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. 2023 Oct;44(10):3535-3544.
doi: 10.1007/s10072-023-06857-y. Epub 2023 May 25.

Cardiovascular autonomic regulation correlates with cognitive performance in patients with a history of traumatic brain injury

Ruihao Wang  1 , Dafin Muresanu  2   3 , Katharina Hösl  4 , Max J Hilz  5   6
Affiliations

Cardiovascular autonomic regulation correlates with cognitive performance in patients with a history of traumatic brain injury

Ruihao Wang et al. Neurol Sci. 2023 Oct.

Abstract

Background and objective: Traumatic brain injury (TBI) may afflict brain areas contributing to both cardiovascular autonomic regulation and cognitive performance. To evaluate possible associations between both functions in patients with a history of TBI (post-TBI-patients), we determined correlations between cardiovascular autonomic regulation and cognitive function in post-TBI-patients.

Methods: In 86 post-TBI-patients (33.1 ± 10.8 years old, 22 women, 36.8 ± 28.9 months after injury), we monitored RR intervals (RRI), systolic and diastolic blood pressures (BPsys, BPdia), and respiration (RESP) at rest. We calculated parameters of total cardiovascular autonomic modulation (RRI-standard-deviation (RRI-SD), RRI-coefficient-of-variation (RRI-CV), RRI-total-powers), sympathetic (RRI-low-frequency-powers (RRI-LF), normalized (nu) RRI-LF-powers, BPsys-LF-powers) and parasympathetic modulation (root-mean-square-of-successive-RRI-differences (RMSSD), RRI-high-frequency-powers (RRI-HF), RRI-HFnu-powers), sympathetic-parasympathetic balance (RRI-LF/HF-ratios), and baroreflex sensitivity (BRS). We used the Mini-Mental State Examination and Clock Drawing Test (CDT) to screen the general global and visuospatial cognitive function, and applied the standardized Trail Making Test (TMT)-A assessing visuospatial abilities and TMT-B assessing executive function. We calculated correlations between autonomic and cognitive parameters (Spearman's rank correlation test; significance: P < 0.05).

Results: CDT values positively correlated with age (P = 0.013). TMT-A values inversely correlated with RRI-HF-powers (P = 0.033) and BRS (P = 0.043), TMT-B values positively correlated with RRI-LFnu-powers (P = 0.015), RRI-LF/HF-ratios (P = 0.036), and BPsys-LF-powers (P = 0.030), but negatively with RRI-HFnu-powers (P = 0.015).

Conclusions: In patients with a history of TBI, there is an association between decreased visuospatial and executive cognitive performance and reduced parasympathetic cardiac modulation and baroreflex sensitivity with relatively increased sympathetic activity. Altered autonomic control bears an increased cardiovascular risk; cognitive impairment compromises quality of life and living conditions. Thus, both functions should be monitored in post-TBI-patients.

Keywords: Cardiovascular autonomic regulation; Cognitive performance; Correlations; Executive function; Traumatic brain injury; Visuospatial function.

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Conflict of interest statement

The authors declare no competing interests.

Figures

Fig. 1
Fig. 1
Correlations between values of TMT-A and RRI (panel A), RMSSD (panel B), RRI-HF-powers (panel C), and BRS (panel D). TMT-A inversely correlated with RRI, RMSSD, RRI-HF-powers, and BRS. TMT, Trail Making Test; RRI, RR intervals; RMSSD, square root of mean squared differences of successive RR intervals; HF, high frequency; BRS, baroreflex sensitivity
Fig. 2
Fig. 2
Correlations between values of TMT-B and RRI-LFnu-powers (panel A), RRI-LF/HF-ratios (panel B), RRI-HFnu-powers (panel C), and BPsys-LF-powers (panel D). TMT-B positively correlated with RRI-LFnu-powers, RRI-LF/HF-ratios, and BPsys-LF-powers, but negatively with RRI-HFnu-powers. TMT, Trail Making Test; RRI, RR intervals; HF, high frequency; LF, low frequency; nu, normalized unit; BPsys, systolic blood pressure
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