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Review
. 2023 Mar 1:17:1055445.
doi: 10.3389/fnins.2023.1055445. eCollection 2023.

The connection between heart rate variability (HRV), neurological health, and cognition: A literature review

Xianghong Arakaki  1 , Rebecca J Arechavala  2 , Elizabeth H Choy  2 , Jayveeritz Bautista  2 , Bishop Bliss  2 , Cathleen Molloy  1 , Daw-An Wu  3 , Shinsuke Shimojo  3 , Yang Jiang  4 , Michael T Kleinman  2 , Robert A Kloner  5   6
Affiliations
Review

The connection between heart rate variability (HRV), neurological health, and cognition: A literature review

Xianghong Arakaki et al. Front Neurosci. .

Abstract

The heart and brain have bi-directional influences on each other, including autonomic regulation and hemodynamic connections. Heart rate variability (HRV) measures variation in beat-to-beat intervals. New findings about disorganized sinus rhythm (erratic rhythm, quantified as heart rate fragmentation, HRF) are discussed and suggest overestimation of autonomic activities in HRV changes, especially during aging or cardiovascular events. When excluding HRF, HRV is regulated via the central autonomic network (CAN). HRV acts as a proxy of autonomic activity and is associated with executive functions, decision-making, and emotional regulation in our health and wellbeing. Abnormal changes of HRV (e.g., decreased vagal functioning) are observed in various neurological conditions including mild cognitive impairments, dementia, mild traumatic brain injury, migraine, COVID-19, stroke, epilepsy, and psychological conditions (e.g., anxiety, stress, and schizophrenia). Efforts are needed to improve the dynamic and intriguing heart-brain interactions.

Keywords: cognition; erratic sinus rhythm; heart and brain; heart rate fragmentation; heart rate variability; inhibitory control; neurological conditions; vagal functioning.

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Conflict of interest statement

The authors declare that the research was conducted in the absence of any commercial or financial relationships that could be construed as a potential conflict of interest.

Figures

FIGURE 1
FIGURE 1
The neural communication pathways interacting between the heart and brain are responsible for the generation of HRV. The intrinsic cardiac nervous system integrates information from the extrinsic nervous system and the sensory neurites within the heart. The extrinsic cardiac ganglia located in the thoracic cavity have connections to the lungs and esophagus and are indirectly connected via the spinal cord to many other organs, including the skin and arteries. The vagal nerve (parasympathetic) primarily consists of afferent (flowing to the brain) fibers that connect to the medulla. Used with permission from the Institute of HeartMath, Boulder Creek, California (McCraty and Shaffer, 2015).
FIGURE 2
FIGURE 2
The number of publications on HRV and cognition increases in recent years.
FIGURE 3
FIGURE 3
HRV and brain cognition have bidirectional connections: Decreased HRV (from lower top-down inhibitory control) links with reduced executive function, decision making, or emotional regulation and presents in pathological conditions (dementia, mTBI, migraine, etc.). Approach increasing HRV also improves brain activity (e.g., alpha frequency oscillation ranged 8–12 Hz) and top-down control, and vice versa. AD, Alzheimer’s disease; ADRD, Alzheimer’s disease and related dementia; HRV, heart rate variability; LBD, Lewy body dementia; LFO, Low frequency Oscillation; mTBI, mild traumatic brain injury; NS, nerval system; PFC, prefrontal cortex; RIPC, remote ischemic preconditioning; Sym., sympathetic activity; TMS, Transcranial magnetic stimulation; vagal, vagal activity; VD, vascular dementia.
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References

    1. Ahmed M. W., Kadish A. H., Parker M. A., Goldberger J. J. (1994). Effect of physiologic and pharmacologic adrenergic stimulation on heart rate variability. J. Am. Coll. Cardiol. 24 1082–1090. - PubMed
    1. Akter T., Ferdousi S. (2017). Autonomic dysfunction and migraine: assessed by time series analysis of heart rate variability. J. Bangladesh. Soc. Physiol. 12 57–60. - PubMed
    1. Albott C. S., Wozniak J. R., Mcglinch B. P., Wall M. H., Gold B. S., Vinogradov S. (2020). Battle buddies: rapid deployment of a psychological resilience intervention for healthcare workers during the COVID-19 Pandemic. Anesth. Analg. 131 43–54. 10.1213/ANE.0000000000004912 - DOI - PMC - PubMed
    1. Allan L. M., Ballard C. G., Allen J., Murray A., Davidson A. W., Mckeith I. G., et al. (2007). Autonomic dysfunction in dementia. J. Neurol. Neurosurg. Psychiatry 78 671–677. - PMC - PubMed
    1. Allen J. J., Chambers A. S., Towers D. N. (2007). The many metrics of cardiac chronotropy: a pragmatic primer and a brief comparison of metrics. Biol. Psychol. 74 243–262. 10.1016/j.biopsycho.2006.08.005 - DOI - PubMed