Cognitive dysfunction in postural tachycardia syndrome
Open accessAbstract
Mental clouding is an almost universal complaint among patients with postural tachycardia syndrome (POTS) but remains poorly understood. Thus, we have determined whether POTS patients exhibit deficits during neuropsychological testing relative to healthy subjects. A comprehensive battery of validated neuropsychological tests was administered to 28 female POTS patients and 24 healthy subjects in a semi-recumbent position. Healthy subjects were matched to POTS patients on age and gender. Selective attention, a primary outcome measure, and cognitive processing speed were reduced in POTS patients compared with healthy subjects (Ruff 2&7 Speed t-score: 40±9 compared with 49±8; P=0.009; Symbol Digit Modalities Test t-score: 45±12 compared with 51±8; P=0.011). Measures of executive function were also lower in POTS patients (Trails B t-score: 46±8 compared with 52±8; P=0.007; Stroop Word Color t-score: 45±10 compared with 56±8; P=0.001), suggesting difficulties in tracking and mental flexibility. Measures of sustained attention, psychomotor speed, memory function or verbal fluency were not significantly different between groups. The present study provides evidence for deficits in selective attention and cognitive processing in patients with POTS, in the seated position when orthostatic stress is minimized. In contrast, other measures of cognitive function, including memory assessments, were not impaired in these patients, suggesting selectivity in these deficits. These findings provide new insight into the profile of cognitive dysfunction in POTS and provide the basis for further studies to identify clinical strategies to better manage the mental clouding associated with this condition.
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"Brain fog" or perceived cognitive impairment is a particularly disabling symptom in POTS, often worse with upright posture.
“A particularly disabling symptom is “brain fog” or perceived cognitive impairment,19 which is often worse with upright posture.20”
From Diagnosis and management of postural orthostatic tachycardia syndrome (2022) · cites this paper as [19]
The Introduction and Clinical Perspectives sections describe cognitive impairment or mental clouding as an almost universal complaint in POTS, supporting the identification of the symptom. The paper does not call it particularly disabling. It reports worsening with head-up tilt in POTS patients with comorbid chronic fatigue syndrome, but its own testing was conducted seated, so it does not establish that upright posture often worsens cognition across POTS patients (page numbers unavailable). (LLM, conf=0.82)
Experimental — accuracy not yet measuredA comprehensive neuropsychological evaluation of 28 seated POTS patients found deficits in selective attention, cognitive processing, and executive functioning, but memory function did not differ from healthy controls.
“A comprehensive neuropsychological evaluation of 28 patients in a seated position found deficits in selective attention and cognitive processing, as well as impaired executive functioning. Memory function did not differ from healthy controls [29].”
From Postural tachycardia syndrome: beyond orthostatic intolerance (2015) · cites this paper as [29]
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“However, as cerebral blood flow reductions, orthostatic symptoms and cognitive impairment can occur during and after upright as well as seated positions in people with POTS (Anderson et al., 2014; Lewis et al., 2013; McDonald et al., 2014; Ross et al., 2013; Raj et al., 2018; Arnold et al., 2015; Campen et al., 2020;…”
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Talati, A., Uppal, J., Sheldon, R. S., & Raj, S. R. (2024) · Elsevier eBooks · doi:10.1016/b978-0-443-15734-9.00016-9
Self-citationBrosbe, M. S., Zegelbone, P. M., Radtke, S. R., & de la Uz, C. M. (2024) · Cardiology in the Young · doi:10.1017/s1047951124026003
de Lazcano, A. R., Pérez-Núñez, P., Pallarès‐Sastre, M., García-Sanchoyerto, M., García, I., & Amayra, I. (2025) · Clinical Autonomic Research · doi:10.1007/s10286-025-01106-y
Rich, E. M., Vas, A., Evetts, C. L., Kaplan-Smith, G., & Goodman, B. P. (2025) · Neurorehabilitation · doi:10.1177/10538135251395291
Gunning, W. T., Spatafore, J. W., Morran, M. P., Karabin, B. L., Hart, B. R., & Grubb, B. P. (2026) · Biomedicines · doi:10.3390/biomedicines14071605
Postural Orthostatic Tachycardia Syndrome (POTS)
Chung, T., & Raj, S. R. (2026) · JAMA · doi:10.1001/jama.2026.14809
Self-citation
- Authors
- Arnold, A. C., Haman, K., Garland, E. M., Raj, V., Dupont, W. D., Biaggioni, I., Robertson, D., & Raj, S. R.
- Affiliations
- Vanderbilt University (US)
- Corresponding author
- Biaggioni, Italo
- Robertson, David
- ORCID
- Venue
- Clinical Science
- Publisher
- Portland Press Ltd.
- Published
- 2014-08-27
- Volume
- 128
- Issue
- 1
- Pages
- 39-45
- ISSN
- 0143-5221 (ISSN-L)
- 1470-8736
- PMC
- PMC4161607
- OpenAlex
- W2072302096
- Cited by
- 53
- References
- 46
- Citations by year
- 2026: 2 · 2025: 4 · 2024: 5 · 2023: 4 · 2022: 8 · 2021: 5 · 2020: 7 · 2019: 5 · 2018: 6 · 2017: 2 · 2016: 3 · 2015: 2
- FWCI
- 2.31
- Type
- journal article
- Language
- en
- Open access
- green
- www.ncbi.nlm.nih.gov
- Locations
- Clinical Science (publishedVersion)
- PubMed (publishedVersion)
- PubMed Central (acceptedVersion)
- Funders
- National Institutes of Health (UL1TR000445)
- National Heart, Lung, and Blood Institute (P01HL056693, R01HL102387, P01 HL-56693)
- National Institute of Mental Health (RC1MH088329, R34MH094535)
- National Institute of General Medical Sciences (T32GM007569)
- National Institute of Neurological Disorders and Stroke (U54NS065736)
- NIH Clinical Center
- National Center for Advancing Translational Sciences
- Topics
- Health Sciences › Medicine › Surgery › Cardiovascular Syncope and Autonomic Disorders
- Health Sciences › Medicine › Neurology › Long-Term Effects of COVID-19
- Health Sciences › Medicine › Cardiology and Cardiovascular Medicine › Heart Rate Variability and Autonomic Control
- Keywords
- postural orthostatic tachycardia syndrome, cognitive impairment, selective attention, processing speed, executive function, neuropsychological assessment, orthostatic stress, female patients
- MeSH terms
- Adult, Attention, Cognition Disorders, Female, Humans, Neuropsychological Tests, Posture, Psychomotor Performance, Case-Control Studies, Postural Orthostatic Tachycardia Syndrome, Executive Function, Stroop Test
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