Closed-loop modeling of the heart-rate reflex for improved diagnosis and monitoring of Mild Cognitive Impairment.

Analysis of beat-to-beat spontaneous cerebral hemodynamic data has yielded predictive dynamic models of cerebral hemodynamics and has shown previously that patients with Mild Cognitive Impairment (MCI) exhibit significantly reduced cerebral vasomotor reactivity to CO relative to cognitively normal control subjects [1]. The present work examines the heart-rate reflex (HRR) dynamics of 46 MCI patients compared to 20 control subjects, using closed-loop modeling of HRR under resting conditions of spontaneous variations of arterial blood pressure (baroreflex) and end-tidal CO (chemoreflex). These subject-specific predictive dynamic models are obtained via the methodology of Principal Dynamic Modes [2] and allow the computation of model-based markers of baroreflex and chemoreflex function. We found that the chemoreflex gain is significantly weakened in MCI patients relative to controls (p=0.0086), while the baroreflex is not significantly affected. These findings offer another tool for diagnosis and monitoring of MCI (via model-based markers), when used in conjunction with current methods.