心率变异性,主要是副交感神经活动的定量测量,已被用于评估许多类型的精神和神经系统疾病,包括痴呆(或神经认知障碍)。然而,尽管痴呆症患者的心率变异性(各种指标)通常明显低于健康对照组,不同类型的痴呆有不同的心率变异性特征,不同研究的结果并不相同.我们设计了一个系统的综述和荟萃分析,以纳入来自不同研究的数据。
我们收集了比较痴呆患者和健康对照者心率变异性的研究。以几种方式分析心率变异性:按层次顺序(主要分析)的副交感神经功能,总变异性,不同亚型痴呆患者心率变异性的比较,心率变异性和心率变异性反应性的具体指标。
在最初的搜索中,我们找到了3425篇相关文章,其中24项研究共有1107名痴呆患者和1017名对照参与者最终进入主要荟萃分析.痴呆患者的副交感神经功能的静息心率变异性(Hedges\'g=-0.3596,p=0.0002)和总变异性(Hedges\'g=-0.3059,p=0.0002)明显低于对照组。对于相对于对照的诊断亚组分析,轻度认知障碍患者(Hedges\'g=-0.3060)和路易体痴呆患者(Hedges\'g=-1.4154,p<0.0001)的心率变异性显著降低。相对于阿尔茨海默病患者,路易体痴呆患者的心率变异性显著降低(Hedges\'g=-1.5465,p=0.0381).Meta回归显示,性别比例与效应大小显著相关。
我们的结果表明,痴呆症患者(尤其是患有路易体和轻度认知障碍的痴呆症患者)的副交感神经活动比健康人低。应仔细解释性别对结果的影响。
Heart rate variability, a quantitative measure of mainly parasympathetic activity, has been applied in evaluating many types of psychiatric and neurological disorders, including dementia (or neurocognitive disorders). However, although dementia patients often showed significantly lower heart rate variability (various indices) than healthy controls, and different types of dementia had distinct heart rate variability features, the results were not identical across studies. We designed a systematic review and meta-analysis for incorporating data from different studies.
We gathered studies comparing heart rate variability in patients with dementia and in healthy controls. Heart rate variability was analysed in several ways: parasympathetic function in hierarchical order (main analysis), total variability, comparison of heart rate variability between different subtypes of dementia, specific indices of heart rate variability and heart rate variability reactivity.
In the initial search, we found 3425 relevant articles, from which 24 studies with a total of 1107 dementia patients and 1017 control participants finally entered the main meta-analysis. The dementia patients had a significantly lower resting heart rate variability for parasympathetic function (Hedges\' g = -0.3596, p = 0.0002) and total variability (Hedges\' g = -0.3059, p = 0.0002) than the controls. For diagnostic subgroup analysis relative to the controls, heart rate variability was significantly lower in patients with mild cognitive impairment (Hedges\' g = -0.3060) and in patients with dementia with Lewy bodies (Hedges\' g = -1.4154, p < 0.0001). Relative to patients with Alzheimer\'s disease, heart rate variability in patients with dementia with Lewy bodies was significantly lower (Hedges\' g = -1.5465, p = 0.0381). Meta-regression revealed that gender proportion was significantly associated with effect size.
Our results show that dementia patients (especially those with dementia with Lewy bodies and mild cognitive impairment) have lower parasympathetic activity than healthy people. The influence of gender on the results should be carefully interpreted.