Please use this identifier to cite or link to this item: https://hdl.handle.net/2440/130189
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Type: Journal article
Title: Cerebral blood flow and cognitive performance in postural tachycardia syndrome: insights from sustained cognitive stress test
Author: Wells, R.
Malik, V.
Brooks, A.G.
Linz, D.
Elliott, A.D.
Sanders, P.
Page, A.
Baumert, M.
Lau, D.H.
Citation: Journal of the American Heart Association, 2020; 9(24):1-10
Publisher: Ovid Technologies (Wolters Kluwer Health)
Issue Date: 2020
ISSN: 2047-9980
2047-9980
Statement of
Responsibility: 
Rachel Wells, Varun Malik, Anthony G. Brooks, Dominik Linz, Adrian D. Elliott, Prashanthan Sanders ... et al.
Abstract: BACKGROUND: The physiology underlying "brain fog" in the absence of orthostatic stress in postural tachycardia syndrome(POTS) remains poorly understood. METHODS AND RESULTS: We evaluated cognitive and hemodynamic responses (cardiovascular and cerebral: heart rate, blood pressure, end-tidal carbon dioxide, and cerebral blood flow velocity (CBFv) in the middle cerebral artery at baseline, after initial cognitive testing, and after (30-minutes duration) prolonged cognitive stress test (PCST) whilst seated; as well as after 5-minute standing in consecutively enrolled participants with POTS (n=22) and healthy controls (n=18). Symptom severity was quantified with orthostatic hypotensive questionnaire at baseline and end of study. Subjects in POTS and control groups were frequency age- and sex-matched (29±11 versus 28±13 years; 86 versus 72% women, respectively; both P≥0.4). The CBFv decreased in both groups (condition, P=0.04) following PCST, but a greater reduction in CBFv was observed in the POTS versus control group (−7.8% versus −1.8%; interaction, P=0.038). Notably, the reduced CBFv following PCST in the POTS group was similar to that seen during orthostatic stress (60.0±14.9 versus 60.4±14.8 cm/s). Further, PCST resulted in greater slowing in psychomotor speed (6.1% versus 1.4%, interaction, P=0.027) and a greater increase in symptom scores at study completion (interaction, P<0.001) in the patients with POTS, including increased difficulty with concentration. All other physiologic responses (blood pressure and end-tidal carbon dioxide) did not differ between groups after PCST (all P>0.05). CONCLUSIONS: Reduced CBFv and cognitive dysfunction were evident in patients with POTS following prolonged cognitive stress even in the absence of orthostatic stress.
Keywords: Cognitive dysfunction; postural tachycardia syndrome; cerebral blood flow; transcranial doppler; orthostatic intolerance
Rights: © 2020 The Authors. Published on behalf of the American Heart Association, Inc., by Wiley Blackwell This is an open access article under the terms of the Creative Commons Attribution‐NonCommercial‐NoDerivs License, which permits use and distribution in any medium, provided the original work is properly cited, the use is non‐commercial and no modifications or adaptations are made.
DOI: 10.1161/jaha.120.017861
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