Short Article
Halinouskaya Natallia
Abstract
The aim of the study was to determine the status of the autonomic nervous system (ANS) in patients with chronic cerebrovascular insufficiency with cognitive impairment (CCICI). Study design: Prospective cohort study. Place and Duration of Study: Department of Neurology and Neurosurgery at the Gomel State Medical University, Neurological Department of the Gomel Regional Veterans Hospital, between September 2014 and May 2016. Methodology: 24 patients with CCICI (12 male and 12 female) and 14 volunteers (5 male and 9 female) were observed. To describe status of the ANS heart rate variability (HRV) linear parameters were used. Were analyzed using the following four parameters: SDNN (standard deviation of the normal-to-normal R-R intervals, in ms), ΔX (the difference between maximal and minimal R-R interval, in ms), Mo (mode of the durations of R-R intervals, in ms), AMo (amplitude of the R-R intervals mode, in percent). HRV linear parameters were measured at 1st day after admission. Central regulation of the autonomic nervous system: Central nervous system control of the autonomic nervous system involves several interconnected structures distributed throughout the neuraxis. The central autonomic network is organized into closely interconnected spinal, bulbopontine, pontomesencephalic, and forebrain levels. The spinal level mediates segmental sympathetic or sacral parasympathetic reflexes. The bulbopontine level is involved in the reflex control of respiration and circulation. The pontomesencephalic level controls pain modulation and the integration of behavioral responses to stress. The forebrain level includes the hypothalamus and the anterior limbic circuit, which includes the insula. The forebrain is involved in goal-related autonomic and endocrine responses for homeostasis and adaptation. The insular cortex integrates visceral, pain, and temperature sensation. It is divided into an anterior and a smaller posterior part. The posterior part of the insula has a viscerotropic organization and receives input from the gustatory, visceral, muscle and skin receptors via the thalamus and projects to the right anterior insula, which integrates this input with emotional and cognitive processing to convey the conscious experience of bodily sensation. The insula carries a visceromotor function controlling sympathetic and parasympathetic outputs via a relay in the lateral hypothalamus.