Focusing neurovisceral integration: cognition, heart rate variability, and cerebral blood flow

Development and Validation of a Machine Learning Model for Early Prediction of Delirium in Intensive Care Units Using Continuous Physiological Data: Retrospective Study

BACKGROUND

Delirium in intensive care unit (ICU) patients poses a significant challenge, affecting patient outcomes and health care efficiency. Developing an accurate, real-time prediction model for delirium represents an advancement in critical care, addressing needs for timely intervention and resource optimization in ICUs.

OBJECTIVE

We aimed to create a novel machine learning model for delirium prediction in ICU patients using only continuous physiological data.

METHODS

We developed models integrating routinely available clinical data, such as age, sex, and patient monitoring device outputs, to ensure practicality and adaptability in diverse clinical settings. To confirm the reliability of delirium determination records, we prospectively collected results of Confusion Assessment Method for the ICU (CAM-ICU) evaluations performed by qualified investigators from May 17, 2021, to December 23, 2022, determining Cohen κ coefficients. Participants were included in the study if they were aged ≥18 years at ICU admission, had delirium evaluations using the CAM-ICU, and had data collected for at least 4 hours before delirium diagnosis or nondiagnosis. The development cohort from Yongin Severance Hospital (March 1, 2020, to January 12, 2022) comprised 5478 records: 5129 (93.62%) records from 651 patients for training and 349 (6.37%) records from 163 patients for internal validation. For temporal validation, we used 4438 records from the same hospital (January 28, 2022, to December 31, 2022) to reflect potential seasonal variations. External validation was performed using data from 670 patients at Ajou University Hospital (March 2022 to September 2022). We evaluated machine learning algorithms (random forest [RF], extra-trees classifier, and light gradient boosting machine) and selected the RF model as the final model based on its performance. To confirm clinical utility, a decision curve analysis and temporal pattern for model prediction during the ICU stay were performed.

RESULTS

The κ coefficient between labels generated by ICU nurses and prospectively verified by qualified researchers was 0.81, indicating reliable CAM-ICU results. Our final model showed robust performance in internal validation (area under the receiver operating characteristic curve [AUROC]: 0.82; area under the precision-recall curve [AUPRC]: 0.62) and maintained its accuracy in temporal validation (AUROC: 0.73; AUPRC: 0.85). External validation supported its effectiveness (AUROC: 0.84; AUPRC: 0.77). Decision curve analysis showed a positive net benefit at all thresholds, and the temporal pattern analysis showed a gradual increase in the model scores as the actual delirium diagnosis time approached.

CONCLUSIONS

We developed a machine learning model for delirium prediction in ICU patients using routinely measured variables, including physiological waveforms. Our study demonstrates the potential of the RF model in predicting delirium, with consistent performance across various validation scenarios. The model uses noninvasive variables, making it applicable to a wide range of ICU patients, with minimal additional risk.

Effects of Exergame Training on Executive Function and Heart Rate Variability in Middle-Aged and Older Adults: A Randomized Controlled Study

Exergame has become widely popular and offers great levels of cognitive demands, thus may facilitate cognitive benefits. In addition, researchers have proposed that cardiac autonomic function, assessed via heart rate variability (HRV), is associated with cognitive executive function. However, few exergame training studies have investigated this relationship. This study aimed to investigate the effects of 10-week exergame training on executive function and HRV in middle-aged and older adults. Ninety-one participants were randomly assigned to either an exergame training group (63.73 ± 4.48 years) or a control group (62.46 ± 4.77 years). The training program was 50 min per session, twice per week for 10 weeks. The control group was instructed to maintain their usual lifestyle. All participants completed questionnaires and received assessments of executive functions and electrocardiography at baseline and postintervention. Results revealed significant group-by-time interaction effects for the three indices of the digit span test and the total initiation time of the Tower of London task with better postintervention performances achieved by the exergame group. The 6 min walk test also improved significantly in the exergame group but not in the control group. No significant change in HRV was observed for both groups. There were significant correlations between HRV and digit span test scores. Our results suggest that the 10-week exergame training program was effective in improving executive functions of working memory, inhibitory control, and planning ability as well as aerobic fitness in middle-aged and older adults. Moreover, HRV was associated with improved executive function.

The intricate brain-heart connection: The relationship between heart rate variability and cognitive functioning

In the last years, there has been a growing interest in the brain-heart connection. A core aspect of this connection appears to be the autonomic nervous system, particularly through the vagus nerve. Accordingly, vagally mediated heart rate variability (vmHRV) is currently considered as an index of top-down control processes involved in cognition and emotion regulation. Recent evidence indicates that higher vmHRV is associated with enhanced cognitive performance across multiple domains, such as executive functions, memory, attention, and language skills. From this premises, this study examined the relationship between cardiac vagal tone, as indicated by heart rate variability (vmHRV), and cognitive functions. A sample of 143 healthy young adults completed a comprehensive neuropsychological battery. The results revealed a strong correlation between resting vmHRV and cognitive functions, particularly in executive processes. Participants with higher resting vagal tone showed superior cognitive performance in tasks requiring cognitive control, motor and cognitive inhibition, cognitive flexibility, and working memory in comparison to those with lower resting vagal tone. Furthermore, vagal-mediated heart rate variability was also found to be associated with memory, attention, and executive performance. The current research provides new insights into the interactions between cognitive and autonomic systems, further supporting evidence for body-brain interactions.

The Effect of Yoga Nidra Intervention on Blood Pressure and Heart Rate Variability Among Hypertensive Adults: A Single-arm Intervention Trial

Background Hypertension [blood pressure (BP) >130/80 mmHg] contributes significantly to cardiovascular morbidity and mortality. Lifestyle modifications, including mindfulness-based practices like Yoga, meditation, and relaxation techniques, have emerged as promising adjuncts to pharmacotherapy. This study aimed to explore the acute effects of Yoga Nidra (YN) on BP in essential hypertension and the potential mechanisms of the effect of YN on BP, in the form of changes in heart rate variability (HRV) components. Methods A total of 32 hypertensive individuals (mean age: 43 ±0.54 years; 22 males, 10 females) were enrolled at the Lifestyle Disease Clinic. Patients were provided regular consultation and pharmacotherapy. BP and HRV were assessed before and after a 16-minute YN session. HRV parameters included time and frequency domain measures. Statistical analysis included linear regression to study the relationship of components of HRV with those of the changes in BP. Results Following YN intervention, there was a significant reduction in both systolic BP (SBP) (7 mmHg) and diastolic BP (DBP) (6 mmHg). HRV analysis revealed significant increases. Regression analysis showed changes in SBP having significant coefficients. Conclusions A single session of YN reduced the systolic and diastolic BP and increased HRV parameters. Regression analyses showed that the reduction in BP can be explained by an increase in HRV parameters. Thus, this study demonstrates the positive effect of YN as an intervention for essential hypertension and also the potential mechanisms behind it, which can be explained by the Neurovisceral Integration Model.

Insight and non-insight problem solving: A heart rate variability study

Occasionally, problems are solved with a sudden Aha! moment (insight), while the mundane approach to solving problems is analytical (non-insight). At first glance, non-insight appears to depend on the availability and taxation of cognitive resources to execute the step-by-step approach, whereas insight does not, or to a lesser extent. However, this remains debated. To investigate the reliance of both solution types on cognitive resources, we assessed the involvement of the prefrontal cortex using vagally mediated heart rate variability (vmHRV) as an index. Participants (N = 68) solved 70 compound remote associates word puzzles solvable with insight and non-insight. Before, during, and after solving the word puzzles, we measured the vmHRV. Our results showed that resting-state vmHRV (trait) showed a negative association with behavioural performance for both solution types. This might reflect inter-individual differences in inhibitory control. As the solution search requires one to think of remote associations, inhibitory control might hamper rather than aid this process. Furthermore, we observed, for both solution types, a vmHRV increase from resting-state to solution search (state), lingering on in the post-task recovery period. This could mark the increase of prefrontal resources to promote an open-minded stance, essential for divergent thinking, which arguably is crucial for this task. Our findings suggest that, at a general level, both solution types share common aspects. However, a closer analysis of early and late solutions and puzzle difficulty suggested that metacognitive differentiation between insight and non-insight improved with higher trait vmHRV, and that a unique association between trait vmHRV and puzzle difficulty was present for each solution type.

Unveiling the acute neurophysiological responses to strength training: An exploratory study on novices performing weightlifting bouts with different motor learning models

Currently, there is limited evidence regarding various neurophysiological responses to strength exercise and the influence of the adopted practice schedule. This study aimed to assess the acute systemic effects of snatch training bouts, employing different motor learning models, on skill efficiency, electric brain activity (EEG), heart rate variability (HRV), and perceived exertion as well as mental demand in novices. In a within-subject design, sixteen highly active males (mean age: 23.13 ± 2.09 years) randomly performed snatch learning bouts consisting of 36 trials using repetitive learning (RL), contextual interference (blocked, CIb; and serial, CIs), and differential learning (DL) models. Spontaneous resting EEG and HRV activities were recorded at PRE and POST training bouts while measuring heart rate. Perceived exertion and mental demand were assessed immediately after, and barbell kinematics were recorded during three power snatch trials performed following the POST measurement. The results showed increases in alpha, beta, and gamma frequencies from pre- to post-training bouts in the majority of the tested brain regions (p values ranging from < 0.0001 to 0.02). The CIb model exhibited increased frequencies in more regions. Resting time domain HRV parameters were altered following the snatch bouts, with increased HR (p < 0.001) and decreased RR interval (p < 0.001), SDNN, and RMSSD (p values ranging from < 0.0001 to 0.02). DL showed more pronounced pulse-related changes (p = 0.01). Significant changes in HRV frequency domain parameters were observed, with a significant increase in LFn (p = 0.03) and a decrease in HFn (p = 0.001) registered only in the DL model. Elevated HR zones (> HR zone 3) were more dominant in the DL model during the snatch bouts (effect size = 0.5). Similarly, the DL model tended to exhibit higher perceived physical (effect size = 0.5) and mental exertions (effect size = 0.6). Despite the highest psycho-physiological response, the DL group showed one of the fewest significant EEG changes. There was no significant advantage of one learning model over the other in terms of technical efficiency. These findings offer preliminary support for the acute neurophysiological benefits of coordination-strength-based exercise in novices, particularly when employing a DL model. The advantages of combining EEG and HRV measurements for comprehensive monitoring and understanding of potential adaptations are also highlighted. However, further studies encompassing a broader range of coordination-strength-based exercises are warranted to corroborate these observations.

Resting heart rate causally affects the brain cortical structure: Mendelian randomization study

Resting heart rate (RHR) has been linked to impaired cortical structure in observational studies. However, the extent to which this association is potentially causal has not been determined. Using genetic data, this study aimed to reveal the causal effect of RHR on brain cortical structure. A Two-Sample Mendelian randomization (MR) analysis was conducted. Sensitivity analyses, weighted median, MR Pleiotropy residual sum and outlier, and MR-Egger regression were conducted to evaluate heterogeneity and pleiotropy. A causal relationship between RHR and cortical structures was identified by MR analysis. On the global scale, elevated RHR was found to decrease global surface area (SA; P < 0.0125). On a regional scale, the elevated RHR significantly decreased the SA of pars triangularis without global weighted (P = 1.58 × 10-4) and the thickness (TH) of the paracentral with global weighted (P = 3.56 × 10-5), whereas it increased the TH of banks of the superior temporal sulcus in the presence of global weighted (P = 1.04 × 10-4). MR study provided evidence that RHR might be causally linked to brain cortical structure, which offers a different way to understand the heart-brain axis theory.

Physiological Indicators of Fluency and Engagement during Sequential and Simultaneous Modes of Human-Robot Collaboration

OCCUPATIONAL APPLICATIONSAn understanding of fluency in human-robot teaming from a physiological standpoint is still incomplete. In our experimental study involving 24 participants, we designed a scenario for shared-space human-robot collaboration (HRC) for a material sorting task. When compared to a sequential mode of interaction, the simultaneous mode resulted in significantly higher perceptions of fluency and engagement, primarily by reducing human idle time. These observations were complemented by significant changes in physiological responses, such as ECG entropy and low frequency power. These responses could predict fluency and engagement with accuracies of 90 and 97%, respectively. Notably, the perception of fluency and preferred mode of interaction were influenced by individual preferences. Hence, it is crucial to consider both physiological responses and user preferences when designing HRC systems, to ensure a positive experience with the robot teammate and to foster engagement in long-term teamwork. Furthermore, these signals can be obtained using a single robust, low-cost, and comfortable sensor.

Effects of Aerobic Exercise Combined With Attentional Bias Modification in the Care of Male Patients With a Methamphetamine Use Disorder

OBJECTIVE

It remains unclear which individual or combined strategies are most beneficial for methamphetamine use disorders (MUDs). We compared the effects of aerobic exercise, attentional bias modification, and combined intervention on male patients with MUD.

METHOD

One hundred male patients with MUD were randomly assigned to combined intervention, aerobic exercise, attentional bias modification, or control groups (25 patients per group). The 8-week intervention protocol included three 60-minute sessions of aerobic exercises per week. Primary outcomes included high- and low-frequency heart rate variability, executive function, and cardiorespiratory fitness measured by customized software, computerized tests, and the Harvard step test, respectively. Secondary outcomes included psychiatric symptoms, drug craving, training acceptability, and persistence.

RESULTS

Participant characteristics were matched between groups at baseline. Executive function, heart rate variability, cardiorespiratory fitness, drug craving, and most psychiatric symptoms had significant time-group interactions at posttest (p < .05, η2 = .08-.28). Compared with the attentional bias modification and control groups, the combined intervention and aerobic exercise groups improved significantly in executive function, heart rate variability, cardiorespiratory fitness, and most secondary outcomes. In addition, high-frequency heart rate variability and cardiorespiratory fitness in the aerobic exercise group were significantly higher than those in the combined intervention group.

CONCLUSIONS

Combination strategies showed comparable efficacy to aerobic exercise alone in improving executive function, psychiatric symptoms, and drug craving and significantly exceeded other conditions. For heart rate variability and cardiorespiratory fitness, aerobic exercise alone was the most effective. For acceptability and persistence, combination strategies were preferred over single-domain training and health education intervention.

Clinical analysis of patients with hemodynamic depression after carotid artery stenting

Hemodynamic depression (HD) is a complication after carotid artery stenting (CAS). However, there are existing controversies in predicting postoperative risk factors and subsequent clinical outcomes, especially in high-risk patients. Therefore, the present study aimed to investigate the rate of incidence, clinical predictors, and clinical significance associated with persistent HD (p-HD) pathology, as well as obstinate persistent HD (op-HD) after CAS in our center. We retrospectively analyzed 162 consecutively recruited carotid arteriosclerotic stenosis (CASS) patients who received interventional therapy in our hospital between September 2020 and September 2022. The acute/subacute effects of proximal internal CAS on p-HD and op-HD were studied to explore the relationship between CAS and perioperative adverse events. Logistic regression analysis was performed to identify independent predictors of p-HD after CAS. Pathological associations between p-HD/op-HD and clinical events at the 30-day time point were analyzed. Of 162 patients, 18.5 % (n = 30) patients had p-HD, while op-HD was observed in 5.6 % (n = 9) of patients. Hypertension (OR: 8.73; 95 % CI: 1.05-72.90; P = 0.045), history of stroke/transient ischemic attack (TIA) (OR: 4.05; 95 % CI: 1.55-10.59; P = 0.004), coronary artery disease (CAD) (OR: 3.38; 95 % CI: 1.29-8.89; P = 0.013), and distance from the carotid bifurcation to the lesion with maximum stenosis (OR: 2.467; 95 % CI: 1.02-5.93; P = 0.044) were significantly associated with p-HD onset. Patients with either p-HD or op-HD suffered from longer intensive care unit (ICU) stays (all P < 0.001) and were associated with a higher risk of stroke (P = 0.003; P < 0.001). Our data suggest that hypertension, previous stroke/TIA, CAD, and distance from the carotid bifurcation to the lesion with maximum stenosis may play roles in the development of p-HD after CAS. Moreover, this study indicates that either p-HD/op-HD can be associated with the risk of clinical adverse events, especially stroke.

Impact of Cardiac Autonomic Dysfunction on Cognitive Event-Related Potential in Type 2 Diabetes Mellitus Patients: A Cross-Sectional Study

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.

Dysregulation of the autonomic nervous system in adult attention deficit hyperactivity disorder. A systematic review

Background: Adult Attention Deficit Hyperactivity Disorder (aADHD) is characterised by inattention, hyperactivity, impulsivity, and emotional instability, all of which were linked to altered modulation of the autonomic nervous system. This and the clinical effectiveness of sympathomimetic medication raised the question if autonomic modulation is altered in aADHD patients.Methods: We systematically searched PubMed, Cochrane Library, and Web Of Science for publications investigating autonomic modulation in aADHD and controls during resting-state and/or under task conditions.Results: We reviewed 15 studies involving 846 participants (424 aADHD and 422 controls), including 4 studies on sympathetic tone at rest, 13 studies on sympathetic modulation during tasks, 3 studies on resting state parasympathetic modulation and 3 papers on task-related parasympathetic modulation. Studies comprised measurements of electrodermal activity, heart rate variability, blood pressure variability, blood volume pulse, pre-ejection period, and baroreflex sensitivity. 2 studies reported reduced sympathetic tone in aADHD; 7 papers described lower sympathetic reactivity to task demands in this cohort. One study linked aADHD to impaired vagal tone, while no indications of altered tasks-related parasympathetic reactivity in aADHD patients were reported.Conclusion: The reviewed data revealed impaired cardiovascular autonomic modulation in aADHD patients, predominantly in sympathetic modulation and during stress exposure.

High-trait anxious individuals show positive relationship between HRV and threat vigilance

Selectively attending to threat-related stimuli in the environment, known as threat bias (TB), is a prominent feature of anxiety. Individuals with high anxiety also tend to show lower heart rate variability (HRV), a reflection of reduced parasympathetic cardiac control. Previous investigations have established associations between low HRV and various attentional processes that facilitate attention to threat, though these have primarily been conducted among non-anxious individuals. The current analysis, derived from a larger TB modification study, examined the relationship between TB and HRV among a young, nonclinical sample of individuals with either high or low trait anxiety (HTA, LTA, respectively; M_age  = 25.8, SD = 13.2, 61.3% female). Consistent with expectations, HTA (β = -.18, p = .087) trended toward an association with higher threat vigilance. A significant moderation effect showed the relationship between HRV and threat vigilance was influenced by TA (β = .42, p = .004). Simple slopes analysis revealed that for the LTA group, lower HRV trended toward higher threat vigilance (p = .123), consistent with expectations. However, this relationship was unexpectedly reversed for the HTA group, for whom higher HRV was a significant predictor of higher threat vigilance (p = .015). These results are interpreted within a cognitive control framework, in which regulatory ability, as assessed via HRV, may influence which cognitive strategy is employed when encountering threatening stimuli. Results suggest that HTA individuals with greater regulatory ability may employ a contrast avoidance mechanism, while those with reduced regulatory ability engage in cognitive avoidance.

Effects of a Randomised Trial of 5-Week Heart Rate Variability Biofeedback Intervention on Cognitive Function: Possible Benefits for Inhibitory Control

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.

Associations between Autonomic Function and Cognitive Performance among Patients with Cerebral Small Vessel Disease

Data linking heart rate variability (HRV) and cognitive status remains controversial and scarce, particularly in cerebral small vessel disease (CSVD) patients. Whether the association between HRV and cognitive performance exists in CSVD patients is unclear. Hence, we aimed to investigate the association between HRV and cognitive performance in patients with CSVD. This cross-sectional study was conducted among 117 CSVD patients. All patients underwent HRV assessment and global cognitive evaluation by the Mini-Mental-State Examination (MMSE) and Montreal Cognitive Assessment (MoCA). Multivariable analyses were performed to evaluate the association between HRV and cognitive status. The mean age of study population was 59.5 ± 11.8 years and 39.3% were female. After adjusting for confounding factors, a higher high frequency (HF) norm was independently associated with better MMSE scores (β = 0.051; 95% confidence interval (CI): 0.012~0.090; p = 0.011) and MoCA scores (β = 0.061; 95% CI: 0.017~0.105; p = 0.007), while a higher low frequency (LF)/HF ratio was independently associated with worse MMSE scores (β = -0.492; 95% CI: -0.893~-0.092; p = 0.017) and MoCA scores (β = -0.691; 95% CI: -1.134~-0.248; p = 0.003). The HF norm was positively associated with global cognitive performance, whereas the LF/HF ratio was negatively associated with global cognitive performance among CSVD patients. Further study of the relationship between autonomic function and cognitive performance is warranted.

Characterizing cardiac autonomic dynamics of fear learning in humans

Understanding transient dynamics of the autonomic nervous system during fear learning remains a critical step to translate basic research into treatment of fear-related disorders. In humans, it has been demonstrated that fear learning typically elicits transient heart rate deceleration. However, classical analyses of heart rate variability (HRV) fail to disentangle the contribution of parasympathetic and sympathetic systems, and crucially, they are not able to capture phasic changes during fear learning. Here, to gain deeper insight into the physiological underpinnings of fear learning, a novel frequency-domain analysis of heart rate was performed using a short-time Fourier transform, and instantaneous spectral estimates extracted from a point-process modeling algorithm. We tested whether spectral transient components of HRV, used as a noninvasive probe of sympathetic and parasympathetic mechanisms, can dissociate between fear conditioned and neutral stimuli. We found that learned fear elicited a transient heart rate deceleration in anticipation of noxious stimuli. Crucially, results revealed a significant increase in spectral power in the high frequency band when facing the conditioned stimulus, indicating increased parasympathetic (vagal) activity, which distinguished conditioned and neutral stimuli during fear learning. Our findings provide a proximal measure of the involvement of cardiac vagal dynamics into the psychophysiology of fear learning and extinction, thus offering new insights for the characterization of fear in mental health and illness.

Unraveling the cognitive correlates of heart rate variability with the drift diffusion model

The Neurovisceral Integration Model posits a link between resting vagally mediated heart rate variability (vmHRV) and cognitive control. Empirical support for this link is mixed, potentially due to coarse performance metrics such as mean response time (RT). To clarify this issue, we tested the relationships between resting vmHRV and refined estimates of cognitive control- as revealed by the ex-Gaussian model of RT and, to a greater extent, the drift diffusion model (DDM, a computational model of two-choice performance). Participants (N = 174) completed a five-minute resting baseline while ECG was collected followed by a Simon spatial conflict task. The root mean square of successive differences in interbeat intervals was calculated to index resting vmHRV. Resting vmHRV was unrelated to Simon's mean RT and accuracy rates, but was inversely related to the ex-Gaussian parameter reflecting slow RTs (tau); however, this finding was attenuated after adjustment for covariates. High resting vmHRV was related to faster drift rates and slower non-decision times, DDM parameters reflecting goal-directed cognition and sensorimotor processes, respectively. The DDM effects survived covariate adjustment and were specific to incongruent trials (i.e., when cognitive control demands were high). Findings suggest a link between vmHRV and cognitive control vis-a-vis drift rate, and potentially, a link between vmHRV and motoric inhibition vis-a-vis non-decision time. These cognitive correlates would have been missed with reliance on traditional performance. Findings are discussed with respect to the inhibitory processes that promote effective performance in high vmHRV individuals.

Inhibitory Control and Brain–Heart Interaction: An HRV-EEG Study

Background: Motor inhibition is a complex cognitive function regulated by specific brain regions and influenced by the activity of the Central Autonomic Network. We investigate the two-way Brain–Heart interaction during a Go/NoGo task. Spectral EEG ϑ, α powerbands, and HRV parameters (Complexity Index (CI), Low Frequency (LF) and High Frequency (HF) powers) were recorded. Methods: Fourteen healthy volunteers were enrolled. We used a modified version of the classical Go/NoGo task, based on Rule Shift Cards, characterized by a baseline and two different tasks of different complexity. The participants were divided into subjects with Good (GP) and Poor (PP) performances. Results: In the baseline, CI was negatively correlated with α/ϑ. In task 1, the CI was negatively correlated with the errors and α/ϑ, while the errors were positively correlated with α/ϑ. In task 2, CI was negatively correlated with the Reaction Time and positively with α, and the errors were negatively correlated with the Reaction Time and positively correlated with α/ϑ. The GP group showed, at baseline, a negative correlation between CI and α/ϑ. Conclusions: We provide a new combined Brain–Heart model underlying inhibitory control abilities. The results are consistent with the complementary role of α and ϑ oscillations in cognitive control.

Subjective memory in adults over 50 years of age: associations with affective and physiological markers of emotion regulation

OBJECTIVES

To examine associations among subjective memory reports, psychophysiological markers of emotion regulation, and cognitive performance in healthy adults over 50 years of age.

METHOD

A cross-sectional laboratory study was conducted with healthy, community-dwelling, non-depressed adults (M age = 60.4 years, SD = 8.4). The Metamemory in Adulthood (MIA) questionnaire provided reports of subjective memory capacity and stability (versus decline) and anxiety about memory. Poorer emotion regulation was marked by greater negative affect (NA) and lower high frequency heart rate variability (HF-HRV) responses to a challenging working memory task. Regression models were used to identify associations between subjective memory and emotion regulation markers, and structural equation modeling was used to explore whether emotion regulation mediated associations between subjective memory and objective task performance.

RESULTS

A total of 115 participants were included in the final sample. Subjective memory decline (indicated by lower scores on memory stability) was associated with lower HF-HRV response and worse working memory performance. Poorer subjective memory capacity and more anxiety about memory were both associated with greater negative affect in response to the working memory task. There was an indirect effect of subjective memory capacity on working memory performance through negative affect response.

CONCLUSIONS

The findings here suggest that worse subjective memory may signal reduced capacity for emotion regulation. Along with known cognitive risks of depression and anxiety, more subtle emotion regulation difficulties may be involved in pathways of poor cognitive aging.

Analysis of Heart Rate Variability and Game Performance in Normal and Cognitively Impaired Elderly Subjects Using Serious Games

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.

Brain-Heart Link in Schizophrenia: Cognitive Inhibitory Control Deficit in Patients Is Specifically Related to Parasympathetic Dysregulation

BACKGROUND

This study examined the connection between two prominent deficits in schizophrenia: the deficit in parasympathetic regulation and the deficit in cognitive inhibitory control, within the framework of the Neurovisceral Integration Model (NIM).

STUDY DESIGN

Thirty healthy controls and 30 patients with schizophrenia performed the internationally standardized antisaccade protocol while their electrocardiographic data were recorded. The interaction between the group, the cognitive inhibitory control as measured with error rate (ER) in the antisaccade task and parasympathetic activity as measured with the High Frequency power component of Heart Rate Variability (HF-HRV) was tested.

STUDY RESULTS

Findings confirmed that decreased HF-HRV was specifically related to increased ER in patients with schizophrenia. In contrast, patient deficits in other oculomotor function measures such as reaction time and reaction time variability related to volitional movement control and cognitive stability respectively were not linked to the deficit in parasympathetic regulation.

CONCLUSIONS

Our study validates the theory behind NIM proposing that cognitive inhibition has common physiological substrate with parasympathetic regulation. Future research could test this brain-heart link in other mental disorders especially those with a prominent deficit in inhibitory cognitive function.

Acute Prenatal Hypoxia in Rats Affects Physiology and Brain Metabolism in the Offspring, Dependent on Sex and Gestational Age

Hypoxia is damaging to the fetus, but the developmental impact may vary, with underlying molecular mechanisms unclear. We demonstrate the dependence of physiological and biochemical effects of acute prenatal hypoxia (APH) on sex and gestational age. Compared to control rats, APH on the 10th day of pregnancy (APH-10) increases locomotion in both the male and female offspring, additionally increasing exploratory activity and decreasing anxiety in the males. Compared to APH-10, APH on the 20th day of pregnancy (APH-20) induces less behavioral perturbations. ECG is changed similarly in all offspring only by APH-10. Sexual dimorphism in the APH outcome on behavior is also observed in the brain acetylation system and 2-oxoglutarate dehydrogenase reaction, essential for neurotransmitter metabolism. In view of the perturbed behavior, more biochemical parameters in the brains are assessed after APH-20. Of the six enzymes, APH-20 significantly decreases the malic enzyme activity in both sexes. Among 24 amino acids and dipeptides, APH-20 increases the levels of only three amino acids (Phe, Thr, and Trp) in male offspring, and of seven amino acids (Glu, Gly, Phe, Trp, Ser, Thr, Asn) and carnosine in the female offspring. Thus, a higher reactivity of the brain metabolism to APH stabilizes the behavior. The behavior and brain biochemistry demonstrate sexually dimorphic responses to APH at both gestational stages, whereas the APH effects on ECG depend on gestational age rather than sex.

Accessing the States of Enhanced Cognition in a Gaming Context: The Importance of Psychophysiological Arousal

The goal of this study was to examine activities and experiences where enhanced cognitive states (ECSs), characterized by dramatic boosts in focused attention, could be elicited under specific gaming contexts. In Experiment 1, expert gamers were tested on the attentional blink task before and after playing games of different genres, varying on four game design dimensions (perspective, "adrenaline-rush," immersivity, and collaborative vs. individual context) and two cognitive dimensions (speed of processing and attentional focus). In Experiment 2, using ECG-HRV methodology, we examined the physiological markers of gaming dimensions found to be critical for accessing ECSs in Experiment 1. The findings suggest that ECSs are a universal phenomenon that demands focusing one's attention on a single task from the egocentric perspective, and ought to involve an adventurous "adrenaline-rush" type of activity. Furthermore, the results demonstrated that an underlying physiological mechanism of ECSs includes parasympathetic nervous system (PSNS) withdrawal-associated arousal. Specifically, the gaming dimensions leading to greater PSNS withdrawal-associated arousal resulted in greater improvements on the attentional blink task during ECSs. These findings suggest that individuals can transcend what was hitherto assumed to be a limitation of human cognition, granting new prospects for eliciting exceptional human performance.

Associations between Heart Rate Variability and Brain Activity during a Working Memory Task: A Preliminary Electroencephalogram Study on Depression and Anxiety Disorder

Heart rate variability (HRV) has been suggested to reflect executive function and related neural activity. Executive dysfunction has been suggested to play an important role in the pathophysiology of emotional disorders. The purpose of this study was to investigate whether HRV showed a significant correlation with electroencephalogram (EEG) during a working memory performance in patients with depressive or anxiety disorder. A retrospective analysis was conducted with data from 61 patients with depressive disorder (43 women and 18 men) and 59 patients with anxiety disorder (35 women and 24 men). HRV was measured in the resting state, and EEG was recorded in the resting state and during the execution of a working memory task. It was performed in patients with depressive and anxiety disorder, and the paired sample t-test between resting state and task performance, as well as the partial correlation analysis between HRV and EEG, was conducted. Both depressed and anxious patients showed weaker beta relative power during the working memory task compared to the rest period. The resting-state EEG did not correlate with HRV parameters in both groups. In depressed patients, HRV showed a positive correlation with delta power during the task and a negative correlation with beta relative power during the task. In patients with anxiety disorder, HRV showed a significant positive correlation with theta power of the right frontal region during the task. Our results suggest that HRV would be related to executive-function-related neural activity in patients with depressive or anxiety disorder. Future studies with more subjects, including healthy controls, are needed to verify the correlation between HRV and EEG and to come up with a more comprehensive picture of neurobiological changes in emotional disorders.

Effect of aerobic exercise on executive function in individuals with methamphetamine use disorder: Modulation by the autonomic nervous system

This study assessed the effects of aerobic exercise on cardiac autonomic nervous system function (based on heart rate variability [HRV]) and executive function among individuals with methamphetamine use disorder (MUD). We further examine the role of autonomic nervous system control in aerobic exercise (assessed via cardiopulmonary fitness) and executive function. A total of 330 individuals with MUD were randomly divided into exercise (n = 165) and control (n = 165) groups, who underwent eight-week aerobic exercise/health education program consisting of five 60 min sessions a week. The outcome measures included cardiopulmonary fitness, HRV time-domain and frequency-domain parameters, and executive function. Our statistical analyses comprised repeated-measures analyses of variance, correlation analyses, and mediation and moderation effect tests. The results indicated that aerobic exercise could simultaneously improve autonomic nervous system function and executive function among individuals with MUD. Moreover, the changes in cardiopulmonary fitness, high frequency HRV, and executive function were positively correlated. HRV did not significantly mediate the relationship between aerobic exercise and executive function; however, it did have a moderating effect, which was eliminated after adjusting for demographic and drug-use covariates. Among the covariates, age was the greatest confounder and was inversely proportional to cardiopulmonary function, HRV, and executive function. Cardiac autonomic nervous system function exerted a moderating, rather than a mediating, effect on the relationship between aerobic exercise and executive function. However, this potential effect was largely influenced by covariates, particularly age.

Using the Ball-in-Bowl Metaphor to Outline an Integrative Framework for Understanding Dysregulated Emotion

Dysregulated emotion plays an important role for mental health problems. To elucidate the underlying mechanisms, researchers have focused on the domains of strategy-based emotion regulation, psychophysiological self-regulation, emotion evaluations, and resulting emotion dynamics. So far, these four domains have been looked at in relative isolation from each other, and their reciprocal influences and interactive effects have seldom been considered. This domain-specific focus constrains the progress the field is able to make. Here, we aim to pave the way towards more cross-domain, integrative research focused on understanding the raised reciprocal influences and interactive effects of strategy-based emotion-regulation, psychophysiological self-regulation, emotion evaluations, and emotion dynamics. To this aim, we first summarize for each of these domains the most influential theoretical models, the research questions they have stimulated, and their strengths and weaknesses for research and clinical practice. We then introduce the metaphor of a ball in a bowl that we use as a basis for outlining an integrative framework of dysregulated emotion. We illustrate how such a framework can inspire new research on the reciprocal influences and interactions between the different domains of dysregulated emotion and how it can help to theoretically explain a broader array of findings, such as the high levels of negative affect in clinical populations that have not been fully accounted for by deficits in strategy-based emotion regulation and the positive long-term consequences of accepting and tolerating emotions. Finally, we show how it can facilitate individualized emotion regulation interventions that are tailored to the specific regulatory impairments of the individual patient.

The Radically Embodied Conscious Cybernetic Bayesian Brain: From Free Energy to Free Will and Back Again

Drawing from both enactivist and cognitivist perspectives on mind, I propose that explaining teleological phenomena may require reappraising both "Cartesian theaters" and mental homunculi in terms of embodied self-models (ESMs), understood as body maps with agentic properties, functioning as predictive-memory systems and cybernetic controllers. Quasi-homuncular ESMs are suggested to constitute a major organizing principle for neural architectures due to their initial and ongoing significance for solutions to inference problems in cognitive (and affective) development. Embodied experiences provide foundational lessons in learning curriculums in which agents explore increasingly challenging problem spaces, so answering an unresolved question in Bayesian cognitive science: what are biologically plausible mechanisms for equipping learners with sufficiently powerful inductive biases to adequately constrain inference spaces? Drawing on models from neurophysiology, psychology, and developmental robotics, I describe how embodiment provides fundamental sources of empirical priors (as reliably learnable posterior expectations). If ESMs play this kind of foundational role in cognitive development, then bidirectional linkages will be found between all sensory modalities and frontal-parietal control hierarchies, so infusing all senses with somatic-motoric properties, thereby structuring all perception by relevant affordances, so solving frame problems for embodied agents. Drawing upon the Free Energy Principle and Active Inference framework, I describe a particular mechanism for intentional action selection via consciously imagined (and explicitly represented) goal realization, where contrasts between desired and present states influence ongoing policy selection via predictive coding mechanisms and backward-chained imaginings (as self-realizing predictions). This embodied developmental legacy suggests a mechanism by which imaginings can be intentionally shaped by (internalized) partially-expressed motor acts, so providing means of agentic control for attention, working memory, imagination, and behavior. I further describe the nature(s) of mental causation and self-control, and also provide an account of readiness potentials in Libet paradigms wherein conscious intentions shape causal streams leading to enaction. Finally, I provide neurophenomenological handlings of prototypical qualia including pleasure, pain, and desire in terms of self-annihilating free energy gradients via quasi-synesthetic interoceptive active inference. In brief, this manuscript is intended to illustrate how radically embodied minds may create foundations for intelligence (as capacity for learning and inference), consciousness (as somatically-grounded self-world modeling), and will (as deployment of predictive models for enacting valued goals).

Perceiving utilitarian gradients: Heart rate variability and self-regulatory effort in the moral dilemma task

It is not yet clear which response behavior requires self-regulatory effort in the moral dilemma task. Previous research has proposed that utilitarian responses require cognitive control, but subsequent studies have found inconsistencies with the empirical predictions of that hypothesis. In this paper, we treat participants’ sensitivity to utilitarian gradients as a measure of performance. We confronted participants (N = 82) with a set of five dilemmas evoking a gradient of mean utilitarian responses in a 4-point scale and collected data on heart rate variability and utilitarian responses. We found positive correlations between tonic and phasic HRV and sensitivity to the utilitarian gradient in the high tonic group, but not in the low tonic group. Moreover, the low tonic group misplaced a scenario with a selfish incentive at the high end of the gradient. Results suggest that performance is represented by sensitivity correlated with HRV and accompanied with a reasonable placement of individual scenarios within the gradient.

Structural covariance of the salience network associated with heart rate variability

The salience network (SN) anchored by the anterior insula and cingulate is crucial for the autonomic control of body homeostasis. Resting-sate fMRI studies have linked intrinsic SN connectivity with multiple autonomic measures, but little is known about the structural organization of this system relating to cardiac vagal function. To address the above issue, the current study used covariance analysis of MRI-based gray matter volume (GMV) to map structural covariance of SN with two independent datasets, and then determined whether interregional structural connections within SN related to individual differences in vagally-mediated heart rate variability (HRV). The results showed a significant positive association between structural covariance of the SN and vagal component of HRV in two independent samples. More importantly, the conjunction and pooled data analysis revealed that structural correlation from left anterior insula to dorsal anterior cingulate cortex positively interacted with vagally-mediated HRV. The current results demonstrated a crucial role of the SN in the cortical modulation of efferent vagal activity to the heart, and provided new insight into structural neural network implicated in cardiac vagal control.

Autonomic nervous system dysfunction in schizophrenia: impact on cognitive and metabolic health

Schizophrenia (SCZ) is a psychiatric disorder characterized by a wide range of positive, negative and cognitive symptoms, along with an increased risk of metabolic syndrome and cardiovascular disease that contribute to a 15-20-year reduced life expectancy. Autonomic dysfunction, in the form of increased sympathetic activity and decreased parasympathetic activity, is postulated to be implicated in SCZ and its treatment. The aim of this narrative review is to view SCZ through an autonomic lens and synthesize the evidence relating autonomic dysfunction to different domains of SCZ. Using various methods of assessing autonomic activity, autonomic dysfunction was found to be associated with multiple aspects of SCZ pathophysiology, including symptom severity, cognitive impairment, and the development of cardiometabolic comorbidities, such as metabolic syndrome and high BMI. The strongest association of low heart rate variability was noted among patients on antipsychotic treatment with high-affinity muscarinic antagonism (i.e., clozapine, olanzapine and quetiapine). The review will also suggest ways in which studying autonomic dysfunction can help reduce morbidity and mortality associated with SCZ and its treatment.

Covariate effects of resting heart rate variability on affective ratings and startle reflex during cognitive reappraisal of negative emotions

Heart Rate Variability (HRV) has been widely studied in laboratory settings due to its clinical implications, primarily as a potential biomarker of emotion regulation (ER). Studies have reported that individuals with higher resting HRV show more distinct startle reflexes to negative stimuli as compared to those with lower HRV. These responses have been associated with better defense system function when managing the context demands. There is, however, a lack of empirical evidence on the association between resting HRV and eyeblinks during laboratory tasks using instructed ER. This study explored the influence of tonic HRV on voluntary cognitive reappraisal through subjective and startle responses measured during an independent ER task. In total, 122 healthy participants completed a task consisting of attempts to upregulate, downregulate, or react naturally to emotions prompted by unpleasant pictures. Tonic HRV was measured for 5 minutes before the experiment began. Current results did not support the idea that self-reported and eyeblink responses were influenced by resting HRV. These findings suggest that, irrespective of resting HRV, individuals may benefit from strategies such as reappraisal that are useful for managing negative emotions. Experimental studies should further explore the role of individual differences when using ER strategies during laboratory tasks.

[Influences of Autonomic Function, Salivary Cortisol and Physical Activity on Cognitive Functions in Institutionalized Older Adults with Mild Cognitive Impairment: Based on Neurovisceral Integration Model]

PURPOSE

This study aimed to investigate objectively measured physical activity (PA) in institutionalized older adults with mild cognitive impairment (MCI) and to elucidate the influence of autonomic nervous function, salivary cortisol, and PA on cognitive functions based on neurovisceral integration model.

METHODS

Overall cognitive function was evaluated using the mini-mental state examination (MMSE) and executive function was evaluated using semantic verbal fluency test and clock drawing test. Actigraph for PA, HRV and sAA for autonomous function, and the geriatric depression scale for depression were used. Saliva specimens were collected in the morning for sAA and cortisol.

RESULTS

Ninety-eight older adults from four regional geriatric hospitals participated in the study. They took 4,499 steps per day on average. They spent 753.93 minutes and 23.12 minutes on average in sedentary and moderate-to-vigorous activity, respectively. In the multiple regression analysis, lower salivary cortisol level (β = - .33, p = .041) and greater step counts (β = .37, p = .029) significantly improved MMSE score. Greater step count (β = .27, p = .016) also exerted a significant influence on verbal fluency, and greater sAA (β = .35, p = .026) was significantly associated with a better clock drawing test result.

CONCLUSION

Salivary cortisol, sAA and physical activity were significantly associated with cognitive functions. To prevent older adults from developing dementia, strategies are needed to increase their overall PA amount by decreasing sedentary time and to decrease salivary cortisol for cognitive function, and to maintain their sympathetic nervous activity for executive function.

Probing Neurovisceral Integration via Functional Near-Infrared Spectroscopy and Heart Rate Variability

The neurovisceral integration model (NVM) proposes that an organism’s ability to flexibly adapt to its environment is related to biological flexibility within the central autonomic network (CAN). One important aspect of this flexibility is behavioral inhibition (Thayer and Friedman, 2002). During a behavioral inhibition task, the CAN, which comprises a series of feedback loops, must be able to integrate information and react to these inputs flexibly to facilitate optimal performance. The functioning of the CAN is shown to be associated with respiratory sinus arrhythmia (RSA), as the vagus nerve is part of this feedback system. Although the NVM has been examined through neural imaging and RSA, only a few studies have examined these measures simultaneously during the neuroimaging procedure. Furthermore, these studies were done at rest or used tasks that were not targeted at processes associated with the NVM, such as behavioral inhibition and cognitive flexibility. For this reason, the present study assessed RSA and neural activation in the pre-frontal cortex simultaneously while participants completed a behavior inhibition task. RSA and functional near-infrared spectroscopy were collected in 38 adults, and resting levels of pre-frontal activation were negatively related to RSA, but pre-frontal activation during the behavior inhibition task was not. The negative relationship between RSA and oxygenated hemoglobin is consistent with previous functional magnetic resonance imaging work examining the NVM at baseline and should be further studied. Additional research investigating how this relationship may change based on task demands or environmental contexts would help clarify the applicability of the model.

Effects of mindfulness training on posttraumatic stress symptoms from a community-based pilot clinical trial among survivors of intimate partner violence

Objective: Exposure to intimate partner violence (IPV) is a significant public health issue associated with deleterious mental and medical health comorbidities, including posttraumatic stress disorder (PTSD). The hallmark symptoms of posttraumatic stress (PTS), even when not meeting the threshold for a diagnosis of PTSD, appear to be underpinned by poor self-regulation in multiple domains, including emotion, cognitive control, and physiological stress. Mindfulness-based stress reduction (MBSR) holds promise for treating PTS symptoms because evidence suggests it targets these domains. The current study was a pilot randomized clinical trial designed to examine changes in emotion regulation, attentional function, and physiological stress dysregulation among women IPV survivors with elevated PTS symptoms after participation in a group-based, 8-week MBSR program. Method: In total, 29 participants were randomized to receive MBSR (n = 19) or an active control (n = 10). Assessments were conducted at study entry, as well as 8 and 12 weeks later. Results: Between-group differences on primary outcomes were nonsignificant; however, when exploring within groups, statistically significant decreases in PTS symptoms, F(1.37, 16.53) = 5.19, p < .05, and emotion dysregulation, F(1.31, 14.46) = 9.36, p < .01, were observed after MBSR but not after the control intervention. Further, decreases in PTSD and emotion dysregulation were clinically significant for MBSR participants but not control participants. Conclusions: These preliminary data signal that MBSR may improve PTS symptoms and emotion regulation and suggest further study of the effectiveness of PTSD interventions guided by integrative models of MBSR mechanisms and psychophysiological models of stress regulation. (PsycInfo Database Record (c) 2020 APA, all rights reserved).

Vagal Flexibility Mediates the Association Between Resting Vagal Activity and Cognitive Performance Stability Across Varying Socioemotional Demands

Vagal flexibility describes the ability to modulate cardiac vagal responses to fit a dynamic range of challenges. Extant theory on vagal function implies that vagal flexibility is a mediating mechanism through which resting vagal activity, a putative individual difference related to self-regulation, affects adaptive behavior and cognition. Nevertheless, little research has directly tested this hypothesis, thereby leaving fundamental mechanisms of vagal function and adaptability unclear. To this end, 47 healthy subjects completed a 5 min baseline followed by Stroop tasks combined with concurrent auditory distractors. There were four different Stroop task conditions that varied the social and emotional content of the auditory distractors. Electrocardiogram was continuously recorded to assess vagal responses to each condition as heart rate variability [root mean square of successive differences (RMSSDs)] reactivity. Vagal flexibility significantly mediated the association between resting vagal activity and stability of inhibition performance (Stroop interference) scores. In particular, higher resting RMSSD was related to higher standard deviation of RMSSD reactivity scores, reflecting greater differences in RMSSD reactivity between distractor conditions (i.e., greater vagal flexibility). Greater vagal flexibility was in turn related to more stability in Stroop interference across the same conditions. The mean of RMSSD reactivity scores across conditions was not significantly related to resting RMSSD or stability in Stroop performance, and mean RMSSD reactivity did not mediate relations between resting RMSSD and stability in Stroop performance. Overall, findings suggest that vagal flexibility may promote the effects of resting vagal activity on stabilizing cognitive inhibition in the face of environmental perturbations.

Heart Rate Variability in the Perinatal Period: A Critical and Conceptual Review

Neonatal intensive care units (NICUs) greatly expand the use of technology. There is a need to accurately diagnose discomfort, pain, and complications, such as sepsis, mainly before they occur. While specific treatments are possible, they are often time-consuming, invasive, or painful, with detrimental effects for the development of the infant. In the last 40 years, heart rate variability (HRV) has emerged as a non-invasive measurement to monitor newborns and infants, but it still is underused. Hence, the present paper aims to review the utility of HRV in neonatology and the instruments available to assess it, showing how HRV could be an innovative tool in the years to come. When continuously monitored, HRV could help assess the baby’s overall wellbeing and neurological development to detect stress-/pain-related behaviors or pathological conditions, such as respiratory distress syndrome and hyperbilirubinemia, to address when to perform procedures to reduce the baby’s stress/pain and interventions, such as therapeutic hypothermia, and to avoid severe complications, such as sepsis and necrotizing enterocolitis, thus reducing mortality. Based on literature and previous experiences, the first step to efficiently introduce HRV in the NICUs could consist in a monitoring system that uses photoplethysmography, which is low-cost and non-invasive, and displays one or a few metrics with good clinical utility. However, to fully harness HRV clinical potential and to greatly improve neonatal care, the monitoring systems will have to rely on modern bioinformatics (machine learning and artificial intelligence algorithms), which could easily integrate infant’s HRV metrics, vital signs, and especially past history, thus elaborating models capable to efficiently monitor and predict the infant’s clinical conditions. For this reason, hospitals and institutions will have to establish tight collaborations between the obstetric, neonatal, and pediatric departments: this way, healthcare would truly improve in every stage of the perinatal period (from conception to the first years of life), since information about patients’ health would flow freely among different professionals, and high-quality research could be performed integrating the data recorded in those departments.

Effects of Chronic and State Loneliness on Heart Rate Variability in Women

BACKGROUND

Loneliness, the subjective experience of social isolation, represents one of the largest risk factors for physical illness and early death in humans. However, the mechanisms by which loneliness leads to adverse health outcomes are not well understood.

PURPOSE

In this study, we examined altered parasympathetic nervous system function as a potential pathway by which chronic loneliness and state loneliness may "get under the skin" to impact cardiovascular physiology.

METHODS

In a controlled laboratory setting, vagally mediated resting heart rate variability (HRV), HRV reactivity to an induction of state loneliness, and HRV reactivity to a cognitive challenge task were assessed in a sample of 316 healthy women (18-28 years).

RESULTS

Greater chronic loneliness in women predicted lower resting HRV, an independent risk factor for cardiovascular disease and all-cause mortality, after controlling for demographic, psychosocial, and health behavior covariates. Furthermore, women higher in chronic loneliness experienced significantly larger increases in HRV to state loneliness and reported significantly higher levels of negative affect immediately following state loneliness, compared with their less chronically lonely counterparts. Chronic loneliness also predicted blunted HRV reactivity-a maladaptive physiological response-to cognitive challenge.

CONCLUSIONS

The current findings provide evidence that chronic loneliness is associated with altered parasympathetic function (both resting HRV and HRV reactivity) in women, and that the immediate experience of state loneliness is linked to a proximate increase in HRV among chronically lonely women. Results are discussed in terms of implications for cardiovascular health and the evolutionary functions of loneliness.

Inverse associations between parasympathetic activity and cognitive flexibility in African Americans: Preliminary findings

Previous research suggests that vagal activity and executive function (EF) are positively associated. However, existing data exploring the relationship between HRV and EF remains limited. Though Blacks may have higher HRV, they remain underrepresented in previous research examining HRV and EF. The current study aimed to determine the relationship between EF and HRV in a sample of 92 Black undergraduates (Mean age = 20.32, SD = 2.28). Participants wore an 6‑lead ambulatory electrocardiographic impedance monitoring system to obtain the root mean square of interbeat interval differences (rMSSD) and Cardiac Sympathetic Index. After baseline autonomic activity assessment, participants completed the Berg Card Sorting Test. Utilizing hierarchical regression analyses, HRV was negatively associated with correct responses (Beta = -0.40, SE = 0.04, p=0.01) and categories experienced (Beta = -0.37, SE = 0.01, p=0.01), and positively associated with total errors (Beta = 0.39, SE =0.04, p=0.01). To further elucidate these findings, participants were assigned to coinhibition (n = 12), parasympathetically dominant (n = 34), sympathetically dominant (n = 35), or coactivation (n = 11) autonomic space subgroups. Participants in the sympathetically dominant subgroup completed more categories (M = 6.86, SD = 2.13) and committed fewer errors (M = 30.63, SD = 11.53) than their parasympathetic counterparts (M = 5.74, SD = 2.44; M = 43.29, SD = 18.83, respectively). This study suggests that a state of sympathetic arousal immediately prior to the administration of an EF task, may aid in better task performance.

Mindfulness-oriented recovery enhancement reduces opioid dose in primary care by strengthening autonomic regulation during meditation

The current opioid crisis was fueled by escalation of opioid dosing among patients with chronic pain. Yet, there are few evidence-based psychological interventions for opioid dose reduction among chronic pain patients treated with long-term opioid analgesics. Mindfulness-Oriented Recovery Enhancement (MORE), which was designed to target mechanisms underpinning chronic pain and opioid misuse, has shown promising results in 2 randomized clinical trials (RCTs) and could facilitate opioid sparing and tapering by bolstering self-regulation. Here we tested this hypothesis with secondary analyses of data from a Stage 2 RCT. Chronic pain patients (N = 95) on long-term opioid therapy were randomized to 8 weeks of MORE or a support group (SG) control delivered in primary care. Opioid dose was assessed with the Timeline Followback through 3-month follow-up. Heart rate variability (HRV) during mindfulness meditation was quantified as an indicator of self-regulatory capacity. Participants in MORE evidenced a greater decrease in opioid dosing (a 32% decrease) by follow-up than did the SG, F(2, 129.77) = 5.35, p = .006, d = 1.07. MORE was associated with a significantly greater increase in HRV during meditation than was the SG. Meditation-induced change in HRV partially mediated the effect of MORE on opioid dose reduction (p = .034). MORE may boost self-regulatory strength via mindfulness and thereby facilitate self-control over opioid use, leading to opioid dose reduction in people with chronic pain. (PsycInfo Database Record (c) 2020 APA, all rights reserved).

A Systematic Review of Associations Between Interoception, Vagal Tone, and Emotional Regulation: Potential Applications for Mental Health, Wellbeing, Psychological Flexibility, and Chronic Conditions

Background: Interoception and heart rate variability have been found to predict outcomes of mental health and well-being. However, these have usually been investigated independently of one another.

Objectives: This systematic review aimed to explore a key gap in the current literature, that being, identifying whether HRV and interoception predict emotional regulation outcomes and strategies.

Methods: The process of article retrieval and selection followed the PRISMA guidelines. Databases PsychINFO, Web of Science, PubMed, CINAHL, and MEDLINE were scanned for papers published. Preliminary inclusion and exclusion criteria were specified following the PICO framework, whilst the CHARMS framework was used to help formulate the research question, and critically assess for bias.

Results: Two hundred and thirty-seven studies were identified after initial database searches. Of these, eight studies were included in the final selection. Six studies explored the associations between HRV and ER, whilst three investigated the associations between interoception and ER (one study included both). Results show that greater HRV and interoception are associated with better ER. Specifically, high parasympathetic activity largely predicted the use of adaptive ER strategies such as reappraisal, and better acceptance of emotions. High interoception, instead, was predictive of effective downregulation of negative emotions and handling of social uncertainty, there was no association with any specific ER strategy.

Conclusions: Awareness of one's own bodily feelings and vagal activation seem to be of central importance for the effective regulation of emotional responses. However, one limitation is the small sample of studies found, thus more studies in this area are needed in the future.

Autonomic function in amnestic and non-amnestic mild cognitive impairment: spectral heart rate variability analysis provides evidence for a brain-heart axis

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.

Parasympathetic and sympathetic nervous systems interactively predict change in cognitive functioning in midlife adults

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.

Transcutaneous Vagus Nerve Stimulation May Enhance Only Specific Aspects of the Core Executive Functions. A Randomized Crossover Trial

Background

Individuals are able to perform goal-directed behaviors thanks to executive functions. According to the neurovisceral integration model, executive functions are upregulated by brain areas such as the prefrontal and cingulate cortices, which are also crucially involved in controlling cardiac vagal activity. An array of neuroimaging studies already showed that these same brain areas are activated by transcutaneous vagus nerve stimulation (tVNS). Despite evidence toward effects of tVNS on specific executive functions such as inhibitory control, there have been no studies investigating what type of inhibition is improved by tVNS by systematically addressing them within the same experiment. Furthermore, the effect of tVNS on another core executive function, cognitive flexibility, has not yet been investigated.

Objective

We investigated the effects of tVNS on core executive functions such as inhibitory control and cognitive flexibility.

Methods

Thirty-two participants (nine women, M _age = 23.17) took part in this study. Vagally mediated heart rate variability parameters (root mean square of successive differences, RMSSD, and high frequency, HF) were measured while participants performed four different cognitive tasks that mainly rely on different aspects of both the aforementioned executive functions.

Results

Despite clear conflict effects in the four tasks, only performance on the task used to measure set-shifting paradigm was improved by tVNS, with switch costs being lower during tVNS than during sham stimulation. Furthermore, HF increased during each of the cognitive flexibility tasks, although HF during tVNS did not differ from HF during sham stimulation.

Conclusion

The results indicate for the first time (a) that tVNS can increase cognitive flexibility in a set-shifting paradigm, and (b) that tVNS may exert a stronger effect on cognitive flexibility than inhibition. The present study provides only partial evidence for the neurovisceral integration model. Future studies should address further paradigms that demand cognitive flexibility, thus investigating this new hypothesis on the specificity of the tVNS effects on cognitive flexibility.

Heart Rate Variability and Academic Performance of First-Year University Students

BACKGROUND

Heart rate variability (HRV) measures have been shown to be positively associated with cognitive processing, while a positive association between cognitive processing and academic performance has been demonstrated.

OBJECTIVES

To determine whether resting HRV or HRV marker response to either a cognitive or an orthostatic challenge is significantly associated with a first-year university student's academic performance.

METHOD

HRV markers used in the study included total power (TP) as a measure of overall HRV and the root mean square of successive differences (RMSSD) as a measure of parasympathetic influence on the heart. Academic performance was determined by standardized general mean scores.

RESULTS

Greater supine overall HRV (TP) was significantly associated with greater academic performance predominantly in females. Vagal (RMSSD) measures were not shown to be associated with academic performance.

CONCLUSIONS

This, to our knowledge, is the first study to show that overall HRV has a significant positive association with academic performance of a first-year university student.

Sugary Drink Consumption Among NYC Children, Youth, and Adults: Disparities Persist Over Time, 2007-2015

Sugary drink consumption is associated with many adverse health outcomes, including weight gain, diabetes, and other chronic conditions. These beverages are widely marketed and ubiquitously available. This analysis explores sugary drink consumption across all age groups among New York City (NYC) residents using representative survey data. Three population-based representative surveys of NYC residents of different age groups were analyzed. Adult participants, youth participants, and caregivers of child participants self-reported the number of sugary drinks they consumed per day. Mean sugary drink intake per day was estimated overall and by demographic characteristics, for the 2015 cycle of each survey and the 2007-2015 cycles of the adult survey. T tests were used to determine whether means differed by demographics. Long-term trends in mean sugary drink consumption among adult participants were conducted to examine changes over time overall and by demographic characteristics. In 2015, the mean daily number of sugary drinks consumed was 0.53 (95% CI 0.45, 0.61) among children 0-5 years old, 1.05 (95% CI 0.90, 1.21) among children 6-12 years old, and 1.16 (95% CI 1.09, 1.29) among NYC high school students. Among all NYC adults, sugary drink intake decreased 36% from 1.03 (95% CI 0.99, 1.08) in 2007 to 0.66 (95% CI 0.62, 0.70) drinks per day in 2015, p < 0.01. However, at each age level, there were persistent disparities in sugary drink consumption by sex, race/ethnicity, educational attainment, and poverty level. Decreasing overall rates of sugary drink consumption are promising; however, disparities by socio-demographics are a concern. Reducing sugary drink consumption across all ages is recommended as is minimizing the introduction at an early age. Reduction of sugary drink consumption will require a collaborative, multi-sectoral approach.

Association of Heart Rate Variability With Cognitive Performance: The Multi-Ethnic Study of Atherosclerosis

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.

Associations between physiological responses to social-evaluative stress and daily functioning in first-episode schizophrenia

Schizophrenia (SZ) is associated with impaired adaptive functioning, including difficulties managing the demands of independent living, work, school, and interpersonal relationships. Prior studies have linked the physiological stress response with less effective coping in daily life. Differences in stress-response tendencies may also support heterogeneity in daily functioning in SZ. The present study examined two established measures of the stress response in patients with first-episode SZ. Salivary cortisol was included as an index of hypothalamic-pituitary-adrenal response. Vagal suppression (VS), a measure of stress-related reduction in heart rate variability, was used to assess parasympathetic flexibility. Greater cortisol response and VS to social-evaluative stress were predicted to be associated with better functioning in SZ over and above relationships with social cognition and neurocognition, two well-established predictors of functional outcome. Thirty-eight first-episode SZ outpatients and 29 healthy comparison subjects (HC) provided social cognitive, neurocognitive, and physiological measurements before and after the Trier Social Stress Test (TSST). Although SZ and HC did not differ on VS to the TSST, patients exhibited significant associations between VS and functioning across all four domains of the Role Functioning Scale. Furthermore, greater VS predicted more effective functioning with friends, beyond the contributions associated with social cognition and neurocognition, and strengthened the positive effects of higher levels of social cognition on independent living/self-care. VS elicited by social-evaluative stress in the laboratory may reflect stress-response tendencies in daily life that are relevant for daily functioning in first-episode SZ.

A Neurovisceral Integrative Study on Cognition, Heart Rate Variability, and Fitness in the Elderly

The association between physical fitness and cognitive performance has been widely investigated in the literature. However, the neurophysiological mechanisms underlying this relationship are not yet clear. Here, we aim to evaluate the interactions between executive function measures, heart rate variability (HRV), and physical fitness in the context of the neurovisceral integration (NVI) theory. Twenty-eight healthy elderly subjects (>60 years) were submitted to evaluation of executive performance with three computerized tests: the N-back test measured working memory capacity, the Stroop Color test evaluated inhibitory control and selective attention, and the Wisconsin Card Sorting Test (WCST) evaluated abstract reasoning and cognitive flexibility. We also used the Physical Testing Battery for the Elderly to measure aerobic capacity, dynamic balance, upper body flexibility, and handgrip strength. Our results confirm the relationship between executive function and physical fitness, particularly between working memory, cardiorespiratory fitness, and dynamic balance. We also demonstrate an association between executive performance and HRV in older people, corroborating previous results from other groups obtained in young adults. However, our regression models did not indicate that HRV mediates the relationship between cognition and physical fitness in the elderly, suggesting that age-related degeneration of autonomic control can affect aspects of NVI in this population.