The relationship between emotion regulation capacity, heart rate variability, and quality of life in individuals with alcohol-related brain damage

Figures & data

Table 1 Sociodemographics, medical information, and relevant pharmacological treatment in each patient

Characteristics	ARBD1	ARBD2	ARBD3	ARBD4	ARBD5	ARBD6	ARBD7	ARBD8	ARBD9
Sociodemographics
Age at time of study (years)	46.9	57.4	55.4	45.7	49.6	64.7	60.1	61.3	59.6
Time living in present ward, at time of study (months)	3	19	107	4	101	19	106	28	20
Marital status	Divorced	Married	Single	Divorced	Divorced	Divorced	Divorced	Divorced	Divorced
Work status	Invalidity	–	Invalidity	Invalidity	Invalidity	Retired	–	Invalidity	Retired
Alcohol abuse >10 years	X	–	X	X	X	X	X	X	X
History of alcoholism in family	X	–	–	X	–	–	–	X	X
Medical information
ICD10 diagnosis, primary	F10.6	F10.6	F10.6	F10.6	F10.6	F10.6	F10.6	F10.6	F10.6
ICD10 diagnosis, secondary	K86.0	F32	F32	G62.1	I62.1	F32	E11	F32	F32
CIRS-G
Organ-specific categories endorsed	4	4	3	4	3	6	4	6	5
Organ categories with moderate disabilities	2	2	1	2	2	3	3	4	2
Overall severity index	2.0	2.0	2.0	2.0	2.3	1.8	2.3	2.0	2.2
Atrophies on MRI
Mammillary bodies	–	X	X	X	–	X	X	X	X
Cerebellum	–	–	–	X	–	–	–	–	X
Cortex	–	X	X	X	–	X	X	–	–
Pharmacological treatment
Beta-blocker	–	–	–	–	–	–	–	X	X
BZD and related substances	–	X	–	X	–	X	–	X	–
Neuroleptic	–	–	–	X	X*	–	X	X	–
Antidepressant	X	X	X	–	X	X*	–	X	–
Thyroid extract	–	–	–	–	–	X	–	–	–

Notes: CIRS-G.⁴⁴ Organ-specific categories rated on a Likert-type scale from 0 (no problem) to 4 (extremely severe, organ failure): heart, vascular, hematopoietic, respiratory, eyes/ears/nose/throat/larynx, upper gastrointestinal tract, lower gastrointestinal tract, liver, renal, genitourinary, musculoskeletal-integument, neurological, endocrine-metabolic-breast, and psychiatric illness. A moderate disability is defined by requiring a first-line therapy, overall severity index represents the number of organ-specific categories endorsed/total score (unreported here).

* If required.

Abbreviations: ARBD, alcohol-related brain damage; BZD, benzodiazepines; CIRS-G, Cumulative Illness Rating Scale for Geriatrics; ICD, International Classification of Diseases; MRI, magnetic resonance imaging; “–”, data not available or condition does not apply; “X”, condition applies.

Table 2 QoL and dysexecutive failures as rated by patients and health carers, and heart rate variability results

	ARBD1		ARBD2		ARBD3		ARBD4		ARBD5		ARBD6		ARBD7		ARBD8		ARBD9		P
	S	P	S	P	S	P	S	P	S	P	S	P	S	P	S	P	S	P
QoL-profile
Subjective physical and mental performance (scale 1)	–	–	2.0	0.9	3.2	1.7	–	–	2.4	2.2	2.2	1.6	2.6	2.4	1.8	1.6	3.2	2.4	0.014
Ability to have pleasure and relaxation (scale 2)	–	–	2.5	1.0	3.0	2.2	–	–	3.0	2.6	2.7	2.4	3.1	2.9	2.4	1.7	2.4	1.6	0.006
Presence of positive mood (scale 3)	–	–	1.8	0.1	3.0	1.5	–	–	2.8	1.8	1.6	1.7	3.2	2.4	1.8	0.7	2.2	1.3	0.004
Absence of negative mood (scale 4)	–	–	2.4	0.8	2.1	2.9	–	–	4.0	3.3	3.6	2.9	3.6	3.4	2.7	2.2	3.1	2.2	0.098
Ability to relate/contact/approach (scale 5)	–	–	1.7	0.6	3.8	1.8	–	–	2.8	1.6	2.3	1.8	1.7	2.7	2.5	1.2	2.7	1.7	0.059
Sense of affiliation (scale 6)	–	–	3.0	1.2	3.4	2.2	–	–	3.4	2.6	3.4	2.5	3.4	3.1	2.2	2.5	1.4	1.4	0.050
DEX
Total score	16	18	–	–	22	35	7	41	28	31	–	–	8	29	–	–	–	–	0.071
Vagally mediated heart rate variability
Number of measurements Parameters, mean (SD)	3		2		3		3		3		3		2		2		3		n/a
Interbeat interval	826.4 (50.3)		643.8 (23.8)		683.6 (32.1)		612.3 (22.6)		673.5 (80.3)		794.7 (135.4)		794.1 (21.3)		730.2 (91.5)		729.9 (183.2)		n/a
Heart rate	72.8 (4.5)		93.3 (3.4)		87.9 (4.0)		98.1 (3.6)		89.9 (10.2)		77.1 (14.4)		75.4 (2.0)		82.8 (10.4)		85.3 (18.8)		n/a
rMSSD	17.5 (5.9)		5.1 (2.5)		8.1 (2.2)		3.9 (0.5)		11.3 (4.2)		11.1 (1.9)		15.4 (1.5)		11.4 (6.6)		12.6 (15.4)		n/a
HF-HRV	163.6 (70.8)		8.6 (6.5)		23.8 (10.0)		3.9 (2.1)		53.5 (40.4)		37.1 (20.9)		56.9 (32.1)		26.3 (23.4)		35.5 (56.6)		n/a

Notes: QoL-profile for chronically ill patients.³¹ For scale names, please refer to the text. Higher scores indicate a more positive QoL rating. DEX taken from the BADS.³² Higher DEX scores indicate higher ratings on the occurrence of everyday cognitive failures. HF-HRV (0.15–0.40 Hz) expressed in absolute values P of scale mean differences (dependent t-tests, two-tailed) between self- and proxy ratings. Number of measurements, number of vagally mediated heart rate variability assessments available and taken into account per person in the context of the present study.

Abbreviations: ARBD, alcohol-related brain damage; BADS, Behavioral Assessment of the Dysexecutive Syndrome; DEX, Dysexecutive Questionnaire; HF-HRV, high frequency component; n/a, not available; P, proxy rating from acquainted health care professionals; QoL-profile, quality of life profile; rMSSD, root mean square of successive difference; S, self-rating; SD, standard deviation; “–”, data not available or not provided.

Table 3 Parametric/nonparametric correlation coefficients and robustness for relationships among vmHRV, QoL, and everyday cognitive failures

Parameters	QoL-profile												DEX
	Subjective physical and mental performance (scale 1)		Ability to have pleasure and relaxation (scale 2)		Presence of positive mood (scale 3)		Absence of negative mood (scale 4)		Ability to relate/contact/approach (scale 5)		Sense of affiliation (scale 6)		Total score
	S	P	S	P	S	P	S	P	S	P	S	P	S	P
rMSSD
Spearman’s rho	0.25	0.78*	0.06	0.43	0.40	0.46	0.51	0.45	−0.11	0.51	−0.20	0.58	0.20	−1.00*
Pearson’s r	0.20	0.87*	0.27	0.68	0.36	0.76*	0.69	0.71	−0.15	0.84*	−0.15	0.66	0.08	−0.94*
SE	0.39	0.14	0.42	0.39	0.40	0.34	0.24	0.41	0.59	0.31	0.40	0.42	0.59	0.05
95% CI [LL,UL]	[−0.56,0.83]	[0.47,0.99]	[−0.79,0.86]	[−0.65,0.96]	[−0.69,0.88]	[−0.35,0.98]	[−0.17,0.97]	[−0.61,0.96]	[−0.98,0.96]	[−0.30,0.98]	[−0.84,0.84]	[−0.68,1]	[−1,1]	[−1, −0.83]
Robustfit
β Differences	0.00	0.00	0.00	0.00	0.00	0.00	0.00	0.00	0.24	0.00	−0.01	−0.04	0.02	−0.01
Z	−0.02	0.00	−0.01	−0.03	−0.01	−0.03	0.02	0.01	1.98	−0.03	−0.05	−0.44	0.01	−0.01

Notes: DEX taken from the BADS.³² We report bootstrapped Pearson’s r, with SE for each correlation coefficient. Robustfit is a robustness algorithm implemented in MATLAB^® (The MathWorks, Inc., Natick, MA, USA) software. β Scores for both least square regression and robust regression are checked for differences and the significance is reported as Z-statistic.

* Relationship is significant at P<0.05.

Abbreviations: BADS, Behavioral Assessment of the Dysexecutive Syndrome; CI, confidence interval; DEX, Dysexecutive Questionnaire; LL, lower limit; P, proxy ratings; QoL-profile, quality of life profile; rMSSD, root mean square of successive differences; S, self-ratings; SE, standard error; UL, upper limit; vmHRV, vagally mediated heart rate variability.

Figure 1 Comparison of ordinary least square regressions and robust regressions for self- and proxy ratings on the six QoL-profile scales (A–L) and the occurrence of everyday executive dysfunctions (M and N).

Notes: QoL-profile for chronically ill patients.³¹ For scale names, please refer to the text. Higher scores indicate a more positive QoL rating. DEX taken from the BADS.³² Higher DEX scores indicate higher ratings on the occurrence of everyday cognitive dysfunctions. The red line represents the ordinary least squares regression line. The green line represents the robust regression computed by the robustfit algorithm implemented in MATLAB^® software (The MathWorks, Inc., Natick, MA, USA).
Abbreviations: BADS, Behavioral Assessment of the Dysexecutive Syndrome; DEX, Dysexecutive Questionnaire; rMSSD, root mean square successive difference; QoL-profile, quality of life profile.

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