Cerebral blood flow and cognitive performance in postural tachycardia syndrome: insights from sustained cognitive stress test
Open accessAbstract
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.
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Seated prolonged cognitive stress testing was associated with reduced cerebral blood flow velocity and increased orthostatic symptom burden after the test in people with POTS.
“Seated prolonged cognitive stress testing was associated with both a reduced cerebral blood flow velocity in POTS, and an increase in orthostatic symptom burden after completion of the test (Wells et al., 2020”
From Self-reported symptom burden in postural orthostatic tachycardia syndrome (POTS): A narrative review of observational and interventional studies (2023) · cites this paper as Wells et al., 2020
The Discussion reports reduced cerebral blood flow velocity after prolonged cognitive stress testing while participants with POTS remained seated. It also reports increased orthostatic symptoms, but these were assessed at the completion of the entire study protocol, which included a subsequent standing test—not immediately after the seated cognitive test. (LLM, conf=0.86)
Experimental — accuracy not yet measuredA significant increase in the OHSA OHQ subscale was reported after the entire prolonged cognitive stress test protocol, with a greater increase in people with POTS compared to the control group.
“A significant increase in the OH symptoms assessment (OHSA) OHQ subscale was reported after the entire protocol, with a greater increase in people with POTS compared to the control group”
From Self-reported symptom burden in postural orthostatic tachycardia syndrome (POTS): A narrative review of observational and interventional studies (2023) · cites this paper as Wells et al., 2020
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Cites
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Knoop, I., Picariello, F., Jenkinson, E., Gall, N., Chisari, C., & Moss-Morris, R. (2023) · Autonomic Neuroscience · doi:10.1016/j.autneu.2022.103052 · Cited by 21 · see citing works
“Winker et al., 2003 OIQ - Orthostatic Intolerance Questionnai re Orthostati c Intoleranc e A symptom score that measures the frequency of nausea, tremor in hands, dizziness, palpitation, headache, profuse perspiration, blurred vision, chest discomfort, lightheadedness, and concentration…”
Background
- Authors
- Wells, R., Malik, V., Brooks, A. G., Linz, D., Elliott, A. D., Sanders, P., Page, A., Baumert, M., & Lau, D. H.
- Affiliations
- Royal Adelaide Hospital (AU)
- The University of Adelaide (AU)
- Corresponding author
- Lau, Dennis H.
- ORCID
- Venue
- Journal of the American Heart Association
- Published
- 2020-12-15
- Volume
- 9
- Issue
- 24
- Pages
- e017861-e017861
- ISSN
- 2047-9980 (ISSN-L)
- PMC
- PMC7955388
- OpenAlex
- W3112020768
- Cited by
- 28
- References
- 9
- Citations by year
- 2026: 6 · 2025: 6 · 2024: 2 · 2023: 4 · 2022: 5 · 2021: 5
- FWCI
- 3.20
- Type
- journal article
- Language
- en
- Open access
- gold
- doi.org
- Licence
- cc-by-nc-nd
- Locations
- Journal of the American Heart Association (publishedVersion, cc-by-nc-nd)
- PubMed Central (publishedVersion, cc-by-nc-nd)
- PubMed (publishedVersion)
- Adelaide Research & Scholarship (AR&S) (University of Adelaide) (submittedVersion, cc-by)
- DOAJ (DOAJ: Directory of Open Access Journals) (submittedVersion, cc-by-sa)
- 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, cerebral blood flow velocity, cognitive impairment, brain fog, psychomotor speed, orthostatic stress, symptom severity, middle cerebral artery, autonomic dysfunction
- MeSH terms
- Adolescent, Adult, Blood Pressure, Carbon Dioxide, Cerebrovascular Circulation, Female, Heart Rate, Hemodynamics, Humans, Male, Neuropsychological Tests, Severity of Illness Index, Case-Control Studies, Ultrasonography, Doppler, Transcranial, Middle Cerebral Artery, Orthostatic Intolerance, Postural Orthostatic Tachycardia Syndrome, Young Adult, Cognitive Dysfunction
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