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Published March 1, 2023 | Published
Journal Article Open

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


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.

Additional Information

© 2023 Arakaki, Arechavala, Choy, Bautista, Bliss, Molloy, Wu, Shimojo, Jiang, Kleinman and Kloner. This is an open-access article distributed under the terms of the Creative Commons Attribution License (CC BY). The use, distribution or reproduction in other forums is permitted, provided the original author(s) and the copyright owner(s) are credited and that the original publication in this journal is cited, in accordance with accepted academic practice. No use, distribution or reproduction is permitted which does not comply with these terms. We thank the Dr. Sandya Narayanswami edited the manuscript and Roger Rochart helped with journal discussion. This work was supported by the National Institute of Aging (grant number: R01AG063857). Author contributions. XA, MK, and RK: conception and design of the review. XA, RA, EC, JB, BB, CM, and D-AW: acquisition of the materials. XA and RA: writing the manuscript. XA, RA, EC, JB, BB, CM, D-AW, SS, YJ, MK, and RK: editing the manuscript. All authors contributed toward discussions of the review and the final manuscript. 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.

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August 22, 2023
December 22, 2023