Jandackova Vera K, Scholes Shaun, Britton Annie, Steptoe Andrew
Department of Epidemiology and Public Health, Faculty of Medicine, University of Ostrava, Syllabova 19, 703 00 Ostrava, Czech Republic.
Department of Human Movement Studies, Faculty of Education, University of Ostrava, City Campus Cerna Louka; Moravska Ostrava 3397, 702 00 Ostrava, Czech Republic.
Int J Clin Health Psychol. 2024 Oct-Dec;24(4):100518. doi: 10.1016/j.ijchp.2024.100518. Epub 2024 Nov 20.
Autonomic dysfunction is common in dementia, yet its contribution to neurocognitive changes remains unknown. We investigated whether midlife cardiac vagal modulation, indexed by heart rate variability, associates with subsequent cognitive decline in adults without prior coronary heart disease or stroke.
The sample comprised 2702 (1924 men) individuals initially aged 44-69 years from the UK Whitehall II cohort. Data from the fifth (1997-1999), seventh (2002-2004) and ninth (2007-2009) phases were analysed. Global cognitive function was ascertained from tests assessing memory, reasoning, vocabulary, and fluency. We used 12-lead-ECG-based heart rate variability measures, that primarily reflect vagal modulation (i.e. RMSSD and HF-HRV). Linear mixed-effects models and logistic regression were employed.
Results showed consistent associations between both vagally-mediated HRV measures and faster decline in global cognitive function. Specifically, low RMSSD and HF-HRV (lowest versus upper four quintiles) were associated with 0.07 SD (95% CI: -0.13, -0.01) and 0.06 SD (95% CI: -0.12, -0.004) accelerated 10-year cognitive decline after sociodemographic adjustments and faster decline in older ages. Further adjustments for lifestyle factors, medication use and other cardiometabolic conditions did not change the findings. Cognitive decline in individuals with low RMSSD and HF-HRV was estimated to progress 3 and 3.5 years faster per decade, respectively, compared to their counterparts. Additionally, participants with low RMSSD had 37% higher odds of low cognitive function (lowest quintile) at follow-up (OR 1.37: 95% CI,1.03, 1.80).
Our findings support the aetiological significance of the autonomic nervous system, specifically vagal modulation, in the processes of cognitive decline and neurodegeneration. Low heart rate variability emerges as a potential biomarker indicative of acclerated cognitive decline that may extend over decades.
自主神经功能障碍在痴呆症中很常见，但其对神经认知变化的影响尚不清楚。我们调查了以心率变异性为指标的中年心脏迷走神经调节是否与无冠心病或中风病史的成年人随后的认知衰退有关。
样本包括来自英国白厅II队列的2702名（1924名男性）最初年龄在44 - 69岁的个体。分析了第五阶段（1997 - 1999年）、第七阶段（2002 - 2004年）和第九阶段（2007 - 2009年）的数据。通过评估记忆、推理、词汇和流畅性的测试来确定整体认知功能。我们使用基于12导联心电图的心率变异性测量方法，主要反映迷走神经调节（即RMSSD和HF - HRV）。采用线性混合效应模型和逻辑回归。
结果显示，迷走神经介导的心率变异性测量指标与整体认知功能的更快衰退之间存在一致的关联。具体而言，低RMSSD和HF - HRV（最低五分位数与上四个五分位数相比）在社会人口统计学调整后与10年认知衰退加速0.07标准差（95%置信区间：-0.13，-0.01）和0.06标准差（95%置信区间：-0.12，-0.004）相关，且在老年时衰退更快。对生活方式因素、药物使用和其他心脏代谢状况进行进一步调整后，结果未改变。与RMSSD和HF - HRV正常的个体相比，RMSSD和HF - HRV低的个体的认知衰退估计每十年分别快3年和3.5年。此外，RMSSD低的参与者在随访时认知功能低下（最低五分位数）的几率高37%（比值比1.37：95%置信区间，1.03，1.80）。
我们的研究结果支持自主神经系统，特别是迷走神经调节，在认知衰退和神经退行性变过程中的病因学意义。低心率变异性成为一种潜在的生物标志物，表明认知衰退加速，这种加速可能持续数十年。
