Is there a link between heart rate variability and cognitive decline? A cross-sectional study on patients with mild cognitive impairment and cognitively healthy controls

Grässler, Bernhard; Dordevic, Milos; Darius, Sabine; Herold, Fabian; Forte, Giuseppe; Langhans, Corinna; Halfpaap, Nicole; Müller, Patrick; Glanz, Wenzel; Dantas, Estélio Henrique Martin; Böckelmann, Irina; Müller, Notger; Hökelmann, Anita

doi:10.1055/s-0042-1758862

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Original Article • Arq. Neuro-Psiquiatr. 81 (1) • 2023 • https://doi.org/10.1055/s-0042-1758862 copy

Is there a link between heart rate variability and cognitive decline? A cross-sectional study on patients with mild cognitive impairment and cognitively healthy controls

Existe uma ligação entre a variabilidade da frequência cardíaca e o declínio cognitivo? Um estudo transversal em pacientes com deficiência cognitiva leve e controles cognitivos saudáveis

Authorship SCIMAGO INSTITUTIONS RANKINGS

Abstract

Background

Given that, up to date, there is no effective strategy to treat dementia, a timely start of interventions in a prodromal stage such as mild cognitive impairment (MCI) is considered an important option to lower the overall societal burden. Although autonomic functions have been related to cognitive performance, both aspects have rarely been studied simultaneously in MCI.

Objective

The aim of the present study was to investigate cardiac autonomic control in older adults with and without MCI.

Methods

Cardiac autonomic control was assessed by means of heart rate variability (HRV) at resting state and during cognitive tasks in 22 older adults with MCI and 29 healthy controls (HCs). Resting HRV measurement was performed for 5 minutes during a sitting position. Afterwards, participants performed three PC-based tasks to probe performance in executive functions and language abilities (i.e., Stroop, N-back, and a verbal fluency task).

Results

Participants with MCI showed a significant reduction of HRV in the frequency-domain (high frequency power) and nonlinear indices (SD2, D2, and DFA1) during resting state compared to HCs. Older individuals with MCI exhibited decreases in RMSSD and increases in DFA1 from resting state to Stroop and N-back tasks, reflecting strong vagal withdrawal, while this parameter remained stable in HCs.

Conclusion

The results support the presence of autonomic dysfunction at the early stage of cognitive impairment. Heart rate variability could help in the prediction of cognitive decline as a noninvasive biomarker or as a tool to monitor the effectiveness of therapy and prevention of neurodegenerative diseases.

Keywords
Heart Rate; Cognitive Dysfunction; Cognition; Autonomic Nervous System Diseases

Variable	MCI (n= 22)	HC (n= 29)	p-value	Effect size d
Age (years old)	70.19 ± 6.04	68.18 ± 6.73	0.276 ^a	0.312
Male/female (n)	10/12	6/23	0.074 ^b	0.548
BMI (kg/m²)	25.21 ± 2.05	24.95 ± 3.40	0.734 ^a	0.090
Education (years)	14.18 ± 1.99	14.62 ± 1.80	0.414 ^a	0.234
CERAD (z-score)	-0.62 ± 0.36	0.03 ± 0.35	< 0.001*** ^a	1.834
MMSE (score)	26.41 ± 0.67	28.72 ± 0.80	< 0.001*** ^a	3.092
Reaction time Stroop congruent (ms)	1.041 ± 0.150	0.909 ± 0.172	0.006** ^a	0.727
Error rate Stroop congruent (%)	2.58 ± 2.80	1.49 ± 1.36	0.107 ^a	0.519
Reaction time Stroop incongruent (ms)	1.638 ± 0.554	1.128 ± 0.262	0.001** ^a	1.234
Error rate Stroop incongruent (%)	22.15 ± 29.12	2.59 ± 2.73	0.005** ^a	1.020
Reaction time Stroop mix (ms)	1.312 ± 0.334	1.019 ± 0.256	0.001** ^a	0.906
Error rate Stroop mix (%)	8.11 ± 15.03	1.55 ± 2.09	0.055 ^a	0.658
Reaction time 0-back (ms)	0.489 ± 0.059	0.460 ± 0.060	0.095 ^a	0.487
Error rate 0-back (%)	0.15 ± 0.49	0.00 ± 0.00	0.162 ^a	0.468
Reaction time 1-back (ms)	0.525 ± 0.101	0.471 ± 0.085	0.044* ^a	0.586
Error rate 1-back (%)	0.15 ± 0.49	0.06 ± 0.31	0.406 ^a	0.227
Reaction time 2-back (ms)	0.637 ± 0.133	0.561 ± 0.117	0.035* ^a	0.612
Error rate 2-back (%)	4.55 ± 5.02	3.05 ± 3.40	0.381 ^a	0.360
A… (n)	6.23 ± 1.69	6.83 ± 1.91	0.249 ^a	0.330
F… (n)	7.05 ± 1.94	8.48 ± 2.84	0.037* ^a	0.521
P… (n)	5.55 ± 2.26	6.76 ± 2.37	0.071 ^a	0.521
Sum letter (n)	18,.82 ± 3.50	22.07 ± 5.66	0.011 * ^a	0.691
Forenames (n)	11.73 ± 3.01	16.14 ± 3.86	< 0.001*** ^a	1.130
Fruits (n)	9.27 ± 2.39	10.69 ± 2.35	0.039* ^a	0.540
Flowers (n)	7.45 ± 2.09	9.52 ± 2.65	0.004** ^a	0.767
Sum category (n)	28.45 ± 5.09	36.34 ± 6.79	< 0.001*** ^a	1.315

Variable	MCI (n= 22)	HC (n= 29)	p-value	Effect size d
mHR (bpm)	65.96 ± 7.82	63.98 ± 7.16	0.352	0.266
SDNN (ms)	21.62 ± 8.50	28.56 ± 14.49	0.051	0.565
RMSSD (ms)	25.05 ± 10.49	27.57 ± 15.13	0.507	0.189
LF (ms²)	214.07 ± 312.20	542.91 ± 800.37	0.075	0.515
HF (ms²)	162.00 ± 107.28	283.70 ± 295.74	0.048*	0.519
TP (ms²)	428.14 ± 424.21	906.58 ± 1033.20	0.030*	0.577
LF/HF	1.51 ± 1.55	2.58 ± 3.32	0.171	0.395
SD2 (ms)	24.24 ± 11.14	35.03 ± 18.07	0.017*	0.697
D2	0.47 ± 0.92	1.20 ± 1.42	0.030*	0.593
DFA1	0.84 ± 0.33	1.05 ± 0.29	0.017*	0.682

Condition	Variable	Group difference (95%CI)
Baseline	mHR (bpm)	1.98 (−2.38, 6.05)
	SDNN (ms)	−6.94 (−12.82, 1.24)
	RMSSD (ms)	−2.52 (−9.23, 6,25)
	D2	−0.73 (−1.25, 0.08)
	DFA1	−0.21 (−0.40, −0.04)
Condition	Variable	Group difference (95% CI)	*p-value*	Effect size η2
Stroop congruent	mHR (bpm)	1.24 (−3.15, 5.84)	0.653	0.004
	SDNN (ms)	−7.88 (−15.81, 1.13)	0.509	0.009
	RMSSD (ms)	−8.32 (−18.40, 1.29)	0.052	0.078
	D2	−0.48 (−1.10, 0.16)	0.703	0.003
	DFA1	0.01 (−0.08, 0.18)	0.006**	0.150
Stroop incongruent	mHR (bpm)	1.12 (−3.49, 6.01)	0.651	0.004
	SDNN (ms)	−3.04 (−10.02, 5.19)	0.378	0.017
	RMSSD (ms)	−5.82 (−13.18, 0.32)	0.147	0.044
	D2	−0.45 (−0.93, 0.12)	0.526	0.009
	DFA1	0.13 (0.02, 0.33)	0.001**	0.206
Stroop mix	mHR (bpm)	0.91 (−3.26, 5.42)	0.504	0.010
	SDNN (ms)	−8.71 (−15.82, −0.48)	0.409	0.015
	RMSSD (ms)	−8.62 (−16.20, −1.04)	0.011*	0.131
	D2	−0.62 (−1.18, 0.02)	0.981	0.000
	DFA1	0.10 (−0.01, 0.29)	< 0.001***	0.236
0-back	mHR (bpm)	1.24 (−2.56, 5.40)	0.677	0.004
	SDNN (ms)	−7.31 (−15.93, 3.79)	0.925	0.000
	RMSSD (ms)	−6.73 (−17.61, 5.15)	0.225	0.031
	D2	−0.48(−1.00, 0.16)	0.615	0.005
	DFA1	0.03 (−0.10, 0.25)	0.004**	0.160
1-back	mHR (bpm)	0.56 (−3.33, 4.58)	0.249	0.028
	SDNN (ms)	−8.56(−16.11, 0.96)	0.409	0.015
	RMSSD (ms)	−9.02 (−17.75, 0.59)	0.031*	0.095
	D2	−0.55 (−1.09, 0.04)	0.870	0.001
	DFA1	0.05 (−0.07, 0.21)	0.002**	0.183
2-back	mHR (bpm)	0.93 (−3.02, 5.23)	0.565	0.007
	SDNN (ms)	−8.86 (−17.08, 0.33)	0.300	0.023
	RMSSD (ms)	−8.29 (−18.71, 1.65)	0.041*	0.086
	D2	−0.50 (−0.97, −0.01)	0.765	0.002
	DFA1	−0.09 (−0.20, 0.06)	0.106	0.055
VFT letter	mHR (bpm)	−1.23 (−4.62, 3.39)	0.146	0.045
	SDNN (ms)	−2.57 (−9.47, 3.60)	0.398	0.015
	RMSSD (ms)	−1.18 (−8.74, 4.87)	0.900	0.000
	D2	−0.40 (−1.17, 0.30)	0.726	0.003
	DFA1	0.00 (−0.09, 0.13)	0.015*	0.120
VFT category	mHR (bpm)	−1.56 (−5.41, 3.28)	0.111	0.053
	SDNN (ms)	−3.23 (−10.95, 2.64)	0.699	0.003
	RMSSD (ms)	−1.62 (−11.55, 4.79)	0.729	0.003
	D2	−0.67 (−1.44, −0.50)	0.742	0.002
	DFA1	−0.01 (−0.12, 0.16)	0.044*	0.083

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[1] Address for correspondence Bernhard Grässler (email: bernhard.graessler@ovgu.de).