Association between cardiac autonomic dysfunction, cognitive impairment, and survival in patients with amyotrophic lateral sclerosis.

IF 3.9 3区医学 Q1 CLINICAL NEUROLOGY

Clinical Autonomic Research Pub Date : 2025-03-08 DOI:10.1007/s10286-025-01112-0

Zehui Li, Jingjing Fan, Zhenxiang Gong, Jiahui Tang, Yuan Yang, Mao Liu, Min Zhang

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引用次数: 0

Abstract

Purpose: The aim of this study was to investigate the relationship between cardiac autonomic dysfunction, cognitive impairment, and survival in patients with amyotrophic lateral sclerosis (ALS).

Methods: The heart activity of 65 patients with ALS (28 with normal cognition [ALS-CN]; 37 with impaired cognition [ALS-CI]) and 38 healthy controls (HCs) was measured by 24-h Holter monitoring. Heart rate (HR) measures and heart rate variability (HRV) parameters were compared between the three study groups and, additionally, correlated with five Edinburgh Cognitive and Behavioral ALS Screen (ECAS) domains in the ALS subgroups. Age, gender, and educational level were adjusted. Factors associated with cognitive status were assessed using logistic regression. Survival predictors in patients with ALS were analyzed using the Kaplan-Meier estimator and Cox regression.

Results: Compared to the HCs, patients with ALS-CI exhibited lower RRI (R-R-interval; P = 0.017), SDNN (standard deviation of all normal RR intervals; P = 0.013), SDNN Index (P = 0.044), and VLF power (very low-frequency power; P = 0.012). Total power was reduced in the ALS-CI group compared to the HCs (P = 0.036) and ALS-CN group (P = 0.048). In patients with ALS-CN, language negatively correlated with mean HR (P = 0.001) and positively with the RRI (P = 0.003), SDNN (P = 0.001), SDANN (standard deviation of the average NN intervals; P = 0.005), total power (P = 0.006), VLF power (P = 0.011), and low-frequency power (P = 0.026). Visuospatial function correlated positively with the SDNN Index (P = 0.041). In patients with ALS-CI, executive function (P = 0.015) and ECAS total score (P = 0.009) negatively correlated with the RMSSD (square root of mean sum-of-squares of differences between adjacent NN intervals), while visuospatial function correlated positively with normalized LF value (LFnu; P = 0.049). No associations were observed between the other cognitive domains and any of the 14 HRV/HR measures in patients with either ALS-CI or ALS-CN. SDNN ≤ 100 ms was linked to cognitive impairment (P = 0.039) and also showed a borderline association (P = 0.066) with poorer survival, while cognitive impairment (P = 0.010) was significantly linked to worse outcomes.

Conclusions: Patients with ALS with cognitive impairment demonstrated reduced cardiac autonomic modulations and altered cognitive autonomic associations. Cognitive impairment was linked to reduced survival, with baseline SDNN ≤ 100 ms identified as a potential marker.

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肌萎缩性侧索硬化症患者心脏自主神经功能障碍、认知障碍和生存之间的关系。

目的：本研究的目的是探讨肌萎缩侧索硬化症（ALS）患者心脏自主神经功能障碍、认知障碍和生存之间的关系。方法：对65例ALS患者(认知正常者28例[ALS- cn]；对37例认知障碍患者（ALS-CI）和38例健康对照（hc）进行24小时动态心电图监测。比较三个研究组的心率（HR）测量值和心率变异性（HRV）参数，此外，还与ALS亚组中的五个爱丁堡认知和行为ALS筛查（ECAS）域相关。调整年龄、性别和教育程度。使用逻辑回归评估与认知状态相关的因素。使用Kaplan-Meier估计和Cox回归分析ALS患者的生存预测因子。结果：与hcc患者相比，ALS-CI患者表现出较低的RRI (r - r间期；P = 0.017)， SDNN(所有正态RR区间的标准差；P = 0.013)、SDNN指数（P = 0.044）和甚低频功率(甚低频功率；p = 0.012)。与hc组（P = 0.036）和ALS-CN组（P = 0.048）相比，ALS-CI组总功率降低。在ALS-CN患者中，语言与平均HR （P = 0.001）呈负相关，与RRI （P = 0.003）、SDNN （P = 0.001）、SDANN (NN平均间隔的标准差；P = 0.005)、总功率（P = 0.006）、VLF功率（P = 0.011）、低频功率（P = 0.026）。视觉空间功能与SDNN指数呈正相关（P = 0.041）。在ALS-CI患者中，执行功能（P = 0.015）和ECAS总分（P = 0.009）与RMSSD（相邻NN区间差均值平方和的平方根）呈负相关，而视觉空间功能与归一化LF值(LFnu；p = 0.049)。在ALS-CI或ALS-CN患者中，未观察到其他认知领域与14项HRV/HR测量中的任何一项之间的关联。SDNN≤100 ms与认知障碍相关（P = 0.039），与较差的生存率呈边缘性相关（P = 0.066），而认知障碍与较差的预后显著相关（P = 0.010）。结论：伴有认知障碍的ALS患者表现出心脏自主神经调节减少和认知自主神经关联改变。认知障碍与生存率降低有关，基线SDNN≤100 ms被确定为潜在的标志物。

本文章由计算机程序翻译，如有差异，请以英文原文为准。

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来源期刊

Clinical Autonomic Research 医学-临床神经学

CiteScore

7.40

自引率

6.90%

发文量

审稿时长

>12 weeks

期刊介绍： Clinical Autonomic Research aims to draw together and disseminate research work from various disciplines and specialties dealing with clinical problems resulting from autonomic dysfunction. Areas to be covered include: cardiovascular system, neurology, diabetes, endocrinology, urology, pain disorders, ophthalmology, gastroenterology, toxicology and clinical pharmacology, skin infectious diseases, renal disease. This journal is an essential source of new information for everyone working in areas involving the autonomic nervous system. A major feature of Clinical Autonomic Research is its speed of publication coupled with the highest refereeing standards.