Cognitive performance in hypotensive persons with spinal cord injury

Abstract

Background Due to sympathetic de-centralization, individuals with spinal cord injury (SCI), especially those with tetraplegia, often present with hypotension, worsened with upright posture. Several investigations in the non-SCI population have noted a relationship between chronic hypotension and deficits in memory, attention and processing speed and delayed reaction times. Objective To determine cognitive function in persons with SCI who were normotensive or hypotensive over a 24-h observation period while maintaining their routine activities. Methods Subjects included 20 individuals with chronic SCI (2–39 years), 13 with tetraplegia (C4–8) and 7 with paraplegia (T2–11). Individuals with hypotension were defined as having a mean 24-h systolic blood pressure (SBP) below 110 mmHg for males and 100 mmHg for females, and having spent ≥50% of the total time below these gender-specific thresholds. The cognitive battery used included assessment of memory (CVLT), attention and processing speed (Digit Span, Stroop word and color and Oral Trails A), language (COWAT) and executive function (Oral Trails B and Stroop color–word). Results Demographic parameters did not differ among the hypotensive and normotensive groups; the proportion of individuals with tetraplegia (82%) was higher in the hypotensive group. Memory was significantly impaired (P<0.05) and there was a trend toward slowed attention and processing speed (P<0.06) in the hypotensive compared to the normotensive group. Interpretation These preliminary data suggest that chronic hypotension in persons with SCI is associated with deficits in memory and possibly attention and processing speed, as previously reported in the non-SCI population.

Regional Neurovascular Coupling and Cognitive Performance in Those with Low Blood Pressure Secondary to High-Level Spinal Cord Injury: Improved by Alpha-1 Agonist Midodrine Hydrochloride

“…40 This study clearly showed that NVC of the MCA is preserved to AB levels in those with SCI. These findings appear to be in opposition to that reported by Jegede et al (2010) 9 ; however, differences may be explained by a combination of (a) a dissimilar cognitive task (i.e., verbal fluency versus Stroop test), (b) a more stringent procedure (i.e., seven versus three cycles averaged), or (c) shorter activation period averaged (30 versus 45 seconds that we used in our study). It is unclear from the Jegede et al (2010) 9 study if an eyes-closed rest period preceded cerebral activation, or if verbal responses to cognition influenced PETCO 2 , as the latter was not measured.…”

Endoplasmic Reticulum Stress and Disrupted Neurogenesis in the Brain Are Associated with Cognitive Impairment and Depressive-Like Behavior after Spinal Cord Injury

“…[1][2][3][4][5][6][7][8][9] The cause of the cognitive deficits in these patients is controversial because of potentially confounding factors, such as concurrent traumatic brain injury (TBI). However, cognitive changes after SCI in patients have been reported without a history or signs of TBI.…”

Orthostatic responses to anticholinesterase inhibition in spinal cord injury

“…In otherwise healthy non-SCI individuals, hypotension has been associated with slowed cognitive speed 35 , fewer word recall 36 , decreased accuracy of response 5 , limited attention 36 , prolonged reaction times 5,6,35 and reduced memory and concentration capacity 5,6 compared to normotensive controls. We previously reported significantly reduced memory and marginally reduced attention processing in hypotensive individuals with SCI compared to a normotensive SCI cohort, 10 and speculate that this finding may relate to sub-clinical cerebral hypoperfusion. 37,38 These data strongly suggest that chronic asymptomatic hypotension is not a benign condition and, therefore, treatment options should be considered.…”

“…Moreover, our group recently reported reduced memory and marginally impaired attention processing in hypotensive individuals with spinal cord injury (SCI) compared to a normotensive SCI cohort. 10 Thus, we believe that treatment of asymptomatic hypotension and OH in the SCI population may be clinically warranted.…”