BACKGROUND: Autonomic dysfunction is common in dementia, yet its contribution to neurocognitive changes remains unknown. We investigated whether midlife cardiac vagal modulation, indexed by heart rate variability, associates with subsequent cognitive decline in adults without prior coronary heart disease or stroke. METHODS: The sample comprised 2702 (1924 men) individuals initially aged 44-69 years from the UK Whitehall II cohort. Data from the fifth (1997-1999), seventh (2002-2004) and ninth (2007-2009) phases were analysed. Global cognitive function was ascertained from tests assessing memory, reasoning, vocabulary, and fluency. We used 12-lead-ECG-based heart rate variability measures, that primarily reflect vagal modulation (i.e. RMSSD and HF-HRV). Linear mixed-effects models and logistic regression were employed. RESULTS: Results showed consistent associations between both vagally-mediated HRV measures and faster decline in global cognitive function. Specifically, low RMSSD and HF-HRV (lowest versus upper four quintiles) were associated with 0.07 SD (95% CI: -0.13, -0.01) and 0.06 SD (95% CI: -0.12, -0.004) accelerated 10-year cognitive decline after sociodemographic adjustments and faster decline in older ages. Further adjustments for lifestyle factors, medication use and other cardiometabolic conditions did not change the findings. Cognitive decline in individuals with low RMSSD and HF-HRV was estimated to progress 3 and 3.5 years faster per decade, respectively, compared to their counterparts. Additionally, participants with low RMSSD had 37% higher odds of low cognitive function (lowest quintile) at follow-up (OR 1.37: 95% CI,1.03, 1.80). CONCLUSION: Our findings support the aetiological significance of the autonomic nervous system, specifically vagal modulation, in the processes of cognitive decline and neurodegeneration. Low heart rate variability emerges as a potential biomarker indicative of acclerated cognitive decline that may extend over decades.

Department of Behavioural Science and Health University College London 1 19 Torrington Place London WC1E 7HB United Kingdom

Department of Epidemiology and Public Health Faculty of Medicine University of Ostrava Syllabova 19 703 00 Ostrava Czech Republic

Department of Epidemiology and Public Health University College London 1 19 Torrington Place London WC1E 7HB United Kingdom

Department of Human Movement Studies Faculty of Education University of Ostrava City Campus Cerna Louka; Moravska Ostrava 3397 702 00 Ostrava Czech Republic

See more in PubMed

Acar B., Savelieva I., Hemingway H., Malik M. Automatic ectopic beat elimination in short-term heart rate variability measurement. Computer Methods and Programs in Biomedicine. 2000;63(2):123–131. doi: 10.1016/S0169-2607(00)00081-X. PubMed DOI

Alvarez J.A., Emory E. Executive function and the frontal lobes: A meta-analytic review. Neuropsychology Review. 2006;16(1):17–42. doi: 10.1007/s11065-006-9002-x. PubMed DOI

Batty G.D., Shipley M., Tabák A., Singh-Manoux A., Brunner E., Britton A., Kivimäki M. Generalizability of occupational cohort study findings. Epidemiology. 2014;25(6):932–933. doi: 10.1097/EDE.0000000000000184. PubMed DOI

Borkowski J.G., Benton A.L., Spreen O. Word fluency and brain damage. Neuropsychologia. 1967;5(2):135–140. doi: 10.1016/0028-3932(67)90015-2. DOI

Breit S., Kupferberg A., Rogler G., Hasler G. Vagus nerve as modulator of the brain-gut axis in psychiatric and inflammatory disorders. Frontiers in Psychiatry. 2018;9(MAR) doi: 10.3389/fpsyt.2018.00044. PubMed DOI PMC

Britton A., Shipley M., Malik M., Hnatkova K., Hemingway H., Marmot M. Changes in heart rate and heart rate variability over time in middle-aged men and women in the general population (from the Whitehall II Cohort Study) The American Journal of Cardiology. 2007;100(3):524–527. doi: 10.1016/j.amjcard.2007.03.056. PubMed DOI PMC

Britton A., Singh-Manoux A., Hnatkova K., Malik M., Marmot M.G., Shipley M. The association between heart rate variability and cognitive impairment in middle-aged men and women. The Whitehall II cohort study. Neuroepidemiology. 2008;31(2):115–121. doi: 10.1159/000148257. PubMed DOI PMC

Cheng Y., Huang Y., Huang W.L. Heart rate variability in patients with dementia or neurocognitive disorders : A systematic review and meta-analysis. Australian & New Zealand Journal of Psychiatry. 2022;56:16–27. doi: 10.1177/0004867420976853. PubMed DOI

Cibulcova V., Koenig J., Jackowska M., Jandackova V.K. Influence of a 2-week transcutaneous auricular vagus nerve stimulation on memory: Findings from a randomized placebo controlled trial in non-clinical adults. Clinical Autonomic Research. 2024;34(4):447–462. doi: 10.1007/s10286-024-01053-0. PubMed DOI PMC

Collins O., Dillon S., Finucane C., Lawlor B., Kenny R.A. Parasympathetic autonomic dysfunction is common in mild cognitive impairment. Neurobiology of Aging. 2012;33(10):2324–2333. doi: 10.1016/j.neurobiolaging.2011.11.017. PubMed DOI

Cortes-Canteli M., Iadecola C. Alzheimer's Disease and Vascular Aging: JACC Focus Seminar. Journal of the American College of Cardiology. 2020;75(8):942–951. doi: 10.1016/j.jacc.2019.10.062. PubMed DOI PMC

Creavin S.T., Wisniewski S., Noel-Storr A.H., Trevelyan C.M., Hampton T., Rayment D., Thom V.M., Nash K.J.E., Elhamoui H., Milligan R., Patel A.S., Tsivos D.V., Wing T., Phillips E., Kellman S.M., Shackleton H.L., Singleton G.F., BE Neale, Watton M.E., C S. Mini-Mental State Examination (MMSE) for the detection of dementia in clinically unevaluated people aged 65 and over in community and primary care populations (Review) Cochrane Database of Systematic Reviews. 2016;1 doi: 10.1002/14651858.CD011145.pub2.Copyright. PubMed DOI PMC

Critchley H.D., Eccles J., Garfinkel S.N. Vol. 117. 2013. Interaction between cognition, emotion, and the autonomic nervous system; pp. 59–77. (Handbook of clinical neurology). PubMed DOI

De Heus R.A.A., Tzourio C., Lee E.J.L., Opozda M., Vincent A.D., Anstey K.J., Hofman A., Kario K., Lattanzi S., Launer L.J., Ma Y., Mahajan R., Mooijaart S.P., Nagai M., Peters R., Turnbull D., Yano Y., Claassen J.A.H.R., Tully P.J. Association between Blood Pressure Variability with Dementia and Cognitive Impairment: A Systematic Review and Meta-Analysis. Hypertension. 2021:1478–1489. doi: 10.1161/HYPERTENSIONAHA.121.17797. November. PubMed DOI PMC

Deary I.J. Intelligence. Annual Review of Psychology. 2012;63:453–482. doi: 10.1146/annurev-psych-120710-100353. PubMed DOI

Dedoncker J., Vanderhasselt M.A., Ottaviani C., Slavich G.M. Mental health during the COVID-19 pandemic and beyond: The importance of the vagus nerve for biopsychosocial resilience. Neuroscience and Biobehavioral Reviews. 2021;125(January):1–10. doi: 10.1016/j.neubiorev.2021.02.010. PubMed DOI PMC

Dekker J.M., Crow R.S., Folsom a.R., Hannan P.J., Liao D., Swenne C.a., Schouten E.G. Low Heart Rate Variability in a 2-Minute Rhythm Strip Predicts Risk of Coronary Heart Disease and Mortality From Several Causes : The ARIC Study. Circulation. 2000;102(11):1239–1244. doi: 10.1161/01.CIR.102.11.1239. PubMed DOI

Farmer D.G.S., Patros M., Ottaviani M.M., Dawood T., Kumric M., Bozic J., Badour M.I., Bain A.R., Barak O.F., Dujic Z., Macefield V.G. Firing properties of single axons with cardiac rhythmicity in the human cervical vagus nerve. Journal of Physiology. 2024;0:1–18. doi: 10.1113/JP286423. PubMed DOI PMC

Fathy Y.Y., Hoogers S.E., Berendse H.W., van der Werf Y.D., Visser P.J., de Jong F.J., van de Berg W.D.J. Differential insular cortex sub-regional atrophy in neurodegenerative diseases: A systematic review and meta-analysis. Brain Imaging and Behavior. 2020;14(6):2799–2816. doi: 10.1007/s11682-019-00099-3. PubMed DOI PMC

Femminella G.D., Rengo G., Komici K., Iacotucci P., Petraglia L., Pagano G., De Lucia C., Canonico V., Bonaduce D., Leosco D., Ferrara N. Autonomic dysfunction in Alzheimer's disease: Tools for assessment and review of the literature. Journal of Alzheimer's Disease. 2014;42(2):369–377. doi: 10.3233/JAD-140513. PubMed DOI

Ferreira-Vieira T.H., Guimaraes I.M., Silva F.R., Ribeiro F.M. Alzheimer's disease: Targeting the Cholinergic System. Current Neuropharmacology. 2016;14(1):101–115. doi: 10.2174/1570159x13666150716165726. PubMed DOI PMC

Folstein M.F., Folstein S.E., McHugh P.R. Mini-mental state”: A practical method for grading the cognitive state of patients for the clinician. J Psychiatr Res. 1975;12:189–198. PubMed

Forte G., Favieri F., Casagrande M. Heart rate variability and cognitive function: A systematic review. Frontiers in Neuroscience. 2019;13(JUL):1–11. doi: 10.3389/fnins.2019.00710. PubMed DOI PMC

Frewen J., Finucane C., Savva G.M., Boyle G., Coen R.F., Kenny R.A. Cognitive function is associated with impaired heart rate variability in ageing adults: The Irish longitudinal study on ageing wave one results. Clinical Autonomic Research. 2013;23(6):313–323. doi: 10.1007/s10286-013-0214-x. PubMed DOI

Gauthier S., Rosa-Neto P., Morais J.A., Webster C. Alzheimer's Disease International; London, England: 2021. World alzheimer report 2021: journey through the diagnosis of dementia.https://www.alzint.org/resource/world-alzheimer-report-2021/

Göçmen R., Aktop A., Pinar Y., Toktas N., Jandackova V.K. The effect of heart rate variability biofeedback on performance psychology of basketball players. Applied Psychophysiology Biofeedback. 2023 doi: 10.1007/s10484-023-09600-7. PubMed DOI

Goel V., Dolan R.J. Differential involvement of left prefrontal cortexin inductive and deductive reasoning. Cognition. 2004;(3):93. doi: 10.1016/j.cognition.2004.03.001. PubMed DOI

Goldberg D.P., Hillier V.F. A scaled version of the General Health Questionnaire. Psychological Medicine. 1979;9(1):139–145. PubMed

Hase Y., Polvikoski T.M., Firbank M.J., Craggs L.J.L., Hawthorne E., Platten C., Stevenson W., Deramecourt V., Ballard C., Kenny R.A., Perry R.H., Ince P., Carare R.O., Allan L.M., Horsburgh K., Kalaria R.N. Small vessel disease pathological changes in neurodegenerative and vascular dementias concomitant with autonomic dysfunction. Brain Pathology. 2020;30(1):191–202. doi: 10.1111/bpa.12769. PubMed DOI PMC

Heim A.W. Rev. ed. NFER Pub. Co. Ltd. Windsor (Berks.); 1970. A.H.4 group test of general intelligence manual.https://worldcat.org/title/134906 LK.

Hemingway H., Shipley M., Brunner E., Britton A., Malik M., Marmot M. Does autonomic function link social position to coronary risk? The Whitehall II study. Circulation. 2005;111(23):3071–3077. doi: 10.1161/CIRCULATIONAHA.104.497347. PubMed DOI

Holland N., Robbins T.W., Rowe J.B. The role of noradrenaline in cognition and cognitive disorders. Brain. 2021;144(8):2243–2256. doi: 10.1093/brain/awab111. PubMed DOI PMC

Imahori Y., Vetrano D.L., Xia X., Grande G., Ljungman P., Fratiglioni L., Qiu C. Association of resting heart rate with cognitive decline and dementia in older adults: A population-based cohort study. Alzheimer's and Dementia. 2022;18(10):1779–1787. doi: 10.1002/alz.12495. PubMed DOI

Jackowska M., Koenig J., Vasendova V., Jandackova V.K. A two-week course of transcutaneous vagal nerve stimulation improves global sleep: Findings from a randomised trial in community-dwelling adults. Autonomic Neuroscience: Basic and Clinical. 2022;240(February) doi: 10.1016/j.autneu.2022.102972. PubMed DOI

Jandackova V.K., Britton A., Malik M., Steptoe A. Heart rate variability and depressive symptoms: A cross-lagged analysis over a 10-year period in the Whitehall II study. Psychological Medicine. 2016;46(10):2121–2131. doi: 10.1017/S003329171600060X. PubMed DOI

Jandackova V.K., Scholes S., Britton A., Steptoe A. Are Changes in Heart Rate Variability in Middle-Aged and Older People Normative or Caused by Pathological Conditions? Findings From a Large Population-Based Longitudinal Cohort Study. Journal of the American Heart Association. 2016;5(2) doi: 10.1161/JAHA.115.002365. PubMed DOI PMC

Jandackova V.K., Scholes S., Britton A., Steptoe A. Healthy Lifestyle and Cardiac Vagal Modulation Over 10 Years: Whitehall II Cohort Study. Journal of the American Heart Association. 2019;8(19) doi: 10.1161/JAHA.119.012420. PubMed DOI PMC

Jarczok M.N., Koenig J., Wittling A., Fischer J.E., Thayer J.F. First evaluation of an index of low vagally-mediated heart rate variability as a marker of health risks in human adults: Proof of concept. Journal of Clinical Medicine. 2019;8(11):1–12. doi: 10.3390/jcm8111940. PubMed DOI PMC

Jarczok M.N., Weimer K., Braun C., Williams D.P., Thayer J.F., Gündel H.O., Balint E.M. Heart rate variability in the prediction of mortality : A systematic review and meta-analysis of healthy and patient populations. Neuroscience and Biobehavioral Reviews. 2022;143(October 2021) doi: 10.1016/j.neubiorev.2022.104907. PubMed DOI

La Rovere M.T., Pinna G.D., Maestri R., Mortara A., Capomolla S., Febo O., Ferrari R., Franchini M., Gnemmi M., Opasich C., Riccardi P.G., Traversi E., Cobelli F. Short-Term Heart Rate Variability Strongly Predicts Sudden Cardiac Death in Chronic Heart Failure Patients. Circulation. 2003;107(4):565–570. doi: 10.1161/01.CIR.0000047275.25795.17. PubMed DOI

Laborde S., Allen M.S., Borges U., Dosseville F., Hosang T.J., Iskra M., Mosley E., Salvotti C., Spolverato L., Zammit N., Javelle F. Effects of voluntary slow breathing on heart rate and heart rate variability: A systematic review and a meta-analysis. Neuroscience and Biobehavioral Reviews. 2022;138(April) doi: 10.1016/j.neubiorev.2022.104711. PubMed DOI

Laborde S., Mosley E., Thayer J.F. Heart rate variability and cardiac vagal tone in psychophysiological research - Recommendations for experiment planning, data analysis, and data reporting. Frontiers in Psychology. 2017;8(FEB):1–18. doi: 10.3389/fpsyg.2017.00213. PubMed DOI PMC

Lahiri M.K., Kannankeril P.J., Goldberger J.J. Assessment of autonomic function in cardiovascular disease: Physiological basis and prognostic implications. Journal of the American College of Cardiology. 2008;51(18):1725–1733. doi: 10.1016/j.jacc.2008.01.038. PubMed DOI

Lezak, M. D., Howieson, D. B., .& Loring, D. (2004)..Neuropsychological assessment (J. & H. Hannay & J. Fischer (Eds.); (4th ed.)., p. 429–498). Oxford University Press.

Liu K.Y., Elliott T., Knowles M., Howard R. Heart rate variability in relation to cognition and behavior in neurodegenerative diseases : A systematic review and meta-analysis. Ageing Research Reviews. 2022;73(December 2021) doi: 10.1016/j.arr.2021.101539. PubMed DOI PMC

Livingston G., Huntley J., Sommerlad A., Ames D., Ballard C., Banerjee S., Brayne C., Burns A., Cohen-Mansfield J., Cooper C., Costafreda S.G., Dias A., Fox N., Gitlin L.N., Howard R., Kales H.C., Kivimäki M., Larson E.B., Ogunniyi A.…Mukadam N. Dementia prevention, intervention, and care: 2020 report of the Lancet Commission. The Lancet. 2020;396(10248):413–446. doi: 10.1016/S0140-6736(20)30367-6. PubMed DOI PMC

Magnon V., Vallet G.T., Benson A., Mermillod M., Chausse P., Lacroix A. Does heart rate variability predict better executive functioning ? A systematic review and meta- analysis. Cortex. 2022;155:218–236. doi: 10.1016/j.cortex.2022.07.008. PubMed DOI

Mahinrad S., Jukema J.W., Heemst D.van, Macfarlane P.W., Clark E.N., Craen A.J.M.de, Sabayan B. 10-Second heart rate variability and cognitive function in old age. Neurology. 2016;86(12):1120. doi: 10.1212/WNL.0000000000002499. LP –1127. PubMed DOI

Mahinrad S., Van Heemst D., Macfarlane P.W., Stott D.J., Jukema J.W., De Craen A.J.M., Sabayan B. Short-term heart rate variability and cognitive function in older subjects at risk of cardiovascular disease. Journal of Hypertension. 2015;33(S1):57–58.

Marmot M., Brunner E. Cohort Profile: The Whitehall II study. International Journal of Epidemiology. 2005;34(2):251–256. doi: 10.1093/ije/dyh372. PubMed DOI

Marzano R.J., Kendall J.S., Paynter D.E. In: For the love of words: vocabulary instruction that works,grades K-6. Paynter D.E ., Bodrova E., Doty J., editors. Jossey-Bass; 2005. Appendix: A list of essential words by grade levelle; pp. 127–202.

Ng J.B., Turek M., Hakim A.M. Heart disease as a risk factor for dementia. Clinical Epidemiology. 2013;5:135–145. PubMed PMC

Nolan R.P., Jong P., Barry-Bianchi S.M., Tanaka T.H., Floras J.S. Vol. 15. 2008. Effects of drug, biobehavioral and exercise therapies on heart rate variability in coronary artery disease: A systematic review; pp. 386–396. (European journal of cardiovascular prevention and rehabilitation : official journal of the european society of cardiology, working groups on epidemiology & prevention and cardiac rehabilitation and exercise physiology). PubMed DOI

Ojemann G.A., Schoenfield-McNeill J., Corina D.P. Anatomic subdivisions in human temporal cortical neuronal activity related to recent verbal memory. Nature Neuroscience. 2002;5(1):64–71. doi: 10.1038/nn785. PubMed DOI

Park G., Thayer J.F. From the heart to the mind : Cardiac vagal tone modulates top-down and bottom-up visual perception and attention to emotional stimuli. Frontiers in Psychology. 2014;5(May):1–8. doi: 10.3389/fpsyg.2014.00278. PubMed DOI PMC

Penttilä J., Helminen A., Jartti T., Kuusela T., Huikuri H.V., Tulppo M.P., Coffeng R., Scheinin H. Time domain, geometrical and frequency domain analysis of cardiac vagal outflow: Effects of various respiratory patterns. Clinical Physiology. 2001;21(3):365–376. doi: 10.1046/j.1365-2281.2001.00337.x. PubMed DOI

Rabe-Hesketh S., Skrondal A. Third. Stata Press; 2012. Multilevel and longitudinal modeling using stata.

Raven J.C. [Rev. ed.] H.K. Lewis London; 1965. Guide to using the mill hill vocabulary scale with the progressive matrices scale.https://worldcat.org/title/31730916 LK.

Sabia S., Elbaz A., Dugravot A., Head J., Shipley M., Hagger-Johnson G., Kivimaki M., Singh-Manoux A. Impact of smoking on cognitive decline in early old age: The Whitehall II cohort study. Archives of General Psychiatry. 2012;69(6):627–635. doi: 10.1001/archgenpsychiatry.2011.2016. PubMed DOI PMC

Sabia S., Nabi H., Kivimaki M., Shipley M.J., Marmot M.G., Singh-Manoux A. Health Behaviors From Early to Late Midlife as Predictors of Cognitive Function. American Journal of Epidemiology. 2009;170(4):428–437. doi: 10.1093/aje/kwp161. PubMed DOI PMC

Schaich C.L., Malaver D., Chen H., Shaltout H.A., Hazzouri A.Z.Al, Herrington D.M., Hughes T.M. Association of heart rate variability with cognitive performance: The multi-ethnic study of atherosclerosis. Journal of the American Heart Association. 2020;9(7) doi: 10.1161/JAHA.119.013827. PubMed DOI PMC

Schroeder E.B., Whitsel E.A., Evans G.W., Prineas R.J., Chambless L.E., Heiss G. Repeatability of heart rate variability measures. Journal of Electrocardiology. 2004;37(3):163–172. doi: 10.1016/j.jelectrocard.2004.04.004. PubMed DOI

Shaffer F., Ginsberg J.P. An Overview of Heart Rate Variability Metrics and Norms. Frontiers in Public Health. 2017;5(September):1–17. doi: 10.3389/fpubh.2017.00258. PubMed DOI PMC

Singh-Manoux A., Dugravot A., Brunner E., Kumari M., Shipley M., Elbaz A., Kivimaki M. Interleukin-6 and C-reactive protein as predictors of cognitive decline in late midlife. Neurology. 2014;83(6):486–493. doi: 10.1212/WNL.0000000000000665. PubMed DOI PMC

Singh-Manoux A., Kivimaki M., Glymour M., Elbaz A., Claudine B., Ebmeier K.P., Ferrie J.E., Aline D. Timing of onset of cognitive decline : Results from Whitehall II prospective cohort study. 2012;7622(January):1–8. doi: 10.1136/bmj.d7622. PubMed DOI PMC

Singh J.P., Larson M.G., O'Donnell C.J., Wilson P.F., Tsuji H., Lloyd-Jones D.M., Levy D. Association of hyperglycemia with reduced heart rate variability (The Framingham Heart Study) The American Journal of Cardiology. 2000;86(3):309–312. http://www.ncbi.nlm.nih.gov/pubmed/10922439 PubMed

Slater C., Wang Q. Alzheimer's disease: An evolving understanding of noradrenergic involvement and the promising future of electroceutical therapies. Clinical and Translational Medicine. 2021;11(4) doi: 10.1002/ctm2.397. PubMed DOI PMC

Sloan R.P., Shapiro P.A., Bagiella E., Myers M.M., Gorman J.M. Cardiac Autonomic Control Buffers Blood Pressure Variability Responses to Challenge: A Psychophysiologic Model of Coronary Artery Disease. Psychosomatic Medicine. 1999;(1):61. https://journals.lww.com/psychosomaticmedicine/Fulltext/1999/01000/Cardiac_Autonomic_Control_Buffers_Blood_Pressure.10.aspx PubMed

Stansfeld, S. A., Head, J., Fuhrer, R., Wardle, J., & Cattell, V. (2003). Social inequalities in depressive symptoms and physical functioning in the Whitehall II study: Exploring a common cause explanation. November 2005. 10.1136/jech.57.5.361. PubMed DOI PMC

Task Force of the European Society of Cardiology and The North American Society of Pacing and Electrophysiology Heart rate variability. Standards of measurement, physiological interpretation, and clinical use. European Heart Journal. 1996;17:354–381. http://www.ncbi.nlm.nih.gov/pubmed/8737210 PubMed

Thayer J.F., Ahs F., Fredrikson M., Sollers J.J., Wager T.D. A meta-analysis of heart rate variability and neuroimaging studies: Implications for heart rate variability as a marker of stress and health. Neuroscience and Biobehavioral Reviews. 2012;36(2):747–756. doi: 10.1016/j.neubiorev.2011.11.009. PubMed DOI

Tracey K.J. The inflammatory reflex. Nature. 2002;420(6917):853–859. doi: 10.1038/nature01321. PubMed DOI

Verlinden V.J.A., van der Geest J.N., de Bruijn R.F.A.G., Hofman A., Koudstaal P.J., Ikram M.A. Trajectories of decline in cognition and daily functioning in preclinical dementia. Alzheimer's & Dementia. 2016;12(2):144–153. doi: 10.1016/j.jalz.2015.08.001. PubMed DOI

Weinstein G., Davis-Plourde K., Beiser A.S., Seshadri S. Autonomic Imbalance and Risk of Dementia and Stroke. Stroke. 2021;52(June):2068–2076. doi: 10.1161/STROKEAHA.120.030601. PubMed DOI PMC

World Health Organization . 2020. Who guidelines on physical activity and sedentary behaviour. PubMed

Williams D.W.P., Koenig J., Carnevali L., Sgoifo A., Jarczok M.N., Sternberg E.M., Thayer J.F. Heart rate variability and inflammation: A meta-analysis of human studies. Brain, Behavior, and Immunity. 2019;80(February):219–226. doi: 10.1016/j.bbi.2019.03.009. PubMed DOI

Wilson R.S., Leurgans S.E., Boyle P.A., Bennett D.A. Cognitive decline in prodromal alzheimer disease and mild cognitive impairment. Archives of Neurology. 2011;68(3):351–356. doi: 10.1001/archneurol.2011.31. PubMed DOI PMC

Yaffe K., Vittinghoff E., Pletcher M.J., Hoang T.D., Launer L.J., Whitmer R., Coker L.H., Sidney S. Early adult to midlife cardiovascular risk factors and cognitive function. Circulation. 2014;129(15):1560–1567. doi: 10.1161/CIRCULATIONAHA.113.004798. PubMed DOI PMC

Zeki Al Hazzouri A., Caunca M.R., Nobrega J.C., Elfassy T., Cheung Y.K., Alperin N., Dong C., Elkind M.S.V., Sacco R.L., DeCarli C., Wright C.B. Greater depressive symptoms, cognition, and markers of brain aging: Northern Manhattan Study. Neurology. 2018;90(23):e2077–e2085. doi: 10.1212/WNL.0000000000005639. PubMed DOI PMC

Zeki Al Hazzouri A., Elfassy T., Carnethon M.R., Lloyd-Jones D.M., Yaffe K. Heart Rate Variability and Cognitive Function in Middle-Age Adults: The Coronary Artery Risk Development in Young Adults. American Journal of Hypertension. 2018;31(1):27–34. doi: 10.1093/ajh/hpx125. PubMed DOI PMC