Impact of initial autonomic dysfunction on long-term psychocognitive and functional prognoses in older patients with acute cerebral infarction

Background The prognostic value of autonomic dysfunction, an identifiable and reversible factor, in patients with cerebrovascular diseases has not been fully elucidated. This study aimed to explore the impact of baseline autonomic function on long-term psychocognitive and functional prognoses in older patients with acute cerebral infarction. Methods A total of 420 older patients with acute cerebral infarction who received interventional therapy were enrolled. Baseline assessment was performed on days 7–10 after symptom onset. According to baseline heart rate variability (HRV), patients were classified into the HRV-normal group ( n = 113) and the HRV-abnormal group ( n = 307). All patients were followed up for 1 year. At baseline and at 1-year follow-up, six scales (including PTGI, CD-RISC, MoCA, ACE-III, MBI, and FIM) were used to evaluate posttraumatic growth, cognitive function, and functional ability. Multivariate logistic regression analysis was performed. Results In the HRV-normal group, the probability of achieving favorable performance in all six scores at 1-year follow-up was significantly higher by 20.1 to 88.5% compared with baseline (all p < 0.001). In the HRV-abnormal group, the probability of favorable performance in these scores at 1-year follow-up did not increase relative to baseline (all p > 0.05). Furthermore, compared with the HRV-normal group, older patients with baseline autonomic abnormality had a 19.4 to 53.4% lower probability of achieving favorable psychocognitive and functional performance at 1-year follow-up (all p < 0.001). Conclusion Initial autonomic dysfunction in older patients with acute cerebral infarction may adversely affect their long-term psychocognitive and functional prognoses.