Heart rate variability and falls in Huntington’s disease
Persons with Huntington's disease (HD) have a high incidence of falls. Autonomic nervous system dysfunction has been reported even in early stages of this disease. To date, there has been no analysis of the relationship between heart rate variability (HRV) and falls in this patient population. The aim of the study reported here was to evaluate the relationship between HRV and falls in persons with HD.
Huntington's disease patients enrolled in a prospective study on fear of falling and falls were assessed using short-term HRV analyses and blood pressure measures in both the resting and standing states. Time–frequency domains and nonlinear parameters were calculated. Data on falls, the risk of falling (RoF) and disease-specific scales were collected at baseline and at the end of the 6-month follow-up.
Of the 24 HD patients who were invited to participate in the study, 20 completed the baseline analysis and 18 completed the 6-month follow-up. At baseline, seven (35%) HD patients reported at least one fall (single fallers) and 13 (65%) reported ≥ 2 falls (recurrent fallers) in the previous 12 months. At baseline, recurrent fallers had lower RMSSD (root mean square of successive RR interval differences) in the resting state (RMSSD-resting), higher LF/HF (low/high frequency) ratio in both states and higher DFA-α1 parameter (detrended fluctuation analyses over the short term) in both states. This association was similar at the 6-month follow-up for recurrent fallers, who showed lower RMSSD-resting and higher LF/HF ratio in the standing state (LF/HF-standing) than single fallers. Significant correlations were found between the number of falls, RMSSD-resting and LF/HF-standing. No differences were found between recurrent and single fallers for any blood pressure measures.
The observed HRV pattern is consistent with a higher sympathetic prevalence associated with a higher RoF. Reduced parasympathetic HRV values in this patient population predict being a recurrent faller at 6 months of follow-up, independently of orthostatic phenomena.
KeywordsAutonomic nervous system Fall prediction Heart rate variability Huntington’s disease Risk of falling
CTC, VB, DEV and MM conceptualized and designed the initial project of this manuscript. CTC, VB, DEV and MM made the final research plan. CTC, VB, DEV and MM ran the statistical analyses and made a definitive interpretation of the findings. CTC, VB, DEV and MM wrote the first version of the manuscript. All authors edited and approved the final version of the manuscript.
CTC is a doctoral research fellow from CONICET and received a research award from Fundación HD Lorena Scarafiocca, Buenos Aires, Argentina. The funding agencies did not have a role in the development of the study, analysis of data, and writing of the manuscript.
Compliance with ethics guidelines
Written informed consent was obtained from all the participants after a detailed explanation of the procedures. The local Ethics Committee approved the study, which followed all of the ethical standards set out in the Declaration of Helsinki of 1964 and its later amendments.
Conflict of interest
None of the authors have any conflicts of interest to report.
- 2.Vuong K, Canning CG, Menant JC, Loy CT (2018) Gait, balance, and falls in Huntington disease. Handbook of clinical neurology. Elsevier, AmsterdamGoogle Scholar
- 6.Nocua R, Noury N, Gehin C, Dittmar A, McAdams E (2009) Evaluation of the autonomic nervous system for fall detection. In: EMBC 2009: Proceedings of the 31st annual international conference of the IEEE engineering in medicine and biology society: engineering the future of biomedicine, 2–6 September 2009, Hilton Minneapolis, Minnesota. IEEE, Piscataway, NJGoogle Scholar
- 9.Razjouyan J, Grewal GS, Rishel C, Parthasarathy S, Mohler JNB (2012) Activity monitoring and heart rate variability as indicators of fall risk. J Gerontol Nurs 43(7):1–10Google Scholar
- 19.Hegde R, Sudarshan B, Kumar SCP, Hariprasad S, Satyanarayana B (2013) Technical advances in fall detection system—a review. Int J Comput Sci Mob Comput 2:152–160Google Scholar
- 21.Gibson M, Andres R, Isaacs BW (1987) The prevention of falls in later life. A report of the Kellogg International Work Group on the Prevention of Falls by the Elderly. Dan Med Bull 34(S4):1–24Google Scholar
- 39.Bird ED (1997) Neuroendocrine changes in Huntington’s disease. Adv Neurol 23:291–297Google Scholar
- 43.Sannino G, Melillo P, Pietro G, Stranges S, Pecchia L (2014) To what extent it is possible to predict falls due to standing hypotension by using HRV and wearable devices? Study design and preliminary results from a proof-of-concept study. In: Pecchia L, Chen LL, Nugent C, Bravo J (eds) Ambient assisted living and daily activities (Lecture Notes in Computer Science, vol 8868). International Workshop on Ambient Assisted Living (IWAAL) 2014. Springer, Berlin, pp 167–170CrossRefGoogle Scholar