Liaison Psychiatry and Psycho-Oncology Unit, Department of Psychiatry and Behavioural Sciences, Graduate School of Medical and Dental Sciences, Tokyo Medical and Dental University, Tokyo, Japan.
Wako Hospital, Saitama, Japan.
Psychogeriatrics. 2021 Jan;21(1):62-70. doi: 10.1111/psyg.12625. Epub 2020 Oct 22.
To elucidate the differences in autonomic dysfunction between dementia with Lewy bodies (DLB) and Alzheimer's disease using a simple and convenient method, we investigated the heart rate response to orthostatic challenge.
Ninety-seven people participated in this cross-sectional study, and data from 26 DLB patients, 29 Alzheimer's disease patients, and 25 healthy elderly individuals were analysed. Participants underwent postural changes, including 5 min in a supine position, 1 min in a sitting position, and 3 min in an orthostatic position. Their heart rates were continuously recorded. Two heart rate variables were analysed as main outcomes: (i) the difference between heart rate in the sitting position and the peak heart rate within 15 s of orthostasis, defined as the 'early heart rate increase'; and (ii) the difference between the peak heart rate and the negative peak heart rate after this, defined as 'early heart rate recovery.' An early heart rate increase has been considered to reflect parasympathetic and sympathetic functions. Early heart rate recovery is considered to reflect parasympathetic function. We also investigated the frequency domains of resting heart rate variability.
A significant difference was observed across the three groups in early heart rate increase, and that of the DLB group was lower than that of the healthy control group. Early heart rate recovery also differed significantly across the three groups, and that of the DLB group was less than that of the healthy control group. In addition, the power of the low-frequency component, which represents both sympathetic and parasympathetic activity, was significantly decreased in the DLB group compared to the Alzheimer's disease group.
Impaired heart rate response to standing was detected in patients with DLB. Electrocardiogram is a convenient, non-invasive method that might be useful as a subsidiary marker for DLB diagnosis and differentiation from Alzheimer's disease.
为了用一种简单方便的方法阐明路易体痴呆（DLB）和阿尔茨海默病（AD）之间自主神经功能障碍的差异，我们研究了体位性挑战时的心率反应。
本横断面研究纳入了 97 名参与者，分析了 26 名 DLB 患者、29 名 AD 患者和 25 名健康老年人的数据。参与者接受了体位变化，包括 5 分钟仰卧位、1 分钟坐位和 3 分钟直立位。连续记录他们的心率。分析了两个心率变量作为主要结果：（i）从仰卧位到直立后 15 秒内的心率峰值之间的差异，定义为“早期心率增加”；（ii）该峰值和之后的负向峰值之间的差异，定义为“早期心率恢复”。早期心率增加被认为反映了副交感神经和交感神经功能。早期心率恢复被认为反映了副交感神经功能。我们还研究了静息心率变异性的频域。
三组之间的早期心率增加存在显著差异，DLB 组低于健康对照组。三组之间的早期心率恢复也存在显著差异，DLB 组低于健康对照组。此外，与 AD 组相比，DLB 组代表交感和副交感活动的低频成分的功率显著降低。
在 DLB 患者中检测到对站立的心率反应受损。心电图是一种方便、非侵入性的方法，可能有助于作为 DLB 诊断和与 AD 区分的辅助标志物。
