Autonomic modulation and the risk of dementia in a middle-aged cohort: A 17-year follow-up study

Yu Tsung Chou, Zih Jie Sun, Shih Chieh Shao, Yi Ching Yang, Feng Hwa Lu, Chih Jen Chang, Tzu Chi Liao, Chung Yi Li, Tony Hsiu Hsi Chen, Jin Shang Wu, Edward Chia Cheng Lai

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6 Citations (Scopus)


Background: Altered autonomic modulation, measured by heart rate variability (HRV), has been found to be associated with dementia risk in the elderly. However, long-term follow-up study evaluating the association between autonomic modulation from middle-age and the incidence of dementia has been limited. Methods: This retrospective cohort analyzed data from Taiwan's National Health Insurance Database covering the period from 2001 to 2017, with a linkage to citywide health examinations conducted by Tainan Metropolitan City, Taiwan. We included subjects aged 45–64 years. The mean follow-up period was 15.75 ± 3.40 years. The measurements of HRV included resting heart rate, high frequency (HF), low frequency (LF), standard deviation of normal-to-normal R–R intervals (SDNN), ratio between the 30th and 15th R–R interval after standing up from the supine position (30/15 ratio), ratio between the R–R intervals during expiration and inspiration, and the ratio between the high- and low-frequency components (LF/HF). The main study outcome was the incidence of dementia. We performed multivariable Cox proportional hazard regression models to compare the risk of dementia among different HRV subgroups. Results: We included 565 participants with a mean age of 53 (SD: 6) years, of whom 44% were male. The risk of dementia was significantly increased in association with lower parasympathetic HRV modulation, including SDNN (HR: 3.23, 95% CI: 1.55–6.73) and 30/15 ratio (HR: 3.52, 95%CI: 1.67–7.42). Moreover, the risk of dementia was increased in subjects with higher LF/HF ratios (HR: 2.05, 95% CI: 1.12–3.72). Conclusions: Lower parasympathetic activity and higher sympathetic-vagal imbalance in middle-age were associated with dementia risk.

Original languageEnglish
Article number100576
JournalBiomedical Journal
Issue number6
Publication statusPublished - 2023 Dec

All Science Journal Classification (ASJC) codes

  • General Medicine


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