Autonomic dysfunction in mild cognitive impairment: a transcranial Doppler study

Objectives - The contribution of early microvascular and autonomic derangements to the pathogenesis of mild cognitive impairment (MCI) is unclear. Aim of this study is to evaluate cerebrovascular reactivity (CVR) and cardiac autonomic function in patients with MCI by means of transcranial Doppler (TCD). Material and Methods - Fifteen patients with MCI and 28 controls underwent carotid ultrasound and TCD evaluation, including assessment of mean flow velocity (MFV) in the middle cerebral artery at baseline, after CO2 inhalation and after hyperpnoea. End-tidal CO2, mean arterial blood pressure (MAP), heart rate (HR), and respiratory rate were monitored throughout the procedure, and CVR was calculated. Results - MAP, end-tidal CO2, and MFV variations during hypercapnia and hyperventilation showed no between-group differences. CVR was similar in controls and MCI (2.30 vs 2,39, respectively, P = 0.767). HR significantly increased in hypercapnia (+9.4%, P < 0.0001) and hyperventilation (+18.7%, P < 0.0001) in controls, while in MCI it significantly increased in hyperventilation (+10.4%, P = 0.002), but not in hypercapnia (+1.1%, P = 0.635). Conclusions - This study demonstrates that patients with MCI have a normal CVR, but they exhibit signs of autonomic dysfunction after CO2 challenge. Should this finding be confirmed in larger studies, HR response to CO2 challenge could become a marker of MCI.