Association Between Heart Rate Variability Parameters with Cognitive Performance in Acute Ischemic Stroke

Ischemic stroke is a major cause of disability, with cognitive dysfunction as a frequent complication. Autonomic nervous system (ANS) imbalance, reflected by heart rate variability (HRV), has been linked to post-stroke cognitive impairment (PSCI). This study aimed to evaluate the relationship between HRV parameters and cognitive function in acute ischemic stroke patients. A cross-sectional study was conducted at Dr. Wahidin Sudirohusodo Hospital, Makassar in 2025. Acute ischemic stroke patients with onset < 7 days were recruited. HRV parameters were assessed using time-domain (SDNN, RMSSD), frequency-domain (VLF, LF, HF, LF/HF ratio), and ANS indexes (PNS, SNS). Cognitive function was measured using the Indonesian version of the Montreal Cognitive Assessment (MoCA-Ina). The Mann-Whitney test was used to compare HRV parameters between patients with and without cognitive impairment, and Spearman correlation was used to assess the relationship between HRV parameters with MoCA-Ina scores were analyzed. Fifty-three subjects were included. Cognitive impairment was found in 56.6% of participants (mean MoCA-Ina score: 19.4 ± 8.2). Cognitive impaired patients had lower HF values (23.03 vs. 59.18, p = 0.002) and higher LF/HF ratios (p = 0.010). Correlation analysis showed significant but weak associations between MoCA scores with LF (r = -0.284, p = 0.039), HF (r = 0.314, p = 0.022), and LF/HF (r = -0.329, p = 0.016). No significant relationship was observed with other HRV parameters. HRV frequency-domain parameters, especially HF and LF/HF ratio, are associated with cognitive function in acute ischemic stroke. HRV may serve as a potential biomarker for early detection of cognitive impairment.