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Batallas D, Rodriguez-Hernandez V, Hidalgo V, Salvador A. Loneliness during the post-confinement period: The significance of social living conditions for stress biomarkers and memory. Behav Brain Res 2024; 459:114771. [PMID: 38000531 DOI: 10.1016/j.bbr.2023.114771] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/11/2023] [Revised: 10/29/2023] [Accepted: 11/18/2023] [Indexed: 11/26/2023]
Abstract
In the aftermath of the COVID-19 lockdown, concerns about the impact of loneliness and reduced social interactions on mental health have arisen. This study explored the repercussions of post-lockdown social restrictions across psychological (loneliness, perceived stress, and depressive symptoms), biological (hair cortisol and cardiovascular activity), and cognitive dimensions (subjective memory complaints and working, declarative, and prospective memory), with a specific emphasis on perceived loneliness and the living situation. The study included 45 students: 23 (mean age = 25.69 years) in the Alone Group (AG), who experienced significant family changes and international relocation, and 22 (mean age = 25.50 years) in the Not Alone Group (NAG), who maintained their nuclear family and did not move from their home country. We assessed heart rate variability (HRV) before, during, and after immediate memory evaluations using time-domain (the square root of the mean, RMSSD) measures. The analysis revealed no significant group differences in telematic contact with family and friends, perceived stress, or depression. However, the AG participants reported fewer face-to-face interactions and greater perceived loneliness compared to the NAG. Additionally, the AG group exhibited slightly higher hair cortisol levels and worse working memory (WM) and prospective memory (PM) performance. Importantly, no significant associations were observed between memory outcomes and stress biomarkers. However, a significant interaction effect of loneliness in the relationship between hair cortisol levels and PM was found. That is, hair cortisol concentrations were negatively related to PM when participants perceived high and moderate loneliness. This interaction was absent in the working and declarative memory domains. In summary, these findings underscore the intricate interplay between loneliness, cortisol, and memory, emphasizing the need for comprehensive research on the complex mechanisms governing these multifaceted relationships.
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Affiliation(s)
- Daniela Batallas
- Laboratory of Social Cognitive Neuroscience, Department of Psychobiology and IDOCAL, University of Valencia, Valencia, Spain
| | - Valerie Rodriguez-Hernandez
- Laboratory of Social Cognitive Neuroscience, Department of Psychobiology and IDOCAL, University of Valencia, Valencia, Spain
| | - Vanesa Hidalgo
- Laboratory of Social Cognitive Neuroscience, Department of Psychobiology and IDOCAL, University of Valencia, Valencia, Spain; Department of Psychology and Sociology, Area of Psychobiology, University of Zaragoza, Teruel, Spain
| | - Alicia Salvador
- Laboratory of Social Cognitive Neuroscience, Department of Psychobiology and IDOCAL, University of Valencia, Valencia, Spain; Spanish National Network for Research in Mental Health CIBERSAM, 28029, Spain
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Kong SDX, Gordon CJ, Hoyos CM, Wassing R, D’Rozario A, Mowszowski L, Ireland C, Palmer JR, Grunstein RR, Shine JM, McKinnon AC, Naismith SL. Heart rate variability during slow wave sleep is linked to functional connectivity in the central autonomic network. Brain Commun 2023; 5:fcad129. [PMID: 37234683 PMCID: PMC10208252 DOI: 10.1093/braincomms/fcad129] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/22/2022] [Revised: 02/20/2023] [Accepted: 05/18/2023] [Indexed: 05/28/2023] Open
Abstract
Reduced heart rate variability can be an early sign of autonomic dysfunction in neurodegenerative diseases and may be related to brain dysfunction in the central autonomic network. As yet, such autonomic dysfunction has not been examined during sleep-which is an ideal physiological state to study brain-heart interaction as both the central and peripheral nervous systems behave differently compared to during wakefulness. Therefore, the primary aim of the current study was to examine whether heart rate variability during nocturnal sleep, specifically slow wave (deep) sleep, is associated with central autonomic network functional connectivity in older adults 'at-risk' of dementia. Older adults (n = 78; age range = 50-88 years; 64% female) attending a memory clinic for cognitive concerns underwent resting-state functional magnetic resonance imaging and an overnight polysomnography. From these, central autonomic network functional connectivity strength and heart rate variability data during sleep were derived, respectively. High-frequency heart rate variability was extracted to index parasympathetic activity during distinct periods of sleep, including slow wave sleep as well as secondary outcomes of non-rapid eye movement sleep, wake after sleep onset, and rapid eye movement sleep. General linear models were used to examine associations between central autonomic network functional connectivity and high-frequency heart rate variability. Analyses revealed that increased high-frequency heart rate variability during slow wave sleep was associated with stronger functional connectivity (F = 3.98, P = 0.022) in two core brain regions within the central autonomic network, the right anterior insular and posterior midcingulate cortex, as well as stronger functional connectivity (F = 6.21, P = 0.005) between broader central autonomic network brain regions-the right amygdala with three sub-nuclei of the thalamus. There were no significant associations between high-frequency heart rate variability and central autonomic network connectivity during wake after sleep onset or rapid eye movement sleep. These findings show that in older adults 'at-risk' of dementia, parasympathetic regulation during slow wave sleep is uniquely linked to differential functional connectivity within both core and broader central autonomic network brain regions. It is possible that dysfunctional brain-heart interactions manifest primarily during this specific period of sleep known for its role in memory and metabolic clearance. Further studies elucidating the pathophysiology and directionality of this relationship should be conducted to determine if heart rate variability drives neurodegeneration, or if brain degeneration within the central autonomic network promotes aberrant heart rate variability.
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Affiliation(s)
- Shawn D X Kong
- Correspondence to: Shawn Dexiao KongHealthy Brain Ageing ProgramBrain and Mind Centre, University of Sydney100 Mallett St, Camperdown, NSW 2050, Australia E-mail:
| | - Christopher J Gordon
- CIRUS, Centre for Sleep and Chronobiology, Woolcock Institute of Medical Research, University of Sydney, Glebe, NSW 2037, Australia
- Faculty of Medicine and Health, University of Sydney, Camperdown, NSW 2050, Australia
| | - Camilla M Hoyos
- Healthy Brain Ageing Program, Brain and Mind Centre, University of Sydney, Camperdown, NSW 2050, Australia
- Charles Perkins Centre, University of Sydney, Camperdown, NSW 2050, Australia
- School of Psychology, Faculty of Science, University of Sydney, Camperdown, NSW 2050, Australia
- CIRUS, Centre for Sleep and Chronobiology, Woolcock Institute of Medical Research, University of Sydney, Glebe, NSW 2037, Australia
| | - Rick Wassing
- CIRUS, Centre for Sleep and Chronobiology, Woolcock Institute of Medical Research, University of Sydney, Glebe, NSW 2037, Australia
| | - Angela D’Rozario
- Healthy Brain Ageing Program, Brain and Mind Centre, University of Sydney, Camperdown, NSW 2050, Australia
- School of Psychology, Faculty of Science, University of Sydney, Camperdown, NSW 2050, Australia
- CIRUS, Centre for Sleep and Chronobiology, Woolcock Institute of Medical Research, University of Sydney, Glebe, NSW 2037, Australia
| | - Loren Mowszowski
- Healthy Brain Ageing Program, Brain and Mind Centre, University of Sydney, Camperdown, NSW 2050, Australia
- Charles Perkins Centre, University of Sydney, Camperdown, NSW 2050, Australia
- School of Psychology, Faculty of Science, University of Sydney, Camperdown, NSW 2050, Australia
| | - Catriona Ireland
- Healthy Brain Ageing Program, Brain and Mind Centre, University of Sydney, Camperdown, NSW 2050, Australia
| | - Jake R Palmer
- Healthy Brain Ageing Program, Brain and Mind Centre, University of Sydney, Camperdown, NSW 2050, Australia
| | - Ronald R Grunstein
- CIRUS, Centre for Sleep and Chronobiology, Woolcock Institute of Medical Research, University of Sydney, Glebe, NSW 2037, Australia
- Faculty of Medicine and Health, University of Sydney, Camperdown, NSW 2050, Australia
- Royal Prince Alfred Hospital, University of Sydney, Camperdown, NSW 2050, Australia
| | - James M Shine
- Royal Prince Alfred Hospital, University of Sydney, Camperdown, NSW 2050, Australia
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Effect of Number of Household Members on Falls among Disabled Older People. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2022; 19:ijerph19105888. [PMID: 35627426 PMCID: PMC9141213 DOI: 10.3390/ijerph19105888] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 03/17/2022] [Revised: 04/27/2022] [Accepted: 04/27/2022] [Indexed: 02/01/2023]
Abstract
Objectives: To investigate the effect of the number of cohabitating household members on falls among an disabled aging Korean population. Methods: We used data from the first to the fourth waves of the Korea Longitudinal Study of Aging. Using the first wave at baseline, data included 1414 individuals aged 45 years and older who needed assistance for performance of activities of daily living (ADL) or instrumental activities of daily living (IADL). We classified falls as overall falls, falls requiring medical treatment, and hip fractures caused by falls. The number of cohabitating family members was classified as none (living alone), one, two, or more. A generalized estimating equation with logit link was used to examine the association between the number of cohabitating household members with overall falls and injuries caused by falls. Results: Compared to living with two or more household members, living alone was associated with higher odds of overall falls, falls needing medical treatment, and hip fractures caused by falls (odds ratio (OR) 2.13, 95% confidence interval [CI] 1.36–3.34; OR 2.13, 95% CI 1.28–3.53; OR 1.93, 95% CI 1.01–3.69, respectively). These associations were particularly strong in individuals with cognitive decline. Conclusions Living alone is associated with higher odds of overall falls, falls needing medical treatment, and hip fractures caused by falls, particularly for those with cognitive decline. Conclusions: Intervention programs to prevent falls in disabled, aging adults, especially those living alone and those with declined cognitive function, need to provide home care services and promote the use of safety equipment.
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Ehlen JC, Forman CM, Ostrowski D, Ostrowski TD. Autonomic Dysfunction Impairs Baroreflex Function in an Alzheimer's Disease Animal Model. J Alzheimers Dis 2022; 90:1449-1464. [PMID: 36278348 PMCID: PMC9742304 DOI: 10.3233/jad-220496] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/14/2022]
Abstract
BACKGROUND Alzheimer's disease (AD) patients frequently present with orthostatic hypotension. This inability to reflexively increase blood pressure on standing is a serious health concern and increases the risk of stroke and cardiovascular diseases. OBJECTIVE Since there are no clear mechanisms for orthostatic hypotension in human AD, the present study assessed the autonomic changes that could explain this comorbidity in an AD animal model. METHODS We used the established streptozotocin-induced rat model of AD (STZ-AD), which mimics many hallmark symptoms of sporadic AD in humans. Baroreflex responses were analyzed in anesthetized STZ-AD rats using femoral catheterization for blood pressure and heart rate, and autonomic activity was assessed using specific blockers and splanchnic sympathetic nerve recordings. Expression levels of autonomic receptors at the heart were examined using the western blot technique. RESULTS Baroreflex function in STZ-AD showed a blunted heart rate (HR) response to low blood pressure challenges, and the maximal sympathetic nerve activity was reduced. Conversely, HR responses to high blood pressure were similar to control, indicating no change in parasympathetic nerve activity. Under resting conditions, autonomic blockade demonstrated a baseline shift to increased sympathetic tone in STZ-AD. Protein expression levels of beta-1 adrenergic receptor and muscarinic acetylcholine receptor M2 in the heart were unchanged. CONCLUSION Our study provides the first data on the pathological influence of AD on baroreflex function, which primarily affected the sympathetic nervous system in STZ-AD. These results represent the first mechanisms that may correlate with the orthostatic hypotension in human AD.
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Affiliation(s)
- John C. Ehlen
- Department of Physiology, Kirksville College of Osteopathic Medicine, A.T. Still University of Health Sciences, Kirksville, MO, USA
| | | | | | - Tim D. Ostrowski
- Department of Physiology, Kirksville College of Osteopathic Medicine, A.T. Still University of Health Sciences, Kirksville, MO, USA
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Scarsoglio S, Ridolfi L. Different Impact of Heart Rate Variability in the Deep Cerebral and Central Hemodynamics at Rest: An in silico Investigation. Front Neurosci 2021; 15:600574. [PMID: 34079433 PMCID: PMC8165247 DOI: 10.3389/fnins.2021.600574] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/30/2020] [Accepted: 04/19/2021] [Indexed: 11/18/2022] Open
Abstract
Background: Heart rate variability (HRV), defined as the variability between consecutive heartbeats, is a surrogate measure of cardiac vagal tone. It is widely accepted that a decreased HRV is associated to several risk factors and cardiovascular diseases. However, a possible association between HRV and altered cerebral hemodynamics is still debated, suffering from HRV short-term measures and the paucity of high-resolution deep cerebral data. We propose a computational approach to evaluate the deep cerebral and central hemodynamics subject to physiological alterations of HRV in an ideal young healthy patient at rest. Methods: The cardiovascular-cerebral model is composed by electrical components able to reproduce the response of the different cardiovascular regions and their features. The model was validated over more than thirty studies and recently exploited to understand the hemodynamic mechanisms between cardiac arrythmia and cognitive deficit. Three configurations (baseline, increased HRV, and decreased HRV) are built based on the standard deviation (SDNN) of RR beats. For each configuration, 5,000 RR beats are simulated to investigate the occurrence of extreme values, alteration of the regular hemodynamics pattern, and variation of mean perfusion/pressure levels. Results: In the cerebral circulation, our results show that HRV has overall a stronger impact on pressure than flow rate mean values but similarly alters pressure and flow rate in terms of extreme events. By comparing reduced and increased HRV, this latter induces a higher probability of altered mean and extreme values, and is therefore more detrimental at distal cerebral level. On the contrary, at central level a decreased HRV induces a higher cardiac effort without improving the mechano-contractile performance, thus overall reducing the heart efficiency. Conclusions: Present results suggest that: (i) the increase of HRV per se does not seem to be sufficient to trigger a better cerebral hemodynamic response; (ii) by accounting for both central and cerebral circulations, the optimal HRV configuration is found at baseline. Given the relation inversely linking HRV and HR, the presence of this optimal condition can contribute to explain why the mean HR of the general population settles around the baseline value (70 bpm).
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Affiliation(s)
- Stefania Scarsoglio
- Department of Mechanical and Aerospace Engineering, Politecnico di Torino, Torino, Italy
| | - Luca Ridolfi
- Department of Environmental, Land and Infrastructure Engineering, Politecnico di Torino, Torino, Italy
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Jonell P, Moëll B, Håkansson K, Henter GE, Kucherenko T, Mikheeva O, Hagman G, Holleman J, Kivipelto M, Kjellström H, Gustafson J, Beskow J. Multimodal Capture of Patient Behaviour for Improved Detection of Early Dementia: Clinical Feasibility and Preliminary Results. FRONTIERS IN COMPUTER SCIENCE 2021. [DOI: 10.3389/fcomp.2021.642633] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/17/2022] Open
Abstract
Non-invasive automatic screening for Alzheimer’s disease has the potential to improve diagnostic accuracy while lowering healthcare costs. Previous research has shown that patterns in speech, language, gaze, and drawing can help detect early signs of cognitive decline. In this paper, we describe a highly multimodal system for unobtrusively capturing data during real clinical interviews conducted as part of cognitive assessments for Alzheimer’s disease. The system uses nine different sensor devices (smartphones, a tablet, an eye tracker, a microphone array, and a wristband) to record interaction data during a specialist’s first clinical interview with a patient, and is currently in use at Karolinska University Hospital in Stockholm, Sweden. Furthermore, complementary information in the form of brain imaging, psychological tests, speech therapist assessment, and clinical meta-data is also available for each patient. We detail our data-collection and analysis procedure and present preliminary findings that relate measures extracted from the multimodal recordings to clinical assessments and established biomarkers, based on data from 25 patients gathered thus far. Our findings demonstrate feasibility for our proposed methodology and indicate that the collected data can be used to improve clinical assessments of early dementia.
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Cardiac and Blood Pressure Safety of Transdermal Rivastigmine in Elderly Patients With Dementia With Lewy Bodies. Alzheimer Dis Assoc Disord 2020; 34:339-343. [PMID: 32809983 DOI: 10.1097/wad.0000000000000401] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
BACKGROUND Dementia with Lewy bodies (DLB) is the second most common dementia. Features of DLB include postganglionic cardiac sympathetic denervation and autonomic instability. Rivastigmine therapy, an acetylcholinesterase inhibitor, is widely used in the primary treatment of DLB; however, the cardiovascular safety and tolerability of transdermal rivastigmine needs to be reviewed. OBJECTIVE To evaluate whether transdermal rivastigmine has an effect on blood pressure, heart rate, and electrocardiography measurements. MATERIALS AND METHODS A total of 722 patients diagnosed with dementia were retrospectively screened. Fifty-seven of 98 DLB patients who received transdermal rivastigmine treatment with available serial electrocardiography and blood pressure measurements were included in the study. Baseline and follow-up measurements were compared for patients on the 9.5 to 13.3 mg/d rivastigmine dose for at least 4 weeks. RESULTS The mean age of the patients was 80.77±6.04, and the majority were women (63%). A total of 8 cases with bradycardia and 5 with orthostatic hypotension were detected during follow-up, and rivastigmine patch was stopped in one of those 8 patients due to symptomatic bradycardia. Nonetheless, there was no difference between baseline and follow-up measurements of the patients, including heart rate, cardiac rhythm, electrocardiographic intervals, blood pressure, pulse pressure, and postural blood pressure changes. CONCLUSIONS Transdermal rivastigmine therapy is not associated with arrhythmogenic or hypotensive effects in the elderly patients with DLB. However, when prescribing transdermal rivastigmine, physicians should pay attention to newly emerging orthostatic hypotension during the follow-up in these patients.
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Abstract
PURPOSE OF REVIEW Autonomic dysfunction is common in dementia, particularly in the Lewy body dementias. This review considers the evidence for autonomic dysfunction in dementia, common symptoms and potential management options. RECENT FINDINGS Autonomic dysfunction has been shown in Alzheimer's disease and Lewy body dementias. Common symptoms include orthostatic dizziness, syncope, falls, urinary tract symptoms and constipation. Non-pharmacological management of orthostatic hypotension should include bolus water drinking. Pharmacological management may include the use of midodrine or droxidopa although the latter is not available in Europe. Atomoxetine is a noradrenaline reuptake inhibitor which may be useful if further clinical trials become available. Management of constipation may include the use o f probiotics, osmotic laxatives such as macrogol and chloride type 2 channel activators such as lubiprostone. Management of urinary tract symptoms may include the use of mirabegron. There is a dearth of clinical trials for autonomic dysfunction in dementia and most of the evidence is imputed from trials in Parkinson's disease. However, pragmatic recommendations may be made. There is a need for controlled clinical trials in people with dementia.
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Affiliation(s)
- Louise M Allan
- Institute of Health Research, College of Medicine and Health, University of Exeter, South Cloisters Building, St Luke's Campus, Heavitree Road, Exeter, EX1 2LU, UK.
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Kim MS, Yoon JH, Hong JM. Early differentiation of dementia with Lewy bodies and Alzheimer's disease: Heart rate variability at mild cognitive impairment stage. Clin Neurophysiol 2018; 129:1570-1578. [PMID: 29883835 DOI: 10.1016/j.clinph.2018.05.004] [Citation(s) in RCA: 21] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/28/2017] [Revised: 04/16/2018] [Accepted: 05/19/2018] [Indexed: 11/15/2022]
Abstract
OBJECTIVE Our study aimed to investigate whether heart rate variability (HRV) could be a useful diagnostic screening tool at MCI (mild cognitive impairment) stage of Dementia with Lewy bodies (DLB) from Alzheimer's disease (AD). METHODS This retrospective study used a selected sample from Ajou neurological registry. We identified MCI patients who underwent HRV testing at baseline, and who developed probable DLB (MCI-DLB: n = 23) or AD (MCI-AD: n = 32). RESULTS The MCI-DLB group exhibited significantly lower levels of almost all HRV parameters compared with the MCI-AD group. Fronto-executive function and visuospatial abilities were poorer in the MCI-DLB group, whereas the extent of verbal memory impairment was greater in the MCI-AD. Verbal memory score was negatively correlated with overall HRV parameters, and visuospatial function was positively correlated with the frequency domain of HRV. Receiver operating curve area under the curve (AUC) analysis revealed that the low frequency component was the best potential diagnostic marker (AUC = 0.88). CONCLUSION MCI-DLB patients exhibited greater cardiac autonomic dysfunction (as measured by HRV) and greater fronto-executive and visuospatial deficit compared with MCI-AD patients. SIGNIFICANCE HRV may be useful method to differentiate DLB from AD in patients with MCI; this would facilitate early disease-specific intervention.
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Affiliation(s)
- Min Seung Kim
- Department of Neurology, Ajou University School of Medicine, Suwon, South Korea
| | - Jung Han Yoon
- Department of Neurology, Ajou University School of Medicine, Suwon, South Korea.
| | - Ji Man Hong
- Department of Neurology, Ajou University School of Medicine, Suwon, South Korea
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Reinertsen E, Clifford GD. A review of physiological and behavioral monitoring with digital sensors for neuropsychiatric illnesses. Physiol Meas 2018; 39:05TR01. [PMID: 29671754 PMCID: PMC5995114 DOI: 10.1088/1361-6579/aabf64] [Citation(s) in RCA: 68] [Impact Index Per Article: 11.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/15/2023]
Abstract
Physiological, behavioral, and psychological changes associated with neuropsychiatric illness are reflected in several related signals, including actigraphy, location, word sentiment, voice tone, social activity, heart rate, and responses to standardized questionnaires. These signals can be passively monitored using sensors in smartphones, wearable accelerometers, Holter monitors, and multimodal sensing approaches that fuse multiple data types. Connection of these devices to the internet has made large scale studies feasible and is enabling a revolution in neuropsychiatric monitoring. Currently, evaluation and diagnosis of neuropsychiatric disorders relies on clinical visits, which are infrequent and out of the context of a patient's home environment. Moreover, the demand for clinical care far exceeds the supply of providers. The growing prevalence of context-aware and physiologically relevant digital sensors in consumer technology could help address these challenges, enable objective indexing of patient severity, and inform rapid adjustment of treatment in real-time. Here we review recent studies utilizing such sensors in the context of neuropsychiatric illnesses including stress and depression, bipolar disorder, schizophrenia, post traumatic stress disorder, Alzheimer's disease, and Parkinson's disease.
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Affiliation(s)
- Erik Reinertsen
- Department of Biomedical Engineering, Georgia Institute of Technology, Atlanta, GA, United States of America
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Kröger E, Wilchesky M, Marcotte M, Voyer P, Morin M, Champoux N, Monette J, Aubin M, Durand PJ, Verreault R, Arcand M. Medication Use Among Nursing Home Residents With Severe Dementia: Identifying Categories of Appropriateness and Elements of a Successful Intervention. J Am Med Dir Assoc 2015; 16:629.e1-17. [DOI: 10.1016/j.jamda.2015.04.002] [Citation(s) in RCA: 29] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/16/2015] [Revised: 04/02/2015] [Accepted: 04/02/2015] [Indexed: 12/20/2022]
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Mellingsæter MR, Wyller TB, Ranhoff AH, Bogdanovic N, Wyller VB. Reduced sympathetic response to head-up tilt in subjects with mild cognitive impairment or mild Alzheimer's dementia. Dement Geriatr Cogn Dis Extra 2015; 5:107-15. [PMID: 25873932 PMCID: PMC4386107 DOI: 10.1159/000375297] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/24/2023] Open
Abstract
Background Hemodynamic control was compared in patients with mild cognitive impairment (MCI) or mild Alzheimer's dementia (AD) as well as in healthy elderly subjects. Methods Noninvasive, continuous hemodynamic recordings were obtained from 14 patients and 48 controls during supine rest (tilt of 30 and 70°). Cardiac output, end-diastolic volume, total peripheral resistance, heart rate variability (HRV), systolic blood pressure variability (SBPV), and baroreceptor sensitivity were calculated. Results At 70° tilt, the HRV indices differed significantly, with higher high-frequency (HF) variability as well as lower low-frequency (LF) variability and LF/HF ratios in the patients. The patients had significantly lower SBPV in the LF range at 30° tilt. Conclusions The results indicate a poorer sympathetic response to orthostatic stress in MCI and mild AD. © 2015 S. Karger AG, Basel
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Affiliation(s)
- Marte Rognstad Mellingsæter
- Department of Geriatric Medicine, Oslo University Hospital, Bergen ; Institute of Clinical Medicine, University of Oslo, Bergen
| | - Torgeir Bruun Wyller
- Department of Geriatric Medicine, Oslo University Hospital, Bergen ; Institute of Clinical Medicine, University of Oslo, Bergen
| | - Anette Hylen Ranhoff
- Diakonhjemmet Hospital, Oslo, Bergen ; Department of Clinical Science, University of Bergen, Bergen
| | - Nenad Bogdanovic
- Department of Geriatric Medicine, Oslo University Hospital, Bergen ; Institute of Clinical Medicine, University of Oslo, Bergen
| | - Vegard Bruun Wyller
- Institute of Clinical Medicine, University of Oslo, Bergen ; Department of Pediatrics, Akershus University Hospital, Lørenskog, Norway
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Nicolini P, Ciulla MM, Malfatto G, Abbate C, Mari D, Rossi PD, Pettenuzzo E, Magrini F, Consonni D, Lombardi F. Autonomic dysfunction in mild cognitive impairment: evidence from power spectral analysis of heart rate variability in a cross-sectional case-control study. PLoS One 2014; 9:e96656. [PMID: 24801520 PMCID: PMC4011966 DOI: 10.1371/journal.pone.0096656] [Citation(s) in RCA: 49] [Impact Index Per Article: 4.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/18/2013] [Accepted: 04/11/2014] [Indexed: 12/11/2022] Open
Abstract
BACKGROUND Mild cognitive impairment (MCI) is set to become a major health problem with the exponential ageing of the world's population. The association between MCI and autonomic dysfunction, supported by indirect evidence and rich with clinical implications in terms of progression to dementia and increased risk of mortality and falls, has never been specifically demonstrated. AIM To conduct a comprehensive assessment of autonomic function in subjects with MCI by means of power spectral analysis (PSA) of heart rate variability (HRV) at rest and during provocative manoeuvres. METHODS This cross-sectional study involved 80 older outpatients (aged ≥ 65) consecutively referred to a geriatric unit and diagnosed with MCI or normal cognition (controls) based on neuropsychological testing. PSA was performed on 5-minute electrocardiographic recordings under three conditions--supine rest with free breathing (baseline), supine rest with paced breathing at 12 breaths/minute (parasympathetic stimulation), and active standing (orthosympathetic stimulation)--with particular focus on the changes from baseline to stimulation of indices of sympathovagal balance: normalized low frequency (LFn) and high frequency (HFn) powers and the LF/HF ratio. Blood pressure (BP) was measured at baseline and during standing. Given its exploratory nature in a clinical population the study included subjects on medications with a potential to affect HRV. RESULTS There were no significant differences in HRV indices between the two groups at baseline. MCI subjects exhibited smaller physiological changes in all three HRV indices during active standing, consistently with a dysfunction of the orthosympathetic system. Systolic BP after 10 minutes of standing was lower in MCI subjects, suggesting dysautonomia-related orthostatic BP dysregulation. CONCLUSIONS Our study is novel in providing evidence of autonomic dysfunction in MCI. This is associated with orthostatic BP dysregulation and the ongoing follow-up of the study population will determine its prognostic relevance as a predictor of adverse health outcomes.
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Affiliation(s)
- Paola Nicolini
- Geriatric Unit, Fondazione IRCCS Ca’ Granda Ospedale Maggiore Policlinico, Department of Clinical and Community Sciences, University of Milan, Milan, Italy
| | - Michele M. Ciulla
- Cardiovascular Diseases Unit, Fondazione IRCCS Ca’ Granda Ospedale Maggiore Policlinico, Department of Clinical and Community Sciences, University of Milan, Milan, Italy
| | - Gabriella Malfatto
- Department of Cardiology, Ospedale San Luca, Istituto Auxologico Italiano IRCCS, Milan, Italy
| | - Carlo Abbate
- Geriatric Unit, Fondazione IRCCS Ca’ Granda Ospedale Maggiore Policlinico, Department of Clinical and Community Sciences, University of Milan, Milan, Italy
| | - Daniela Mari
- Geriatric Unit, Fondazione IRCCS Ca’ Granda Ospedale Maggiore Policlinico, Department of Clinical and Community Sciences, University of Milan, Milan, Italy
| | - Paolo D. Rossi
- Geriatric Unit, Fondazione IRCCS Ca’ Granda Ospedale Maggiore Policlinico, Department of Clinical and Community Sciences, University of Milan, Milan, Italy
| | - Emanuela Pettenuzzo
- Geriatric Unit, Fondazione IRCCS Ca’ Granda Ospedale Maggiore Policlinico, Department of Clinical and Community Sciences, University of Milan, Milan, Italy
| | - Fabio Magrini
- Cardiovascular Diseases Unit, Fondazione IRCCS Ca’ Granda Ospedale Maggiore Policlinico, Department of Clinical and Community Sciences, University of Milan, Milan, Italy
| | - Dario Consonni
- Epidemiology Unit, Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Milan, Italy
| | - Federico Lombardi
- Cardiovascular Diseases Unit, Fondazione IRCCS Ca’ Granda Ospedale Maggiore Policlinico, Department of Clinical and Community Sciences, University of Milan, Milan, Italy
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Robles Bayón A, Gude Sampedro F, Torregrosa Quesada J. Bradicardia en la demencia frontotemporal. Neurologia 2014; 29:76-85. [DOI: 10.1016/j.nrl.2013.02.010] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/23/2012] [Revised: 02/13/2013] [Accepted: 02/17/2013] [Indexed: 12/30/2022] Open
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Robles Bayón A, Gude Sampedro F, Torregrosa Quesada J. Bradycardia in frontotemporal dementia. NEUROLOGÍA (ENGLISH EDITION) 2014. [DOI: 10.1016/j.nrleng.2013.02.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022] Open
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17
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Lin PF, Lo MT, Tsao J, Chang YC, Lin C, Ho YL. Correlations between the signal complexity of cerebral and cardiac electrical activity: a multiscale entropy analysis. PLoS One 2014; 9:e87798. [PMID: 24498375 PMCID: PMC3912068 DOI: 10.1371/journal.pone.0087798] [Citation(s) in RCA: 29] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/22/2013] [Accepted: 12/30/2013] [Indexed: 11/18/2022] Open
Abstract
The heart begins to beat before the brain is formed. Whether conventional hierarchical central commands sent by the brain to the heart alone explain all the interplay between these two organs should be reconsidered. Here, we demonstrate correlations between the signal complexity of brain and cardiac activity. Eighty-seven geriatric outpatients with healthy hearts and varied cognitive abilities each provided a 24-hour electrocardiography (ECG) and a 19-channel eye-closed routine electroencephalography (EEG). Multiscale entropy (MSE) analysis was applied to three epochs (resting-awake state, photic stimulation of fast frequencies (fast-PS), and photic stimulation of slow frequencies (slow-PS)) of EEG in the 1–58 Hz frequency range, and three RR interval (RRI) time series (awake-state, sleep and that concomitant with the EEG) for each subject. The low-to-high frequency power (LF/HF) ratio of RRI was calculated to represent sympatho-vagal balance. With statistics after Bonferroni corrections, we found that: (a) the summed MSE value on coarse scales of the awake RRI (scales 11–20, RRI-MSE-coarse) were inversely correlated with the summed MSE value on coarse scales of the resting-awake EEG (scales 6–20, EEG-MSE-coarse) at Fp2, C4, T6 and T4; (b) the awake RRI-MSE-coarse was inversely correlated with the fast-PS EEG-MSE-coarse at O1, O2 and C4; (c) the sleep RRI-MSE-coarse was inversely correlated with the slow-PS EEG-MSE-coarse at Fp2; (d) the RRI-MSE-coarse and LF/HF ratio of the awake RRI were correlated positively to each other; (e) the EEG-MSE-coarse at F8 was proportional to the cognitive test score; (f) the results conform to the cholinergic hypothesis which states that cognitive impairment causes reduction in vagal cardiac modulation; (g) fast-PS significantly lowered the EEG-MSE-coarse globally. Whether these heart-brain correlations could be fully explained by the central autonomic network is unknown and needs further exploration.
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Affiliation(s)
- Pei-Feng Lin
- Department of Geriatrics, Tainan Hospital, Ministry of Health and Welfare, Tainan, Taiwan
- Graduate Institute of Biomedical Electronics and Bioinformatics, National Taiwan University, Taipei, Taiwan
- * E-mail:
| | - Men-Tzung Lo
- Research Center for Adaptive Data Analysis, National Central University, Jongli, Taiwan
| | - Jenho Tsao
- Graduate Institute of Biomedical Electronics and Bioinformatics, National Taiwan University, Taipei, Taiwan
| | - Yi-Chung Chang
- Graduate Institute of Communication Engineering, National Taiwan University, Taipei, Taiwan
| | - Chen Lin
- Research Center for Adaptive Data Analysis, National Central University, Jongli, Taiwan
- Institute of Systems Biology and Bioinformatics, National Central University, Jongli, Taiwan
| | - Yi-Lwun Ho
- Graduate Institute of Clinical Medicine, College of Medicine, National Taiwan University, Taipei, Taiwan
- Cardiology, Department of Internal Medicine, National Taiwan University Hospital, Taipei, Taiwan
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18
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Chung MS, Yang AC, Lin YC, Lin CN, Chang FR, Shen SH, Ouyang WC, Loh EW, Chiu HJ. Association of altered cardiac autonomic function with psychopathology and metabolic profiles in schizophrenia. Psychiatry Res 2013; 210:710-5. [PMID: 23978730 DOI: 10.1016/j.psychres.2013.07.034] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/10/2012] [Revised: 07/23/2013] [Accepted: 07/27/2013] [Indexed: 12/29/2022]
Abstract
Schizophrenia has been associated with autonomic dysregulation and increased cardiovascular co-morbidity. We hypothesised that autonomic dysregulation in patients with schizophrenia is associated with psychopathology and metabolic profiles. In this study, we aimed to evaluate psychopathology, comprehensive metabolic profiles and cardiac autonomic function using heart-rate variability (HRV) analysis in patients with schizophrenia. A total of 94 patients with schizophrenia and 51 healthy controls were recruited. Each patient underwent a physical examination, laboratory tests and rating scale evaluation, and all subjects underwent a 1-h electrocardiogram monitoring. Analysis of variance was used to compare demographic and HRV variables between control and patient groups. We applied multiple regression analysis with backward selection to examine the association between HRV indices and demographic, metabolic and psychopathology profiles. A decreased HRV was found in patient groups, compared to controls. Reduced vagal-related and complexity domain of HRV indices in patient groups were correlated with increased body mass indices, diastolic pressure, triglycerides, high- and low-density lipoprotein and severity of psychosis mainly in the negative symptom domain. This study provides evidence that altered autonomic function is associated with both psychopathology and metabolic profiles in patients with schizophrenia. These findings may warrant future research in using HRV as objective markers to monitor cardiovascular health and the severity of psychosis in patients with schizophrenia.
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Saint Martin M, Sforza E, Thomas-Anterion C, Barthélémy JC, Roche F. Baroreflex sensitivity, vascular risk factors, and cognitive function in a healthy elderly population: the PROOF cohort. J Am Geriatr Soc 2013; 61:2096-2102. [PMID: 24279643 DOI: 10.1111/jgs.12548] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/03/2023]
Abstract
OBJECTIVES To assess the role of the cardiac autonomic nervous system (ANS), as measured according to spontaneous cardiac baroreflex sensitivity (BRS), in the type and degree of cognitive performance in healthy young-elderly individuals, taking into account the presence of other vascular risk factors. DESIGN Community-based cross-sectional study. SETTING In-home and clinical settings. PARTICIPANTS A subset of participants, aged 66.9±0.9, from a prospective study that aimed to assess the influence of ANS activity on cardiovascular and cerebrovascular morbidity and mortality (N=916). MEASUREMENTS All subjects underwent a clinical interview, neuropsychological testing, and autonomic and vascular measurements. Three cognitive domains were defined: attentional (Trail-Making Test Part A, Stroop code and parts I & II), executive (Trail-Making Test Part B, Stroop part III, verbal fluency and similarity tests), and memory (Benton visual retention test, Grober and Buschké procedure). Subjects were stratified according to their scores into normal, low, and impaired performers. RESULTS After adjustments to demographic and vascular data, participants with moderate autonomic dysregulation (3<BRS≤6) were determined to be 1.82 times as likely to have memory impairment (odds ratio (OR)=1.82, 95% confidence interval (CI)=1.13-3.17, P=.02) and those with severe autonomic dysregulation (BRS≤3) to be 2.65 as likely (OR=2.65, 95% CI=1.40-5.59, P=.006) as participants with normal BRS (>6). CONCLUSION In older individuals without dementia, autonomic dysregulation seems to have a direct, gradual, and independent effect on memory. Future studies are needed to evaluate the long-term effects of BRS and other markers of the ANS on cognitive decline.
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Affiliation(s)
- Magali Saint Martin
- Département de Physiologie Clinique et de l'Exercice, Pôle Neuro-OstéoLocomoteur, Centre Hospitalo-Universitaire, Saint-Étienne, France.,Faculté de Médicine de Saint-Etienne, Université Jean Moulin, Saint-Étienne, France.,Pôle de Recherche et d'Enseignement Supérieur, Université de Lyon, Lyon, France.,Laboratoire des Mécanismes Cognitifs, Université de Lyon 2, Lyon, France
| | - Emilia Sforza
- Département de Physiologie Clinique et de l'Exercice, Pôle Neuro-OstéoLocomoteur, Centre Hospitalo-Universitaire, Saint-Étienne, France.,Faculté de Médicine de Saint-Etienne, Université Jean Moulin, Saint-Étienne, France.,Pôle de Recherche et d'Enseignement Supérieur, Université de Lyon, Lyon, France
| | | | - Jean Claude Barthélémy
- Département de Physiologie Clinique et de l'Exercice, Pôle Neuro-OstéoLocomoteur, Centre Hospitalo-Universitaire, Saint-Étienne, France.,Faculté de Médicine de Saint-Etienne, Université Jean Moulin, Saint-Étienne, France.,Pôle de Recherche et d'Enseignement Supérieur, Université de Lyon, Lyon, France
| | - Frédéric Roche
- Département de Physiologie Clinique et de l'Exercice, Pôle Neuro-OstéoLocomoteur, Centre Hospitalo-Universitaire, Saint-Étienne, France.,Faculté de Médicine de Saint-Etienne, Université Jean Moulin, Saint-Étienne, France.,Pôle de Recherche et d'Enseignement Supérieur, Université de Lyon, Lyon, France
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20
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Dias FLDC, Silva RMFLD, Moraes END, Caramelli P. Clinical and autonomic profile of patients with Alzheimer's disease and mixed dementia patients. Rev Assoc Med Bras (1992) 2013; 59:435-41. [PMID: 24119378 DOI: 10.1016/j.ramb.2013.04.004] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/08/2012] [Revised: 04/10/2013] [Accepted: 04/14/2013] [Indexed: 11/17/2022] Open
Abstract
OBJECTIVE To analyze the clinical and autonomical profile of patients with Alzheimer's disease or mixed dementia (MD). METHODS Fifty-four patients with indication for cholinesterase inhibitors use were evaluated through clinical examination, rest electrocardiogram, and spectral analysis of heart rate (HR) variability through digital Holter system recordings. RESULTS Overall, 61.1% of patients were female and were, on average, 77.1 years of age, 3.3 years of schooling and scored 16.4 points on the Mini Mental State Examination. The gap between symptom onset and diagnosis was 26.2 months. Almost all patients (90.7%) presented at least one clinical comorbidity, and each patient took, on average, 3.7 drugs to control them. Thirty-one patients had some alteration on the electrocardiogram and nine (16.6%) had orthostatic hypotension (OH). The latter was associated with the diagnosis of MD (p=0.001), with lower values of low (LF) and high (HF) frequency components of the spectral analysis in the supine position (p=0.000 and p=0.017, respectively) and with lower values of LF in the orthostatic position (p=0.006). Diagnosis of MD was associated with lower values of LF in both positions (p=0.003 and p=0.007). CONCLUSION This sample of patients had frequent comorbidities, which resulted in the prescription of multiple drugs. Signs of autonomic dysfunction resulting in OH were found mainly in those with MD.
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Affiliation(s)
- Filipi Leles da Costa Dias
- Programa de Pós-Graduação em Ciências Aplicadas à Saúde do Adulto, Departamento de Clínica Médica, Faculdade de Medicina, Universidade Federal de Minas Gerais (UFMG), Belo Horizonte, MG, Brasil.
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21
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Whitney J, Close JC, Jackson SH, Lord SR. Understanding Risk of Falls in People With Cognitive Impairment Living in Residential Care. J Am Med Dir Assoc 2012; 13:535-40. [DOI: 10.1016/j.jamda.2012.03.009] [Citation(s) in RCA: 57] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/20/2012] [Revised: 03/29/2012] [Accepted: 03/29/2012] [Indexed: 10/28/2022]
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Windham BG, Fumagalli S, Ble A, Sollers JJ, Thayer JF, Najjar SS, Griswold ME, Ferrucci L. The Relationship between Heart Rate Variability and Adiposity Differs for Central and Overall Adiposity. J Obes 2012; 2012:149516. [PMID: 22649714 PMCID: PMC3357556 DOI: 10.1155/2012/149516] [Citation(s) in RCA: 68] [Impact Index Per Article: 5.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/15/2011] [Revised: 02/23/2012] [Accepted: 02/23/2012] [Indexed: 12/31/2022] Open
Abstract
While frank obesity is associated with reduced HRV, indicative of poorer autonomic nervous system (ANS) function, the association between body mass index (BMI) and HRV is less clear. We hypothesized that effects of adiposity on ANS are mostly mediated by visceral fat and less by subcutaneous fat; therefore, centrally distributed adipose tissue, that is, waist circumference (WC), should be more strongly associated with HRV than overall adiposity (BMI). To examine this hypothesis, we used data collected in a subset of the Baltimore Longitudinal Study of Aging to compare strength of association between HRV and WC to that of HRV and BMI. Time domain HRV variables SDNN (standard deviation of successive differences in normal-to-normal (N-N) intervals) and RMSSD (root mean square of successive differences in N-N intervals) were calculated from 24-hour Holter recordings in 159 participants (29-96 years). Increasing WC was associated with decreasing SDNN and RMSSD in younger but not older participants (P value for WC-by-age interaction = 0.003). BMI was not associated with either SDNN or RMSSD at any age. In conclusion, central adiposity may contribute to sympathetic and parasympathetic ANS declines early in life.
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Affiliation(s)
- B. Gwen Windham
- Division of Geriatrics, Department of Medicine, University of Mississippi Medical Center, Jackson, MS 39216, USA
| | - Stefano Fumagalli
- Unit of Geriatrics, Department of Critical Care Medicine and Surgery, University of Florence and AOU Careggi, 50134 Florence, Italy
| | - Alessandro Ble
- Clinical Research Branch, National Institute on Aging, National Institutes of Health, Baltimore, MD 21225-1290, USA
| | - John J. Sollers
- Department of Psychological Medicine, Faculty of Medical & Health Science, The University of Auckland, Auckland 1142, New Zealand
| | - Julian F. Thayer
- The Ohio State University, Columbus, OH 43210, USA
- *Julian F. Thayer:
| | - Samar S. Najjar
- Clinical Research Branch, National Institute on Aging, National Institutes of Health, Baltimore, MD 21225-1290, USA
- Laboratory of Cardiovascular Science, Department of Biostatistics, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD 21205, USA
| | - Michael E. Griswold
- Center of Biostatistics and Bioinformatics, University of Mississippi Medical Center, Jackson, MS 39216, USA
| | - Luigi Ferrucci
- Clinical Research Branch, National Institute on Aging, National Institutes of Health, Baltimore, MD 21225-1290, USA
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Collins O, Dillon S, Finucane C, Lawlor B, Kenny RA. Parasympathetic autonomic dysfunction is common in mild cognitive impairment. Neurobiol Aging 2011; 33:2324-33. [PMID: 22188719 DOI: 10.1016/j.neurobiolaging.2011.11.017] [Citation(s) in RCA: 70] [Impact Index Per Article: 5.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/06/2011] [Revised: 11/08/2011] [Accepted: 11/10/2011] [Indexed: 10/14/2022]
Abstract
Components of the central autonomic network attract the greatest neurofibrillary degeneration and related cell death during the course of Alzheimer's disease (AD). The insular cortex and brainstem are affected from the early stages of disease. Acetylcholine, the main neurotransmitter of the parasympathetic system may be deficient in mild cognitive impairment (MCI). Hence, autonomic dysfunction may be a novel biomarker of neurodegeneration. Autonomic function was examined in 97 MCI participants and 36 controls using beside cardiovascular reflex tests and heart rate variability. The association between dysautonomia and neuropsychiatric deficits was examined. This observational study was conducted in a clinical setting. MCI participants showed significant parasympathetic deficits in bedside cardiovascular reflex tests and heart rate variability compared with controls. Those with more significant autonomic dysfunction had more severe neuropsychological deficits. MCI participants were 5.60 (95% confidence interval, 1.6-27.2) times more likely than a control to have autonomic dysfunction. Autonomic dysfunction, particularly parasympathetic dysfunction is prevalent in MCI. This may be due to early neuroanatomical and neurochemical changes in the central autonomic network in Alzheimer's disease. This may accelerate cognitive decline via proinflammatory mechanisms and/or hypotension-induced cerebral hypoperfusion. This provides insight into the pathophysiological mechanisms that contribute to cognitive decline, and may lead to the development of effective therapeutic interventions.
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Affiliation(s)
- Orla Collins
- Trinity Institute of Neurosciences, Trinity College, Dublin, Ireland.
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24
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Idiaquez J, Roman GC. Autonomic dysfunction in neurodegenerative dementias. J Neurol Sci 2011; 305:22-7. [PMID: 21440258 DOI: 10.1016/j.jns.2011.02.033] [Citation(s) in RCA: 60] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/09/2010] [Revised: 02/19/2011] [Accepted: 02/28/2011] [Indexed: 12/20/2022]
Abstract
Syncope associated to orthostatic hypotension (OH), urinary incontinence and constipation is common symptoms in demented patients, mainly in dementia with Lewy bodies (DLB) and in Parkinson's disease dementia (PDD). Alzheimer's disease (AD) and fronto temporal lobar degeneration (FTLD) show less autonomic dysfunction. Urinary symptoms are a prominent component of normal pressure hydrocephalus (NPH). There are non invasive tests including standard cardiovascular tests, 123 I-metaiodobenzylguanide (MIBG) cardiac scintigraphy, urodynamic tests, gastrointestinal motility studies, sweating reflexes and pupillary responses that assess autonomic dysfunction in these patients. The study of autonomic symptoms and abnormal tests in patients with dementia is useful to prevent morbidity due falls, severe constipation and to avoid side effects of drugs that interfere with autonomic function.
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Affiliation(s)
- Juan Idiaquez
- Universidad de Valparaíso, Avenida Libertad 63, Viña del Mar, Chile.
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25
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Shah AJ, Su S, Veledar E, Bremner JD, Goldstein FC, Lampert R, Goldberg J, Vaccarino V. Is heart rate variability related to memory performance in middle-aged men? Psychosom Med 2011; 73:475-82. [PMID: 21715297 PMCID: PMC3307789 DOI: 10.1097/psy.0b013e3182227d6a] [Citation(s) in RCA: 64] [Impact Index Per Article: 4.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/05/2023]
Abstract
OBJECTIVE Heart rate variability (HRV), a measure of autonomic function, has been associated with cognitive function, but studies are conflicting. Previous studies have also not controlled for familial and genetic influences. METHODS We performed power spectral analysis on 24-hour ambulatory ECGs in 416 middle-aged male twins from the Vietnam Era Twin Registry. Memory and learning were measured by verbal and visual Selective Reminding Tests (SRTs). Mixed-effect regression models were used to calculate associations between and within twin pairs, while adjusting for covariates. RESULTS The mean age (standard deviation) was 55 (2.9) years. A statistically significant positive association was found between measures of HRV and verbal, but not visual, SRT scores. The most statistically significant unadjusted association was found between very low frequency HRV and verbal total recall SRT, such that each logarithm of increase in very low frequency was associated with an increased verbal SRT score of 4.85 points (p = .002). The association persisted despite the adjustment for demographic and cardiovascular risk factors, and after accounting for familial and genetic factors by comparing twins within pairs. A significant interaction was found between posttraumatic stress disorder (PTSD) and HRV, such that total power and ultra low frequency were associated with SRT in twins (n = 362) without PTSD, but not in those with PTSD. CONCLUSIONS Lower frequency spectra of HRV are associated with verbal, but not visual, learning and memory, particularly in subjects without PTSD. This association may indicate that autonomic nervous system dysregulation plays a role in cognitive decline.
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Affiliation(s)
- Amit J. Shah
- Department of Medicine, Division of Cardiology, Emory University School of Medicine, Atlanta, GA
| | - Shaoyong Su
- Department of Medicine, Division of Cardiology, Emory University School of Medicine, Atlanta, GA
| | - Emir Veledar
- Department of Medicine, Division of Cardiology, Emory University School of Medicine, Atlanta, GA
| | - J. Douglas Bremner
- Department of Psychiatry and Behavioral Sciences, Emory University School of Medicine, Atlanta, GA
| | | | - Rachel Lampert
- Department of Internal Medicine, Division of Cardiovascular Medicine, Yale University School of Medicine
| | - Jack Goldberg
- The Vietnam Era Twin Registry, University of Washington, Seattle, WA
| | - Viola Vaccarino
- Department of Medicine, Division of Cardiology, Emory University School of Medicine, Atlanta, GA
,Department of Epidemiology, Rollins School of Public Health, Emory University, Atlanta, GA
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Toledo MADV, Junqueira LF. Cardiac autonomic modulation and cognitive status in Alzheimer's disease. Clin Auton Res 2009; 20:11-7. [PMID: 19830511 DOI: 10.1007/s10286-009-0035-0] [Citation(s) in RCA: 39] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/13/2009] [Accepted: 09/16/2009] [Indexed: 11/25/2022]
Abstract
INTRODUCTION Although nervous structures affected in Alzheimer's disease are also implicated in autonomic nervous system function, the relationship between autonomic and cognitive functions was not still investigated. METHODS The cardiac autonomic modulation of 5-min heart interval variability evaluated by time- and frequency-domain indexes, in supine and standing positions, of 22 Alzheimer's disease patients (90.9% women) aged 79.6 +/- 1.4 years (mean +/- SE) was correlated with mild to severe cognitive impairment scored by the CAMCOG and MMSE subset tests, by the Spearman's correlation analysis. RESULTS Age and level of education were not correlated with the heart interval variability indexes and the cognitive scores. Significantly positive (r (s) = 0.43-0.47, P = 0.03-0.04) or trend (r (s) = 0.36-0.40, P = 0.06-0.10) correlation was observed in both positions between the cognitive performance and pNN50%, rMSSD and absolute and normalised high-frequency power, considered to express parasympathetic modulation. Negative trend correlation (r (s) = -0.35 to -0.39, P = 0.07-0.10) was observed between absolute sympathetic modulation (low-frequency power and low-to-high frequency power ratio) in supine posture. CONCLUSION The cognitive status and the cardiac sympathovagal modulation appear to be correlated and hypothetically may influence one another in mild to severe Alzheimer's disease. Individuals with more severe cognitive deficiency showed suggestive lower cardiac parasympathetic modulation and trend for higher cardiac sympathetic modulation.
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Affiliation(s)
- Maria Alice de Vilhena Toledo
- Medical Sciences Postgraduate Course, Geriatrics Medicine Center, The Brasilia University Hospital, University of Brasilia, Brasilia, DF, Brazil
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de Vilhena Toledo MA, Junqueira LF. Cardiac sympathovagal modulation evaluated by short-term heart interval variability is subtly impaired in Alzheimer's disease. Geriatr Gerontol Int 2008; 8:109-18. [PMID: 18713163 DOI: 10.1111/j.1447-0594.2008.00456.x] [Citation(s) in RCA: 30] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Abstract
AIM Alzheimer's disease affects several nervous structures involved with the autonomic nervous system. Therefore, the still scarce evaluation of the cardiac autonomic function in this disease is of great functional, clinical, prognostic and therapeutic relevance. METHODS Time- and frequency-domain variability of 5-min R-R interval series in supine and standing positions was comparatively evaluated in 22 Alzheimer's disease subjects, aged 60-87 years (mean +/- standard error of the mean, 79.6 +/- 1.4) with variable cognitive impairment, and 24 healthy individuals, aged 60-91 years (68.6 +/- 1.6). The Student's t-test was used to compare the variability indices between the groups and logistic regression excluded the effects on these indices in the Alzheimer's group of confounding variables different from the control group (age, physical activity and caffeinated intake), at a significance level of P </= 0.05. RESULTS No difference was observed between the groups (P = 0.12-0.72) for each time-domain mean indices and for the frequency-domain indices of overall and absolute sympathetic modulation in both positions (P = 0.21-0.78). Absolute parasympathetic modulation showed borderline decrease in supine position (P = 0.07) and was reduced in the standing (P = 0.05). The sympathovagal balance was altered (P = 0.05) toward relative parasympathetic borderline depression (P = 0.07) and sympathetic exacerbation (P = 0.04) only in the supine posture. CONCLUSION Data indicate that Alzheimer's disease subjects with mild-to-severe cognitive dysfunction showed subtle, absolute and relative parasympathetic depression and relative sympathetic exacerbation, which may even so contribute to distinctive functional and cognitive disturbances.
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Affiliation(s)
- Maria Alice de Vilhena Toledo
- Clinical Medicine Area, Faculty of Medicine, University of Brasilia, and Geriatrics Medicine Center, Brasilia University Hospital, and Medical Sciences Postgraduate Course, Faculty of Medicine, University of Brasilia, Brasilia, Brazil
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Britton A, Singh-Manoux A, Hnatkova K, Malik M, Marmot MG, Shipley M. The association between heart rate variability and cognitive impairment in middle-aged men and women. The Whitehall II cohort study. Neuroepidemiology 2008; 31:115-21. [PMID: 18667838 DOI: 10.1159/000148257] [Citation(s) in RCA: 44] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/22/2008] [Accepted: 05/08/2008] [Indexed: 11/19/2022] Open
Abstract
BACKGROUND To examine the relationship between reduced heart rate variability (HRV) and cognitive function in middle-aged adults in the general population. METHODS HRV, in both time and frequency domains, and cognitive functioning were measured twice in 5,375 male and female participants of the UK Whitehall II study (mean ages = 55 and 61 years, respectively). Logistic regression was used to model associations between HRV and cognition [short-term verbal memory, reasoning (Alice Heim 4-I), vocabulary, phonemic and semantic fluency]. Cross-sectional associations were assessed at both waves, and longitudinal associations were measured as changes in cognition over the 5-year follow-up. RESULTS No consistent associations were found in men or women, either in the cross-sectional, prospective or the longitudinal analyses of declines in cognition. CONCLUSION Reduced cardiovascular autonomic function does not contribute to cognitive impairment in this middle-aged population. Further studies are needed to verify the potential role of HRV measures in predicting the degeneration of cognitive function at older ages.
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Affiliation(s)
- Annie Britton
- Department of Epidemiology and Public Health, University College London, London, UK.
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Lindquist SG, Nielsen JE, Stokholm J, Schwartz M, Batbayli M, Ballegaard M, Erdal J, Krabbe K, Waldemar G. Atypical early-onset Alzheimer's disease caused by the Iranian APP mutation. J Neurol Sci 2008; 268:124-30. [PMID: 18187157 DOI: 10.1016/j.jns.2007.11.021] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/28/2007] [Revised: 11/26/2007] [Accepted: 11/27/2007] [Indexed: 11/30/2022]
Abstract
BACKGROUND Approximately 1% of all cases of Alzheimer's disease are inherited autosomal dominantly, and to date, three causative genes have been found, the Presenilin 1 (PSEN1) gene, the Presenilin 2 (PSEN2) gene and the Amyloid precursor protein (APP) gene. We describe atypical phenotypic features in a family with a pathogenic APP gene mutation and discuss possible explanations for these atypical features. METHODS AND RESULTS We report a family with a history of dementia compatible with autosomal dominant transmission. The disease course in the proband was not typical for Alzheimer's disease as the diagnosis was preceded by 8 years of an isolated amnesia. Further, the proband had epilepsy with complex partial seizures and central degenerative autonomic failure as determined by clinical physiology. Sequencing the three known causative Alzheimer genes revealed a pathogenic missense mutation, APP Thr714Ala (the Iranian mutation). CONCLUSIONS The atypical clinical phenotype with long prodromal phase, autonomic failure and seizures in this new proband with the APP Thr714Ala mutation illustrates the clinical heterogeneity in families with identical pathogenic mutations.
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Affiliation(s)
- Suzanne Granhøj Lindquist
- Memory Disorders Research Group, Department of Neurology, Copenhagen University Hospital Rigshospitalet, Blegdamsvej 9, DK-2100 Copenhagen, Denmark.
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Allan LM, Ballard CG, Allen J, Murray A, Davidson AW, McKeith IG, Kenny RA. Autonomic dysfunction in dementia. J Neurol Neurosurg Psychiatry 2007; 78:671-7. [PMID: 17178816 PMCID: PMC2117678 DOI: 10.1136/jnnp.2006.102343] [Citation(s) in RCA: 146] [Impact Index Per Article: 8.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/03/2022]
Abstract
BACKGROUND There are no studies of autonomic function comparing Alzheimer's disease (AD), vascular dementia (VAD), dementia with Lewy bodies (DLB) and Parkinson's disease dementia (PDD). AIMS To assess cardiovascular autonomic function in 39 patients with AD, 30 with VAD, 30 with DLB, 40 with PDD and 38 elderly controls by Ewing's battery of autonomic function tests and power spectral analysis of heart rate variability. To determine the prevalence of orthostatic hypotension and autonomic neuropathies by Ewing's classification. RESULTS There were significant differences in severity of cardiovascular autonomic dysfunction between the four types of dementia. PDD and DLB had considerable dysfunction. VAD showed limited evidence of autonomic dysfunction and in AD, apart from orthostatic hypotension, autonomic functions were relatively unimpaired. PDD showed consistent impairment of both parasympathetic and sympathetic function tests in comparison with controls (all p<0.001) and AD (all p<0.03). DLB showed impairment of parasympathetic function (all p<0.05) and one of the sympathetic tests in comparison with controls (orthostasis; p = 0.02). PDD had significantly more impairment than DLB in some autonomic parameters (Valsalva ratio: p = 0.024; response to isometric exercise: p = 0.002). Patients with VAD showed impairment in two parasympathetic tests (orthostasis: p = 0.02; Valsalva ratio: p = 0.08) and one sympathetic test (orthostasis: p = 0.04). These results were in contrast with AD patients who only showed impairment in one sympathetic response (orthostasis: p = 0.004). The prevalence of orthostatic hypotension and autonomic neuropathies was higher in all dementias than in controls (all p<0.05). CONCLUSION Autonomic dysfunction occurs in all common dementias but is especially prominent in PDD with important treatment implications.
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Affiliation(s)
- L M Allan
- Institute for Ageing and Health, Wolfson Research Centre, Newcastle General Hospital, Westgate Road, Newcastle upon Tyne NE4 6BE, UK.
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Gordon E, Liddell BJ, Brown KJ, Bryant R, Clark CR, DAS P, Dobson-Stone C, Falconer E, Felmingham K, Flynn G, Gatt JM, Harris A, Hermens DF, Hopkinson PJ, Kemp AH, Kuan SA, Lazzaro I, Moyle J, Paul RH, Rennie CJ, Schofield P, Whitford T, Williams LM. INTEGRATING OBJECTIVE GENE-BRAIN-BEHAVIOR MARKERS OF PSYCHIATRIC DISORDERS. J Integr Neurosci 2007; 6:1-34. [PMID: 17472223 DOI: 10.1142/s0219635207001465] [Citation(s) in RCA: 16] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/15/2007] [Accepted: 02/28/2007] [Indexed: 11/18/2022] Open
Abstract
There is little consensus about which objective markers should be used to assess major psychiatric disorders, and predict/evaluate treatment response for these disorders. Clinical practice relies instead on subjective signs and symptoms, such that there is a "translational gap" between research findings and clinical practice. This gap arises from: a) a lack of integrative theoretical models which provide a basis for understanding links between gene-brain-behavior mechanisms and clinical entities; b) the reliance on studying one measure at a time so that linkages between markers are their specificity are not established; and c) the lack of a definitive understanding of what constitutes normative function. Here, we draw on a standardized methodology for acquiring multiple sources of genomic, brain and behavioral data in the same subjects, to propose candidate markers of selected psychiatric disorders: depression, post-traumatic stress disorder, schizophrenia, attention-deficit/hyperactivity disorder and dementia disorders. This methodology has been used to establish a standardized international database which provides a comprehensive framework and the basis for testing hypotheses derived from an integrative theoretical model of the brain. Using this normative base, we present preliminary findings for a number of disorders in relation to the proposed markers. Establishing these objective markers will be the first step towards determining their sensitivity, specificity and treatment prediction in individual patients.
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Affiliation(s)
- Evian Gordon
- The Brain Resource International Database and the Brain Resource Company, Sydney, NSW 2007, Australia.
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Rufa A, Guideri F, Acampa M, Cevenini G, Bianchi S, De Stefano N, Stromillo ML, Federico A, Dotti MT. Cardiac autonomic nervous system and risk of arrhythmias in cerebral autosomal dominant arteriopathy with subcortical infarcts and leukoencephalopathy (CADASIL). Stroke 2007; 38:276-80. [PMID: 17218610 DOI: 10.1161/01.str.0000254530.38417.07] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
BACKGROUND AND PURPOSE Cerebral autosomal dominant arteriopathy with subcortical infarcts and leukoencephalopathy (CADASIL) is an inherited systemic microangiopathy with prevalently cerebral manifestations. Among the causes of death, sudden unexpected death seems to occur in a significant number of CADASIL patients. Because potential causes of sudden unexpected death may include cardiac arrhythmias and myocardial infarction, we evaluated risk factors for life-threatening arrhythmias, such as reduced heart rate variability, sympathetic overactivity and QT interval (QTc) prolongation, in 23 CADASIL patients. The relationship of these changes with brain MRI pattern was also investigated. METHODS Frequency domain measures of heart rate variability (10 minutes recordings) and QTc interval were recorded in 23 CADASIL patients (17 males, 6 females) and 22 healthy age- and sex-matched control subjects. The following heart rate variability spectral parameters were considered at rest during spontaneous and controlled breathing (Cb): total power, very-low-frequency component, low-frequency component, high-frequency component, low-frequency/high-frequency ratio, and Cb-total power, Cb-very-low-frequency component, Cb-low-frequency component, Cb-high-frequency component, Cb-low-frequency/high-frequency ratio. R-to-R wave and QTc interval were also analyzed. All data were statistically compared between CADASIL and control subjects. Conventional brain MRI was performed in patients with CADASIL and T1-weighted and T2-weighted lesion volumes, and were compared with each spectral component of the tachogram. RESULTS During spontaneous and controlled breathing, total power spectrum and all spectral components (very low frequency component, high-frequency component, low-frequency component) of heart rate variability were significantly reduced in CADASIL patients with respect to controls (P<0.05). The low-frequency/high-frequency component ratio was significantly higher in CADASIL patients than in controls. No significant correlation between heart rate variability spectral parameters and other variables including total brain T2-weighted and T1-weighted lesion volumes were observed in CADASIL subjects. CONCLUSIONS We found a statistically significant reduction in all frequency domain parameters of heart rate variability associated with a higher low frequency/high frequency ratio for CADASIL patients with respect to normal subjects. These data are consistent with autonomic derangement and suggests that CADASIL patients may be at risk for life-threatening arrhythmias. This could at least in part explain their higher recurrence of sudden unexpected death and should be taken into account in planning therapy.
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Affiliation(s)
- Alessandra Rufa
- Dipartimento di Scienze Neurologiche e del Comportamento, Università di Siena, Viale Bracci, 53100 Siena, Italy
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Allan L, McKeith I, Ballard C, Kenny RA. The prevalence of autonomic symptoms in dementia and their association with physical activity, activities of daily living and quality of life. Dement Geriatr Cogn Disord 2006; 22:230-7. [PMID: 16902277 DOI: 10.1159/000094971] [Citation(s) in RCA: 55] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 03/09/2006] [Indexed: 11/19/2022] Open
Abstract
BACKGROUND/AIMS There is little published data regarding autonomic symptoms in dementia. This study aimed to examine the prevalence and severity of autonomic symptoms in patients with different subtypes of dementia in comparison with healthy controls, and their association with levels of physical activity, depression, quality of life and ability to carry out activities of daily living. METHODS Prevalence and severity of autonomic symptoms in Parkinson's disease dementia (PDD, n = 46), dementia with Lewy bodies (DLB, n = 32), vascular dementia (VAD, n = 38), Alzheimer's disease (AD, n = 40) and healthy controls (n = 42) were assessed using a structured symptom scale. The associations between autonomic symptoms and physical activity, Bristol Activities of Daily Living Score, Geriatric and Cornell Depression Scores and quality of life (Medical Outcomes Study 36-Item Short Form Health Survey, SF-36) were examined by multiple linear regressions. RESULTS Total autonomic symptom scores, urinary symptoms, constipation and postural dizziness were significantly higher in PDD, DLB and VAD patients than either controls or AD patients (all p < 0.05). Higher autonomic symptom scores were associated with poorer outcomes in all measures of physical activity, activities of daily living, depression and quality of life. CONCLUSION The burden of autonomic symptoms is high in non-Alzheimer's dementias. The identification of such symptoms is of importance because of the detrimental effect of these symptoms upon physical activity, depression, activities of daily living and quality of life.
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Affiliation(s)
- Louise Allan
- Institute for Ageing and Health, Wolfson Research Centre, Newcastle General Hospital, Newcastle upon Tyne, UK.
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Ballard C, Lane R, Barone P, Ferrara R, Tekin S. Cardiac safety of rivastigmine in Lewy body and Parkinson's disease dementias. Int J Clin Pract 2006; 60:639-45. [PMID: 16805745 DOI: 10.1111/j.1368-5031.2006.00967.x] [Citation(s) in RCA: 30] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/30/2022] Open
Abstract
Cholinesterase inhibition in patients with Alzheimer's disease (AD) may affect heart rate, sometimes inducing bradycardia. Additional cardiac safety considerations apply in patients with dementia with Lewy bodies (DLB) and Parkinson's disease (PDD), in whom cardiovascular autonomic nervous system dysfunction is common. We conducted a review of the safety data available for rivastigmine in these two conditions. A modest reduction in the mean heart rate of 1.5-2 bpm was seen. No clinically meaningful treatment differences in bradycardia or ECG abnormalities were apparent. Compared with placebo, rivastigmine appeared to be associated with fewer vascular disorder adverse events (AEs) (p = 0.002) and fewer AEs of syncope (p = 0.018) in PDD patients (n = 541). A smaller randomised, placebo-controlled study of rivastigmine in DLB (n = 120) showed similar findings. Rivastigmine appears to have a favourable cardiac safety profile in PDD and DLB patients.
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Zulli R, Nicosia F, Borroni B, Agosti C, Prometti P, Donati P, De Vecchi M, Romanelli G, Grassi V, Padovani A. QT dispersion and heart rate variability abnormalities in Alzheimer's disease and in mild cognitive impairment. J Am Geriatr Soc 2006; 53:2135-9. [PMID: 16398898 DOI: 10.1111/j.1532-5415.2005.00508.x] [Citation(s) in RCA: 69] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Abstract
OBJECTIVES To investigate the effect of cardiovascular changes (i.e., QT interval, QT dispersion (QTD), heart rate variability (HRV), and other cardiovascular measures) in subjects with Alzheimer's disease (AD) and mild cognitive impairment (MCI). DESIGN Each subject underwent clinical and cognitive examination, a structural brain imaging study, echocardioDoppler, electrocardiogram (ECG), HRV analysis using 24-hour ECG monitoring, and 24-hour blood pressure monitoring. SETTING Community population-based sample of patients admitted to an AD center for investigation of cognitive disturbances. PARTICIPANTS Thirty-three subjects with AD, 39 subjects with MCI, and 29 cognitive healthy subjects (controls) matched for demographic characteristics, hypertensive condition, smoking habits, and laboratory parameters were enrolled consecutively. MEASUREMENTS Clinical and cognitive examination, structural brain imaging study, echocardioDoppler, ECG, HRV analysis using 24-hour ECG monitoring, and 24-hour blood pressure monitoring. RESULTS QTD and QT corrected dispersion mean values were significantly higher in patients with AD than in patients with MCI and controls and higher in patients with MCI than in controls. HRV time and domain parameters were lower in patients with AD than in patients with MCI and controls. No difference in other cardiovascular measures was found. QTD and HRV were found to be significantly correlated with the degree of cognitive impairment. CONCLUSION These findings support the presence of a peculiar neuroanatomic dysfunction in patients with AD and MCI that parallels the disease progression. These noninvasive parameters might prove to be powerful predictive tools in the worsening of cognitive function and mortality risk.
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Affiliation(s)
- Roberto Zulli
- Institute of Internal Medicine, Department of Medical Sciences, University of Brescia, Brescia, Italy
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