclusion, some ultra-short HRV parameters can be used for ANS evaluation and presumably, for cardiovascular risk stratification among patients with dyslipidemia. These parameters seem to be of great practical value for both inpatient and outpatient settings, because most can be calculated from a standard 10-s ECG strip. The prognostic implications of ECG-derived, ultra-short HRV parameters in patients with dyslipidemia should be further evaluated in future studies.
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Affiliation(s)
- Udi Nussinovitch
- Applicative Cardiovascular Research Center (ACRC) and Department of Cardiology, Meir Medical Center, Kfar Saba, Israel.,Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
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29
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Eggenberger P, Annaheim S, Kündig KA, Rossi RM, Münzer T, de Bruin ED. Heart Rate Variability Mainly Relates to Cognitive Executive Functions and Improves Through Exergame Training in Older Adults: A Secondary Analysis of a 6-Month Randomized Controlled Trial. Front Aging Neurosci 2020; 12:197. [PMID: 32760267 PMCID: PMC7373948 DOI: 10.3389/fnagi.2020.00197] [Citation(s) in RCA: 17] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/01/2020] [Accepted: 06/05/2020] [Indexed: 12/16/2022] Open
Abstract
Heart rate variability (HRV) mirrors autonomic nervous system activities and might serve as a parameter to monitor health status in older adults. However, it is currently unknown which functional health measures, including cognitive, physical, and gait performance parameters, are most strongly related to HRV indices. This knowledge would enable implementing HRV assessments into health monitoring routines and training planning for older adults. Simultaneous cognitive-motor and exergame training may be effective to improve HRV indices but has not been investigated yet. Eighty-nine healthy older adults (≥70 years of age) were randomized into three groups: (1) virtual reality video game dancing, i.e., exergaming (DANCE); (2) treadmill walking with simultaneous verbal memory training (MEMORY); or (3) treadmill walking only (PHYS). Strength and balance exercises complemented each program. Over 6 months, two weekly 1-h training sessions were performed. HRV indices (standard deviation of N-N intervals, SDNN; root mean square of successive R-R interval differences, RMSSD; and absolute power of high-frequency band (0.15-0.4 Hz), HF power) and various measures of cognitive, physical, and gait performance were assessed at baseline and after 3 months and 6 months. Multiple linear regression analyses with planned comparisons were calculated. At baseline, 8-12% of HRV variance was significantly explained by cognitive executive functions and leg strength (inversely related). Verbal long-term memory, aerobic and functional fitness, and gait performance did not contribute to the model (SDNN: R2 = 0.082, p = 0.016; RMSSD: R2 = 0.121, p = 0.013; HF power: R2 = 0.119, p = 0.015). After 6 months, DANCE improved HRV indices, while MEMORY and PHYS did not (time × intervention interactions: first-contrast DANCE/MEMORY vs. PHYS: SDNN p = 0.014 one-tailed, ΔR 2 = 0.020 and RMSSD p = 0.052 one-tailed (trend), ΔR 2 = 0.007; second-contrast DANCE vs. MEMORY: SDNN p = 0.002 one-tailed, ΔR 2 = 0.035, RMSSD p = 0.017 one-tailed, ΔR 2 = 0.012, and HF power p = 0.011 one-tailed, ΔR 2 = 0.013). We conclude that mainly cognitive executive functions are associated with HRV indices and that exergame training improves global and parasympathetic autonomic nervous system activities in older adults. Periodic assessments of HRV in older citizens could be particularly beneficial to monitor cognitive health and provide indications for preventative exercise measures.
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Affiliation(s)
- Patrick Eggenberger
- Empa, Swiss Federal Laboratories for Materials Science and Technology, Laboratory for Biomimetic Membranes and Textiles, St. Gallen, Switzerland.,Department of Health Sciences and Technology, Institute of Human Movement Sciences and Sport, ETH Zurich, Zurich, Switzerland
| | - Simon Annaheim
- Empa, Swiss Federal Laboratories for Materials Science and Technology, Laboratory for Biomimetic Membranes and Textiles, St. Gallen, Switzerland
| | - Kerstin A Kündig
- Empa, Swiss Federal Laboratories for Materials Science and Technology, Laboratory for Biomimetic Membranes and Textiles, St. Gallen, Switzerland.,Department of Health Sciences and Technology, Institute of Human Movement Sciences and Sport, ETH Zurich, Zurich, Switzerland
| | - René M Rossi
- Empa, Swiss Federal Laboratories for Materials Science and Technology, Laboratory for Biomimetic Membranes and Textiles, St. Gallen, Switzerland
| | - Thomas Münzer
- Geriatrische Klinik St. Gallen, St. Gallen, Switzerland.,Department of Geriatric Medicine, University of Zurich, Zurich, Switzerland
| | - Eling D de Bruin
- Department of Health Sciences and Technology, Institute of Human Movement Sciences and Sport, ETH Zurich, Zurich, Switzerland.,Department of Neurobiology, Care Sciences and Society, Karolinska Institutet, Stockholm, Sweden
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30
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Nicolini P, Mari D, Abbate C, Inglese S, Bertagnoli L, Tomasini E, Rossi PD, Lombardi F. Autonomic function in amnestic and non-amnestic mild cognitive impairment: spectral heart rate variability analysis provides evidence for a brain-heart axis. Sci Rep 2020; 10:11661. [PMID: 32669640 PMCID: PMC7363846 DOI: 10.1038/s41598-020-68131-x] [Citation(s) in RCA: 25] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/24/2020] [Accepted: 06/15/2020] [Indexed: 12/27/2022] Open
Abstract
Mild cognitive impairment (MCI) is a heterogeneous syndrome with two main clinical subtypes, amnestic (aMCI) and non-amnestic (naMCI). The analysis of heart rate variability (HRV) is a tool to assess autonomic function. Cognitive and autonomic processes are linked via the central autonomic network. Autonomic dysfunction entails several adverse outcomes. However, very few studies have investigated autonomic function in MCI and none have considered MCI subtypes or the relationship of HRV indices with different cognitive domains and structural brain damage. We assessed autonomic function during an active orthostatic challenge in 253 oupatients aged ≥ 65, [n = 82 aMCI, n = 93 naMCI, n = 78 cognitively normal (CN), neuropsychologically tested] with power spectral analysis of HRV. We used visual rating scales to grade cerebrovascular burden and hippocampal/insular atrophy (HA/IA) on neuroimaging. Only aMCI showed a blunted response to orthostasis. Postural changes in normalised low frequency (LF) power and in the LF to high frequency ratio correlated with a memory test (positively) and HA/IA (negatively) in aMCI, and with attention/executive function tests (negatively) and cerebrovascular burden (positively) in naMCI. These results substantiate the view that the ANS is differentially impaired in aMCI and naMCI, consistently with the neuroanatomic substrate of Alzheimer's and small-vessel subcortical ischaemic disease.
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Affiliation(s)
- Paola Nicolini
- Cardiovascular Diseases Unit, Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Department of Clinical and Community Sciences, University of Milan, Milan, Italy.
| | - Daniela Mari
- Geriatric Unit, Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Department of Clinical and Community Sciences, University of Milan, Milan, Italy
| | - Carlo Abbate
- Geriatric Unit, Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Department of Clinical and Community Sciences, University of Milan, Milan, Italy.,IRCCS Fondazione Don Carlo Gnocchi, Milan, Italy
| | - Silvia Inglese
- Geriatric Unit, Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Department of Clinical and Community Sciences, University of Milan, Milan, Italy
| | - Laura Bertagnoli
- Geriatric Unit, Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Department of Clinical and Community Sciences, University of Milan, Milan, Italy
| | - Emanuele Tomasini
- Geriatric Unit, Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Department of Clinical and Community Sciences, University of Milan, Milan, Italy.,IRCCS Fondazione Don Carlo Gnocchi, Milan, Italy
| | - Paolo D Rossi
- Geriatric Unit, Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Department of Clinical and Community Sciences, University of Milan, Milan, Italy
| | - Federico Lombardi
- Cardiovascular Diseases Unit, Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Department of Clinical and Community Sciences, University of Milan, Milan, Italy
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31
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Knight EL, Giuliano RJ, Shank SW, Clarke MM, Almeida DM. Parasympathetic and sympathetic nervous systems interactively predict change in cognitive functioning in midlife adults. Psychophysiology 2020; 57:e13622. [PMID: 32598489 DOI: 10.1111/psyp.13622] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/03/2019] [Revised: 04/30/2020] [Accepted: 05/04/2020] [Indexed: 12/18/2022]
Abstract
The two branches of the autonomic nervous system (ANS) have been individually linked to changes in cognitive functioning: The parasympathetic nervous system (PNS) has been associated with healthy cognitive aging, whereas excessive sympathetic nervous system (SNS) activity has been linked to heightened cognitive decline. Despite these separate findings and despite the integrative nature of the ANS, little work has examined the two branches simultaneously to better understand their interactive effects on changes in cognitive functioning in midlife adults. We examined cognitive change in two waves of the Midlife in the United States (MIDUS) study cognitive project and indexed PNS and SNS activity from heart rate variability and epinephrine levels, respectively, from the MIDUS biomarker project (minimum n = 843, 57.9% female, mean age at first wave = 53.8 years). Our findings indicate that greater PNS responsivity (i.e., greater withdrawal and greater recovery) in response to cognitive challenge is associated with attenuated cognitive decline, but only among individuals with low SNS levels; at higher SNS levels, the effects of the PNS on cognitive decline are attenuated. These results suggest that future research targeting the ANS and cognitive aging should consider both ANS branch's effects simultaneously.
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Affiliation(s)
- Erik L Knight
- Center for Healthy Aging, Pennsylvania State University, University Park, PA, USA.,Department of Biobehavioral Health, Pennsylvania State University, University Park, PA, USA
| | - Ryan J Giuliano
- Department of Psychology, University of Manitoba, Winnipeg, Manitoba, Canada
| | - Sean W Shank
- Department of Kinesiology, Pennsylvania State University, University Park, PA, USA
| | - Megan M Clarke
- Department of Kinesiology, Pennsylvania State University, University Park, PA, USA
| | - David M Almeida
- Center for Healthy Aging, Pennsylvania State University, University Park, PA, USA.,Department of Human Development and Family Studies, Pennsylvania State University, University Park, PA, USA
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32
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Bonomini MP, Calvo MV, Morcillo AD, Segovia F, Vicente JMF, Fernandez-Jover E. The Effect of Breath Pacing on Task Switching and Working Memory. Int J Neural Syst 2020; 30:2050028. [PMID: 32498643 DOI: 10.1142/s0129065720500288] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
Abstract
The cortical and subcortical circuit regulating both cognition and cardiac autonomic interactions are already well established. This circuit has mainly been analyzed from cortex to heart. Thus, the heart rate variability (HRV) is usually considered a reflection of cortical activity. In this paper, we investigate whether HRV changes affect cortical activity. Short-term local autonomic changes were induced by three breathing strategies: spontaneous (Control), normal (NB) and slow paced breathing (SB). We measured the performance in two cognition domains: executive functions and processing speed. Breathing maneuvres produced three clearly differentiated autonomic states, which preconditioned the cognitive tasks. We found that the SB significantly increased the HRV low frequency (LF) power and lowered the power spectral density (PSD) peak to 0.1[Formula: see text]Hz. Meanwhile, executive function was assessed by the working memory test, whose accuracy significantly improved after SB, with no significant changes in the response times. Processing speed was assessed by a multitasking test. Consistently, the proportion of correct answers (success rate) was the only dependent variable affected by short-term and long-term breath pacing. These findings suggest that accuracy, and not timing of these two cognitive domains would benefit from short-term SB in this study population.
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Affiliation(s)
- Maria Paula Bonomini
- Instituto Argentino de Matemáticas "Alberto P. Calderón" (IAM), CONICET, Saavedra 15, CABA, Argentina.,Instituto de Ingeniería Biomédica, Fac. de Ingeniería, Univ. de Buenos Aires (UBA), Paseo Colón 850, CABA, Argentina
| | - Mikel Val Calvo
- Departamento de Inteligencia Artificial, Universidad Nacional de Educación a Distancia (UNED), Juan del Rosal, 16, 28040, Madrid, Spain.,Departamento Electrónica, Tecnología de Computadoras y Proyectos, Universidad Politécnica de Cartagena, Cartagena, Spain
| | - Alejandro Diaz Morcillo
- Departamento Tecnologías de la Información y las Comunicaciones, Universidad Politécnica de Cartagena, Cartagena, Spain
| | | | - Jose Manuel Ferrandez Vicente
- Departamento Electrónica, Tecnología de Computadoras y Proyectos, Universidad Politécnica de Cartagena, Cartagena, Spain
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33
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Lin FV, Tao Y, Chen Q, Anthony M, Zhang Z, Tadin D, Heffner KL. Processing speed and attention training modifies autonomic flexibility: A mechanistic intervention study. Neuroimage 2020; 213:116730. [PMID: 32165263 PMCID: PMC7165056 DOI: 10.1016/j.neuroimage.2020.116730] [Citation(s) in RCA: 22] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/17/2020] [Revised: 02/26/2020] [Accepted: 03/08/2020] [Indexed: 12/30/2022] Open
Abstract
Adaptation capacity is critical for maintaining cognition, yet it is understudied in groups at risk for dementia. Autonomic nervous system (ANS) is critical for neurovisceral integration and is a key contributor to adaptation capacity. To determine the central nervous system's top-down regulation of ANS, we conducted a mechanistic randomized controlled trial study, using a 6-week processing speed and attention (PS/A)-targeted intervention. Eighty-four older adults with amnestic mild cognitive impairment (aMCI) were randomized to a 6-week PS/A-targeted intervention or an active control without PS/A. Utilizing repeated measures (i.e., PS/A test different from the intervention, resting and cognitive task-based ECG, and resting fMRI) at baseline, immediately post-intervention (post-test), and 6-month follow-up, we aimed to test whether PS/A causally influences vagal control of ANS via their shared central neural pathways in aMCI. We indexed vagal control of ANS using high-frequency heart rate variability (HF-HRV) extracted from ECG data. Functional brain connectivity patterns were extracted from fMRI using advanced statistical tools. Compared to the control group, the intervention group showed significant improvement in PS/A, HF-HRV, salience network (SN), central executive network (CEN), and frontal parietal network (FPN) connectivity at post-test; the effect on SN, CEN, and FPN remained at 6-month follow-up. Changes in PS/A and SN connectivity significantly predicted change in HF-HRV from baseline to post-test and/or 6-month-follow-up. Age, neurodegeneration, nor sex did not affect these relationships. This work provides novel support for top-down regulation of PS/A and associated SN on vagal control of ANS. Intervening PS/A may be a viable approach for promoting adaptation capacity in groups at risk for dementia.
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Affiliation(s)
- Feng V Lin
- Elaine C. Hubbard Center for Nursing Research on Aging, School of Nursing, University of Rochester Medical Center, USA; Department of Psychiatry, School of Medicine and Dentistry, University of Rochester Medical Center, USA; Department of Brain and Cognitive Sciences, University of Rochester, USA; Department of Neuroscience, School of Medicine and Dentistry, University of Rochester Medical Center, USA; Department of Neurology, School of Medicine and Dentistry, University of Rochester Medical Center, USA.
| | - Ye Tao
- Department of Electrical and Computational Engineering, University of Rochester, USA
| | - Quanjing Chen
- Elaine C. Hubbard Center for Nursing Research on Aging, School of Nursing, University of Rochester Medical Center, USA; Department of Psychiatry, School of Medicine and Dentistry, University of Rochester Medical Center, USA
| | - Mia Anthony
- Department of Brain and Cognitive Sciences, University of Rochester, USA
| | - Zhengwu Zhang
- Department of Biostatics and Computational Biology, School of Medicine and Dentistry, University of Rochester Medical Center, USA
| | - Duje Tadin
- Department of Brain and Cognitive Sciences, University of Rochester, USA; Department of Neuroscience, School of Medicine and Dentistry, University of Rochester Medical Center, USA
| | - Kathi L Heffner
- Elaine C. Hubbard Center for Nursing Research on Aging, School of Nursing, University of Rochester Medical Center, USA; Department of Psychiatry, School of Medicine and Dentistry, University of Rochester Medical Center, USA; Division of Geriatrics & Aging, Department of Medicine, School of Medicine and Dentistry, University of Rochester Medical Center, USA
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34
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Schaich CL, Malaver D, Chen H, Shaltout HA, Zeki Al Hazzouri A, Herrington DM, Hughes TM. Association of Heart Rate Variability With Cognitive Performance: The Multi-Ethnic Study of Atherosclerosis. J Am Heart Assoc 2020; 9:e013827. [PMID: 32200711 PMCID: PMC7428623 DOI: 10.1161/jaha.119.013827] [Citation(s) in RCA: 20] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/03/2019] [Accepted: 02/11/2020] [Indexed: 12/19/2022]
Abstract
Background Heart rate variability (HRV) is associated with vascular risk factors for dementia, but whether HRV is associated with specific domains of cognitive performance is unclear. Methods and Results In the Multi-Ethnic Study of Atherosclerosis (N=3018; mean age 59.3±9.2 years), we assessed the relationship of 10-second HRV to scores on tests of global cognitive performance (Cognitive Abilities Screening Instrument), processing speed (Digit Symbol Coding), and working memory (Digit Span). HRV was computed as the SD of normal-normal intervals (SDNN) and root mean square of successive differences (RMSSD) at Exam 1 (2000-2002) and Exam 5 (2010-2012). Cognitive tests were administered at Exam 5. We report regression coefficients (β [95% CI]) representing cognitive test score change per 2-fold increase in HRV. After adjustment for age, race/ethnicity, sex, education, apolipoprotein E genotype, and cardiovascular risk factors and incident disease, higher Exam 1 (β=0.37 [0.06, 0.67]) and Exam 5 (β=0.31 [0.04, 0.59]) SDNN were associated with better Cognitive Abilities Screening Instrument performance. Higher Exam 1 (β=0.80 [0.17, 1.43]) and Exam 5 (β=0.63 [0.06, 1.20]) SDNN, and Exam 5 RMSSD (β=0.54 [0.01, 1.08]) were associated with better Digit Symbol Coding performance. Finally, higher Exam 5 SDNN was associated with better Digit Span performance (β=0.17 [0.01, 0.33]). Associations were attenuated after adjustment for resting heart rate. Conclusions Higher HRV is generally associated with better cognitive performance in this multi-ethnic cohort of aging adults, and further study of the relationship of autonomic function to cognition is warranted.
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Affiliation(s)
- Christopher L. Schaich
- Department of Surgery, Hypertension and Vascular ResearchWake Forest School of MedicineWinston‐SalemNC
| | - Diego Malaver
- Section on Cardiovascular MedicineDepartment of Internal MedicineWake Forest School of MedicineWinston‐SalemNC
| | - Haiying Chen
- Division of Public Health SciencesDepartment of Biostatistics and Data ScienceWake Forest School of MedicineWinston‐SalemNC
| | - Hossam A. Shaltout
- Department of Obstetrics and GynecologyWake Forest School of MedicineWinston‐SalemNC
| | | | - David M. Herrington
- Section on Cardiovascular MedicineDepartment of Internal MedicineWake Forest School of MedicineWinston‐SalemNC
| | - Timothy M. Hughes
- Section on Gerontology and Geriatric MedicineDepartment of Internal MedicineWake Forest School of MedicineWinston‐SalemNC
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35
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Zonneveld MH, Noordam R, van der Grond J, Sabayan B, Mooijaart SP, Mcfarlane PW, Jukema JW, Trompet S. Ventricular Repolarization is Associated with Cognitive Function, but Not with Cognitive Decline and Brain Magnetic Resonance Imaging (MRI) Measurements in Older Adults. J Clin Med 2020; 9:jcm9040911. [PMID: 32225080 PMCID: PMC7230741 DOI: 10.3390/jcm9040911] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/11/2020] [Revised: 03/23/2020] [Accepted: 03/25/2020] [Indexed: 01/24/2023] Open
Abstract
We aimed to investigate the cross-sectional and longitudinal associations of electrocardiogram (ECG)-based QT, QTc, JT, JTc, and QRS intervals with cognitive function and brain magnetic resonance imaging (MRI) measurements in a cohort of older individuals at increased risk for cardiovascular disease, but free of known arrhythmias. We studied 4627 participants (54% female, mean age 75 years) enrolled in the Prospective Study of Pravastatin in the Elderly at Risk (PROSPER). Ten-second ECGs were conducted at baseline. Cognitive function was tested at baseline and repeated during a mean follow-up time of 3.2 years. Structural MRIs were conducted in a subgroup of 535 participants. Analyses were performed with multivariable (repeated) linear regression models and adjusted for cardiovascular risk-factors, co-morbidities, and cardiovascular drug use. At baseline, longer QT, JT, JTc—but not QTc and QRS intervals—were associated with a worse cognitive performance. Most notably, on the Stroop Test, participants performed 3.02 (95% CI 0.31; 5.73) seconds worse per standard deviation higher QT interval, independent of cardiovascular risk factors and medication use. There was no association between longer ventricular de- or repolarization and structural brain measurements. Therefore, specifically ventricular repolarization was associated with worse cognitive performance in older individuals at baseline but not during follow-up.
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Affiliation(s)
- Michelle H. Zonneveld
- Department of Internal Medicine, Section of Gerontology and Geriatrics, Leiden University Medical Center, 2333 ZA Leiden, The Netherlands; (M.H.Z.); (S.P.M.); (S.T.)
| | - Raymond Noordam
- Department of Internal Medicine, Section of Gerontology and Geriatrics, Leiden University Medical Center, 2333 ZA Leiden, The Netherlands; (M.H.Z.); (S.P.M.); (S.T.)
- Correspondence:
| | - Jeroen van der Grond
- Department of Radiology, Leiden University Medical Center, 2333 ZA Leiden, The Netherlands;
| | - Behnam Sabayan
- Feinberg School of Medicine, Northwestern University, Chicago, IL 60611, USA;
| | - Simon P. Mooijaart
- Department of Internal Medicine, Section of Gerontology and Geriatrics, Leiden University Medical Center, 2333 ZA Leiden, The Netherlands; (M.H.Z.); (S.P.M.); (S.T.)
| | - Peter W. Mcfarlane
- Institute of Health and Wellbeing, University of Glasgow, Glasgow G31 2ER, UK;
| | - J. Wouter Jukema
- Department of Cardiology, Leiden University Medical Center, 2333 ZA Leiden, The Netherlands;
| | - Stella Trompet
- Department of Internal Medicine, Section of Gerontology and Geriatrics, Leiden University Medical Center, 2333 ZA Leiden, The Netherlands; (M.H.Z.); (S.P.M.); (S.T.)
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36
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Swor DE, Thomas LF, Maas MB, Grimaldi D, Manno EM, Sorond FA, Batra A, Kim M, Prabhakaran S, Naidech AM, Liotta EM. Admission Heart Rate Variability is Associated with Fever Development in Patients with Intracerebral Hemorrhage. Neurocrit Care 2020; 30:244-250. [PMID: 30756320 DOI: 10.1007/s12028-019-00684-w] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/08/2023]
Abstract
BACKGROUND Fever is associated with worse outcome after intracerebral hemorrhage (ICH). Autonomic dysfunction, commonly seen after brain injury, results in reduced heart rate variability (HRV). We sought to investigate whether HRV was associated with the development of fever in patients with ICH. METHODS We prospectively enrolled consecutive patients with spontaneous ICH in a single-center observational study. We included patients who presented directly to our emergency department after symptom onset, had a 10-second electrocardiogram (EKG) performed within 24 h of admission, and were in sinus rhythm. Patient temperature was recorded every 1-4 h. We defined being febrile as having a temperature of ≥ 38 °C within the first 14 days, and fever burden as the number of febrile days. HRV was defined by the standard deviation of the R-R interval (SDNN) measured on the admission EKG. Univariate associations were determined by Fisher's exact, Mann-Whitney U, or Spearman's rho correlation tests. Variables associated with fever at p ≤ 0.2 were entered in a logistic regression model of being febrile within 14 days. RESULTS There were 248 patients (median age 63 [54-74] years, 125 [50.4%] female, median ICH Score 1 [0-2]) who met the inclusion criteria. Febrile patients had lower HRV (median SDNN: 1.72 [1.08-3.60] vs. 2.55 [1.58-5.72] msec, p = 0.001). Lower HRV was associated with more febrile days (R = - 0.22, p < 0.001). After adjustment, lower HRV was independently associated with greater odds of fever occurrence (OR 0.92 [95% CI 0.87-0.97] with each msec increase in SDNN, p = 0.002). CONCLUSIONS HRV measured on 10-second EKGs is a potential early marker of parasympathetic nervous system dysfunction and is associated with subsequent fever occurrence after ICH. Detecting early parasympathetic dysfunction may afford opportunities to improve ICH outcome by targeting therapies at fever prevention.
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Affiliation(s)
- Dionne E Swor
- Department of Neurology, Northwestern University, Chicago, USA
| | - Leena F Thomas
- Department of Neurology, Northwestern University, Chicago, USA
| | - Matthew B Maas
- Department of Neurology, Northwestern University, Chicago, USA
| | | | - Edward M Manno
- Department of Neurology, Northwestern University, Chicago, USA
| | | | - Ayush Batra
- Department of Neurology, Northwestern University, Chicago, USA
| | - Minjee Kim
- Department of Neurology, Northwestern University, Chicago, USA
| | | | | | - Eric M Liotta
- Department of Neurology, Northwestern University, Chicago, USA.
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37
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Hilz MJ, Wang R, Liu M, Muresanu D, Flanagan S, Winder K, Hösl K, Hummel T. Emotional and Autonomic Processing of Olfactory Stimuli Is Compromised in Patients with a History of Mild Traumatic Brain Injury. J Neurotrauma 2020; 37:125-138. [PMID: 31298614 DOI: 10.1089/neu.2018.6215] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
Patients with a history of mild traumatic brain injury (post-mTBI patients) may have enduring cardiovascular-autonomic dysregulation and emotional problems. Olfactory stimulation (OS) triggers emotional and cardiovascular-autonomic responses that might be compromised in post-mTBI patients. We therefore evaluated these responses to OS in post-mTBI patients. In 17 post-mTBI patients (interval since mTBI: 32.4 ± 6.8 months) and 17 age- and sex-matched controls, we recorded respiration, electrocardiographic RR intervals, and systolic and diastolic blood pressures (BPsys, BPdia) before and during pleasant vanilla stimulation and unpleasant hydrogen sulphide (H2S) stimulation. Participants rated OS-related pleasantness, arousal, intensity, and familiarity on 9-point Likert scales. Analyses of variance (ANOVAs) with post hoc analyses compared parameters within each group before and during OS. To assess associations between pleasantness, arousal, intensity, and familiarity, we correlated OS scores within groups (significance: p < 0.05). Baseline parameters were similar between groups. Only in controls, vanilla stimulation significantly lowered BPsys and BPdia, whereas H2S stimulation lowered RR intervals. Vanilla-related pleasantness scores were lower, intensity scores were higher in patients than controls. During vanilla stimulation, pleasantness scores correlated negatively with arousal scores in controls, whereas familiarity scores correlated positively with intensity scores in patients. During H2S stimulation, familiarity scores correlated negatively with pleasantness scores in controls, whereas pleasantness scores correlated negatively with arousal scores in mTBI patients. Post-mTBI patients could not change BP or RR intervals during OS but perceived vanilla stimuli as less pleasant and more intense than did controls. Associations between pleasantness, arousal, intensity, and familiarity differed between groups suggesting different activation of the olfactory network and the central autonomic network upon OS. Subtle lesions within these networks might cause persistent changes in emotional and cognitive odor perception and cardiovascular responses.
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Affiliation(s)
- Max J Hilz
- Department of Neurology, University of Erlangen-Nuremberg, Erlangen, Germany.,Department of Neurology, Icahn School of Medicine at Mount Sinai, New York, New York
| | - Ruihao Wang
- Department of Neurology, University of Erlangen-Nuremberg, Erlangen, Germany
| | - Mao Liu
- Department of Neurology, University of Erlangen-Nuremberg, Erlangen, Germany
| | - Dafin Muresanu
- Department of Clinical Neurosciences, Iuliu Hatieganu University of Medicine and Pharmacy, Cluj-Napoca, Romania.,RoNeuro Institute for Neurological Research and Diagnostic, Cluj-Napoca, Romania
| | - Steven Flanagan
- Department of Rehabilitation Medicine, New York University School of Medicine, New York, New York
| | - Klemens Winder
- Department of Neurology, University of Erlangen-Nuremberg, Erlangen, Germany
| | - Katharina Hösl
- Department of Psychiatry and Psychotherapy, Paracelsus Medical University, Nuremberg, Germany
| | - Thomas Hummel
- Smell and Taste Clinic, Department of Otorhinolaryngology, TU Dresden, Dresden, Germany
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38
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Forte G, Favieri F, Casagrande M. Heart Rate Variability and Cognitive Function: A Systematic Review. Front Neurosci 2019; 13:710. [PMID: 31354419 PMCID: PMC6637318 DOI: 10.3389/fnins.2019.00710] [Citation(s) in RCA: 229] [Impact Index Per Article: 45.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/11/2018] [Accepted: 06/24/2019] [Indexed: 11/20/2022] Open
Abstract
Background: Autonomic dysfunctions may precede the development of cognitive impairment, but the connection between these dimensions is unclear. This systematic review aims to analyze the relationship between heart rate variability (HRV) and cognitive functions. Methods: The review process was conducted according to the PRISMA-Statement. Restrictions were made, selecting the studies in English and published in peer-review journals, including at least one cognitive measure and presenting the measurement of HRV. Studies that included participants with medical conditions, dementia, psychiatric disorders, strokes, and traumatic brain injury were excluded. Twenty studies were selected, with a total of 19,431 participants. The results were divided into different cognitive domains determined a priori: global cognitive functioning, attention, processing speed, executive functions, memory, language and visuospatial skills. Results: Both increased sympathetic activity and decreased parasympathetic activity seem to be associated with a worse performance in the cognitive domains considered, in the absence of dementia and severe cardiovascular diseases or other medical and psychiatric diseases. Conclusion: The results highlight the influence of the autonomic nervous system (ANS) in cognitive functioning. However, the marked interest facing toward a specific domain, i.e., the executive functions, and the relatively small number of the studies on this topic do not allow understanding better this relationship. Despite these limits, HRV could be considered a promising early biomarker of cognitive impairment in populations without dementia or stroke. This index should be evaluated within a preventative perspective to minimize the risk of developing cognitive impairment.
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Affiliation(s)
- Giuseppe Forte
- Dipartimento di Psicologia, Sapienza Università di Roma, Rome, Italy
| | - Francesca Favieri
- Dipartimento di Psicologia, Sapienza Università di Roma, Rome, Italy
| | - Maria Casagrande
- Dipartimento di Psicologia Dinamica e Clinica, Sapienza Università di Roma, Rome, Italy
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39
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Jester DJ, Rozek EK, McKelley RA. Heart rate variability biofeedback: implications for cognitive and psychiatric effects in older adults. Aging Ment Health 2019; 23:574-580. [PMID: 29381375 DOI: 10.1080/13607863.2018.1432031] [Citation(s) in RCA: 34] [Impact Index Per Article: 6.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
Abstract
OBJECTIVES Two decades of heart rate variability (HRV) biofeedback research have focused on adolescent and adult populations with a variety of symptoms and conditions at the exclusion of older adults. This study explores HRV biofeedback as a novel treatment to decrease psychiatric symptoms and improve cognitive functioning in older adults. METHODS Participants enrolled in a three-week intervention that included six 30-min biofeedback sessions. Neuropsychological and psychiatric measures were administered before and after the intervention. RESULTS Decreases in depression (Cohen's d = 1.02, p < .001), state anxiety (Cohen's d = 0.82, p = .003), and trait anxiety (Cohen's d = 0.84, p = .002) were observed. An increase in attentional skills as measured by the Trail Making Test - Part A was seen (Cohen's d = 1.00, p = .001). Differences in executive skills as measured by the Trial Making Test - Part B and the Stroop Task did not reach statistical significance. CONCLUSION This study suggests that older adults may benefit from HRV biofeedback interventions much like the younger populations that have been studied for decades. Depression, anxiety, and attentional skills were positively affected. Several participants reported improved sleep quality and stress management. Future studies should corroborate these findings.
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Affiliation(s)
- Dylan J Jester
- a Department of Psychology , University of Wisconsin - La Crosse , La Crosse , WI , USA
| | - Ellen K Rozek
- a Department of Psychology , University of Wisconsin - La Crosse , La Crosse , WI , USA
| | - Ryan A McKelley
- a Department of Psychology , University of Wisconsin - La Crosse , La Crosse , WI , USA
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Kumral D, Schaare HL, Beyer F, Reinelt J, Uhlig M, Liem F, Lampe L, Babayan A, Reiter A, Erbey M, Roebbig J, Loeffler M, Schroeter ML, Husser D, Witte AV, Villringer A, Gaebler M. The age-dependent relationship between resting heart rate variability and functional brain connectivity. Neuroimage 2018; 185:521-533. [PMID: 30312808 DOI: 10.1016/j.neuroimage.2018.10.027] [Citation(s) in RCA: 28] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/26/2018] [Revised: 10/05/2018] [Accepted: 10/09/2018] [Indexed: 12/30/2022] Open
Abstract
Resting heart rate variability (HRV), an index of parasympathetic cardioregulation and an individual trait marker related to mental and physical health, decreases with age. Previous studies have associated resting HRV with structural and functional properties of the brain - mainly in cortical midline and limbic structures. We hypothesized that aging affects the relationship between resting HRV and brain structure and function. In 388 healthy subjects of three age groups (140 younger: 26.0 ± 4.2 years, 119 middle-aged: 46.3 ± 6.2 years, 129 older: 66.9 ± 4.7 years), gray matter volume (GMV, voxel-based morphometry) and resting state functional connectivity (eigenvector centrality mapping and exploratory seed-based functional connectivity) were related to resting HRV, measured as the root mean square of successive differences (RMSSD). Confirming previous findings, resting HRV decreased with age. For HRV-related GMV, there were no statistically significant differences between the age groups, nor similarities across all age groups. In whole-brain functional connectivity analyses, we found an age-dependent association between resting HRV and eigenvector centrality in the bilateral ventromedial prefrontal cortex (vmPFC), driven by the younger adults. Across all age groups, HRV was positively correlated with network centrality in the bilateral posterior cingulate cortex. Seed-based functional connectivity analysis using the vmPFC cluster revealed an HRV-related cortico-cerebellar network in younger but not in middle-aged or older adults. Our results indicate that the decrease of HRV with age is accompanied by changes in functional connectivity along the cortical midline. This extends our knowledge of brain-body interactions and their changes over the lifespan.
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Affiliation(s)
- D Kumral
- Department of Neurology, Max Planck Institute for Human Cognitive and Brain Sciences, Leipzig, Germany; MindBrainBody Institute at the Berlin School of Mind and Brain, Humboldt-Universitaet zu Berlin, Berlin, Germany.
| | - H L Schaare
- Department of Neurology, Max Planck Institute for Human Cognitive and Brain Sciences, Leipzig, Germany; International Max Planck Research School NeuroCom, Leipzig, Germany
| | - F Beyer
- Department of Neurology, Max Planck Institute for Human Cognitive and Brain Sciences, Leipzig, Germany; Subproject A1, Collaborative Research Centre 1052 "Obesity Mechanisms", University of Leipzig, Leipzig, Germany
| | - J Reinelt
- Department of Neurology, Max Planck Institute for Human Cognitive and Brain Sciences, Leipzig, Germany
| | - M Uhlig
- Department of Neurology, Max Planck Institute for Human Cognitive and Brain Sciences, Leipzig, Germany; International Max Planck Research School NeuroCom, Leipzig, Germany
| | - F Liem
- Department of Neurology, Max Planck Institute for Human Cognitive and Brain Sciences, Leipzig, Germany
| | - L Lampe
- Department of Neurology, Max Planck Institute for Human Cognitive and Brain Sciences, Leipzig, Germany
| | - A Babayan
- Department of Neurology, Max Planck Institute for Human Cognitive and Brain Sciences, Leipzig, Germany
| | - A Reiter
- Lifespan Developmental Neuroscience, Technical University of Dresden, Dresden, Germany; Department of Neurology, Max Planck Institute for Human Cognitive and Brain Sciences, Leipzig, Germany
| | - M Erbey
- MindBrainBody Institute at the Berlin School of Mind and Brain, Humboldt-Universitaet zu Berlin, Berlin, Germany
| | - J Roebbig
- Department of Neurology, Max Planck Institute for Human Cognitive and Brain Sciences, Leipzig, Germany
| | - M Loeffler
- LIFE - Leipzig Research Center for Civilization Diseases, University of Leipzig, Leipzig, Germany
| | - M L Schroeter
- Department of Neurology, Max Planck Institute for Human Cognitive and Brain Sciences, Leipzig, Germany; LIFE - Leipzig Research Center for Civilization Diseases, University of Leipzig, Leipzig, Germany; Department of Cognitive Neurology, University of Leipzig, Leipzig, Germany
| | - D Husser
- Department of Electrophysiology, Leipzig Heart Centre, University of Leipzig, Leipzig, Germany
| | - A V Witte
- Department of Neurology, Max Planck Institute for Human Cognitive and Brain Sciences, Leipzig, Germany
| | - A Villringer
- Department of Neurology, Max Planck Institute for Human Cognitive and Brain Sciences, Leipzig, Germany; MindBrainBody Institute at the Berlin School of Mind and Brain, Humboldt-Universitaet zu Berlin, Berlin, Germany; Subproject A1, Collaborative Research Centre 1052 "Obesity Mechanisms", University of Leipzig, Leipzig, Germany; LIFE - Leipzig Research Center for Civilization Diseases, University of Leipzig, Leipzig, Germany; Center for Stroke Research Berlin, Charité - Universitaetsmedizin Berlin, Berlin, Germany
| | - M Gaebler
- Department of Neurology, Max Planck Institute for Human Cognitive and Brain Sciences, Leipzig, Germany; MindBrainBody Institute at the Berlin School of Mind and Brain, Humboldt-Universitaet zu Berlin, Berlin, Germany; LIFE - Leipzig Research Center for Civilization Diseases, University of Leipzig, Leipzig, Germany
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Zeki Al Hazzouri A, Elfassy T, Carnethon MR, Lloyd-Jones DM, Yaffe K. Heart Rate Variability and Cognitive Function In Middle-Age Adults: The Coronary Artery Risk Development in Young Adults. Am J Hypertens 2017; 31:27-34. [PMID: 28985245 PMCID: PMC5861561 DOI: 10.1093/ajh/hpx125] [Citation(s) in RCA: 33] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/20/2017] [Revised: 04/28/2017] [Accepted: 07/10/2017] [Indexed: 12/19/2022] Open
Abstract
BACKGROUND Low heart rate variability (HRV), a marker of cardiac autonomic dysfunction, has been associated with major risk factors of cognitive impairment. Yet, the direct association of HRV with cognitive function remains relatively unexplored, particularly in midlife. METHODS In 2005, 2 measures of short-term HRV, the SD of normal-to-normal intervals (SDNN) and the root mean square of successive differences (RMSSD), were calculated for participants of the Coronary Artery Risk Development in Young Adults study, and then categorized into quartiles. Five years later, 3 cognitive tests were administered for verbal memory ("Rey Auditory-Verbal Learning Test", RAVLT, range 0-15), processing speed ("Digit Symbol Substitution Test", DSST, range 0-133), and executive function ("Stroop interference"). RESULTS Two thousand one hundred and eighteen participants (57.7% female, 42.2% Black) with a mean baseline age of 45.3 years were included in this analysis. In demographic-adjusted models, compared to participants with quartile 1 SDNN (lowest quartile), participants in the upper quartiles of SDNN scored better on the DSST (quartile 4: β = 1.83 points better, P = 0.03; and quartile 3: β = 1.95 points better, P = 0.03) and on the stroop (quartile 3: β = 1.19 points better, P < 0.05; and quartile2: β = 1.44 points better, P = 0.02). After adjusting for behavioral and cardiovascular risk factors, higher quartile SDNN remained significantly associated with better stroop score (quartile 3: β = 1.21 points better, P = 0.04; and quartile 2: β = 1.72 points better, P < 0.01) but not with DSST. There was no association between quartile of RMSSD and cognitive function, from fully adjusted models. CONCLUSIONS Our findings suggest that higher quartile SDDN is associated with better executive function in midlife, above, and beyond cardiovascular risk factors.
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Affiliation(s)
- Adina Zeki Al Hazzouri
- Division of Epidemiology, Department of Public Health Sciences, Miller School of Medicine, University of Miami, USA
| | - Tali Elfassy
- Division of Epidemiology, Department of Public Health Sciences, Miller School of Medicine, University of Miami, USA
| | - Mercedes R Carnethon
- Department of Preventive Medicine, Feinberg School of Medicine, Northwestern University, USA
| | - Donald M Lloyd-Jones
- Department of Preventive Medicine, Feinberg School of Medicine, Northwestern University, USA
| | - Kristine Yaffe
- Departments of Neurology, Psychiatry, Epidemiology and Biostatics, University of California San Francisco, USA
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Elias MF, Torres RV. The Renaissance of Heart Rate Variability as a Predictor of Cognitive Functioning. Am J Hypertens 2017; 31:21-23. [PMID: 28985282 DOI: 10.1093/ajh/hpx150] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/01/2017] [Accepted: 08/08/2017] [Indexed: 11/13/2022] Open
Affiliation(s)
- Merrill F Elias
- Department of Psychology and Graduate School of Biomedical Sciences and Engineering, University of Maine, USA
| | - Rachael V Torres
- Department of Kinesiology and Applied Physiology, College of Health Sciences, University of Delaware, USA
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Levendowski DJ, Ferini-Strambi L, Gamaldo C, Cetel M, Rosenberg R, Westbrook PR. The Accuracy, Night-to-Night Variability, and Stability of Frontopolar Sleep Electroencephalography Biomarkers. J Clin Sleep Med 2017; 13:791-803. [PMID: 28454598 PMCID: PMC5443740 DOI: 10.5664/jcsm.6618] [Citation(s) in RCA: 77] [Impact Index Per Article: 11.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/31/2017] [Revised: 03/11/2017] [Accepted: 03/22/2017] [Indexed: 12/21/2022]
Abstract
STUDY OBJECTIVES To assess the validity of sleep architecture and sleep continuity biomarkers obtained from a portable, multichannel forehead electroencephalography (EEG) recorder. METHODS Forty-seven subjects simultaneously underwent polysomnography (PSG) while wearing a multichannel frontopolar EEG recording device (Sleep Profiler). The PSG recordings independently staged by 5 registered polysomnographic technologists were compared for agreement with the autoscored sleep EEG before and after expert review. To assess the night-to-night variability and first night bias, 2 nights of self-applied, in-home EEG recordings obtained from a clinical cohort of 63 patients were used (41% with a diagnosis of insomnia/depression, 35% with insomnia/obstructive sleep apnea, and 17.5% with all three). The between-night stability of abnormal sleep biomarkers was determined by comparing each night's data to normative reference values. RESULTS The mean overall interscorer agreements between the 5 technologists were 75.9%, and the mean kappa score was 0.70. After visual review, the mean kappa score between the autostaging and five raters was 0.67, and staging agreed with a majority of scorers in at least 80% of the epochs for all stages except stage N1. Sleep spindles, autonomic activation, and stage N3 exhibited the least between-night variability (P < .0001) and strongest between-night stability. Antihypertensive medications were found to have a significant effect on sleep quality biomarkers (P < .02). CONCLUSIONS A strong agreement was observed between the automated sleep staging and human-scored PSG. One night's recording appeared sufficient to characterize abnormal slow wave sleep, sleep spindle activity, and heart rate variability in patients, but a 2-night average improved the assessment of all other sleep biomarkers. COMMENTARY Two commentaries on this article appear in this issue on pages 771 and 773.
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Affiliation(s)
| | - Luigi Ferini-Strambi
- Department of Clinical Neurosciences, San Raffaele Scientific Institute, Sleep Disorders Center, Università Vita-Salute San Raffaele, Milan, Italy
| | - Charlene Gamaldo
- Department of Neurology, Johns Hopkins University School of Medicine, Baltimore, Maryland
| | - Mindy Cetel
- Integrative Insomnia and Sleep Health Center, San Diego, California
| | - Robert Rosenberg
- Sleep Disorders Center of Prescott Valley, Prescott Valley, Arizona
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