Correlation between epicardial adipose tissue and cognitive performance in older adults. A role for autonomic nervous system imbalance?

Background: Epicardial Adipose Tissue (EAT) is the visceral fat depot of the heart and evidence suggests that increased EAT thickness is associated with reduced cognitive performance in older adults, although the exact mechanisms remain poorly defined. Heart Rate Variability (HRV), an indicator of autonomic nervous system (ANS) activity, has been linked to both EAT volume and cognitive decline. The aim of this study was to assess the association between EAT thickness and cognitive status in an older population. Further, we explored, through HRV metrics, the ANS as a potential link for this association. Methods: 99 participants aged over 65 were enrolled at the outpatient clinics of the Federico II University Hospital. Participants underwent comprehensive medical and cardiological evaluations, including transthoracic echocardiography, 24 h Holter electrocardiographic (ECG) monitoring, and cognitive assessment using the Mini-Mental State Examination (MMSE). Results: A significant inverse correlation was observed between EAT thickness and MMSE scores (ρ = -0.341, p = 0.001), while EAT thickness showed a positive association with the standard deviation of normal-to-normal intervals (SDNN) index of HRV (ρ = 0.212, p = 0.036). EAT thickness was greater in individuals with dementia compared to cognitively normal subjects, whereas the low frequency (LF)/high frequency (HF) ratio was significantly reduced in the dementia group respect to those with mild cognitive impairment (MCI). Multivariate analysis showed that EAT thickness was an independent predictor of MMSE scores after adjusting for age, sex, body mass index, comorbid conditions, SDNN index and LF/HF. Conclusion: Our findings indicate that greater EAT thickness is independently associated with poorer cognitive performance in older adults and may reflect both increased visceral fat burden and underlying inflammatory processes. Further studies on larger cohorts are needed to clarify the mechanisms underlying the EAT-autonomic-cognition axis.