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ISSN 1812-7231 Klin.inform.telemed. Volume 13, Issue 14, 2018, Pages 32–36


G. Raimondi1, N. Marchitto2, B. Scordamaglia1, A. Ciaramella1, P. Casacci3, M. Pistoia3, S. Sacco1, G. Sancesario4


1University of Roma "Sapienza", 2ASL Latina, 3Liferesult, 4University "Tor Vergata" Roma

Article title

Effect of acetylcholinesterase inhibitors in the Alzheimer patients on the daily cardiovascular neurovegetative assessment

Abstract (resume)

Introduction. The acetylcholinesterase inhibitor (CI) has recently been used for the treatment of senile dementia of Alzheimer type. Therefore, conflicting results exist in the literature on the action of the CI in the cardiovascular neurovegetative regulation.

Aim. In this concern we worked on the ability to remotely monitor patients with dementia in their own homes, with the support of high-tech devices.

Materials and Methods. We studied 36 patients (17 F and 19 M, 74, 5 ± 8, 4 years). At the patients we installed a new devices "Pulse" for a week. From the device we can obtain a record for 5-minute each hour in which the ECG, breath frequency, body position and activity level are reported.
From the records we can extrapolate by means of KUBIOS-HRV software the HRV analysis, both linear and nonlinear. We divided the patients in two groups: in therapy with CI (19–9 F, 72, 6 ± 7, 6 years) and without CI (17–8 F, 75, 3 ± 10, 1 years). The CI administered generally was Donezepil or rivastigmine.

Result. In the morning the indexes of sympathetic tone were more significant high in the patients with CI inhibitors respect to the patients without CI therapy and to the normal control, no differences were present between the control group and thee patients without CI therapy. Respect to patients without CI therapy in the patients with CI therapy we found a surprisingly greater and significant increase in sympathetic activity in all period considered specially during the night periods despite no difference in HR. In fact the linear and nonlinear indexes of the HRV of sympathetic activity was significantly higher in all considered daily period.

Conclusion. Our data, obtained in telemedicine by means a new device "Pulse", show the sympathetic HRV indexes are significantly high in patients with CI therapy in all period of the day and this fact is more pronounced during the night hours.


Telemedicine, HRV, Acetylcholinesterase inhibitor, Alzheimer


1. Akselrod S., Gordon D., Ubel F. A., Shannon D. C., Berger A. C., Cohen R. J. Power spectrum analysis of heart rate fluctuation: a quantitative probe of beat-to-beat cardiovascular control. Science. 1981, vol. 213 (4504), pp. 220–222.

2. Balocchi R., Cantini F., Varanini M., Raimondi G., Legramante J. M., Macerata A. Revisiting the potential of time-domain indexes in short-term HRV analysis. Biomed. Tech., 2006, iss. 51, pp. 190–193.

3. Fukusaki C., Kawakubo K., Yamamoto Y. Assessment of the primary effect of aging on heart rate variability in humans. Clin. Auton. Res., 2000, vol. 10, pp. 123–130.

4. Joaquim L. F., Farah V. M., Bernatova I., Fazan R. Jr., Grubbs R., Morris M. Enhanced heart rate variability and baroreflex index after stress and cholinesterase inhibition in mice. Am. J. Physiol. Heart Circ. Physiol., 2004, iss. 287, H251–H257.

5. Killian T. J., Robertson D., Biaggioni I., Haile V., Biscaia I., Robertson R. M. Sympathetic nervous system function in man is enhanced by acetylcholinesterase inhibition. Circulation, 1990, iss. 82, III–636.

6. Malliani A., Pagani M., Lombardi F., Cerreti S. Cardiovascular neural regulation explored in the frequency domain. Circulation, 1991, vol. 84, iss. 2, pp. 482–492.

7. Martynenko A., Yabluchansky M., Kantor B. Mathematical model of automatic nervous systems. Technology and health care: J. Europ. Society for Engineering and Medicine, 2001, iss. 9, pp. 174–176.

8. Masuda Y., Kawamura A. Acetylcholinesterase Inhibitor (Donepezil Hydrochloride) Reduces Heart Rate Variability. J. Cardiovasc. Pharmacol., 2003, vol. 41, pp. 67–71.

9. Mäkikallio T. H., et al. Prediction of sudden cardiac death by fractal analysis of heart rate variability in elderly subjects. J. Am. Coll. Cardiol., 2001, vol. 37, pp. 1395–1402.

10. Raimondi G., Legramante J. M., Scordamaglia B., Masci I., Montanari G., Pampena R., Skroza N., Potenza M. C. Linear and non-linear R-R interval variability analysis in the neurovegetative cardiovascular assessment in Psoriasis and Obesity. Appl. of Inform. Systems in Engineering and Biosci., 2014, pp. 61–69.

11. Raj S. R., Black B. K., Biaggioni I., Harris P. A., Robertson D. Acetylcholinesterase inhibition improves tachycardia in postural tachycardia syndrome. Circulation, 2005, vol. 31, pp. 2734–2740.

12. Siepmann M., Mück A., Engel S., Rupprecht R. The Influence of Rivastigmine and Donepezil on Heart Rate Variability in Patients with Alzheimer's Disease. German J. Psychiatry, 2006 iss. 9, pp. 133–135.

13. Sindona F., Raimondi G., Pecchia R., Spaziani E., Masci I., Scordamaglia B. The effects of general anaesthesia on heart rate variability during abdominal surgery. J. Medicine, Physiology and Biophysics, 2015, vol. 18, pp. 93–99.

14. Stein R. D., Backman S. B., Collier B., et al. Bradycardia produced by pyridostigmine and physostigmine. Can. J. Anaesth., 1997, vol. 44, pp. 1286–1292.

15. Yamamoto Y., Nakamura Y., Sato H., Yamamoto M., Kato K., and Hughson R. L. On the fractal nature of heart rate variability in humans: effects of vagal blockade. Am. J. Physiol. Regul. Integr. Comp. Physiol., 1995, iss. 269, R830–R837.

16. Yamasaki Y., Kodama M., Matsuhisa M., et al. Diurnal heart rate variability in healthy subjects: effects of aging and sex difference. Am. J. Physiol., 1996, iss. 271, H303–310.

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