Orthostatic Cognitive Dysfunction in Postural Tachycardia Syndrome After Rapid Water Drinking

Abstract

Background: Postural tachycardia syndrome (POTS) is a form of autonomic dysregulation and is characterized by an excessive heart rate (HR) increment upon the upright body position while blood pressure is maintained. Patients experience typical symptoms of orthostatic intolerance such as dizziness, nausea and cognitive impairments. The present study assessed position-dependent attentional and cognitive functioning in POTS patients compared to healthy subjects and tested the response of cognitive performance to acute water intake. Methods: Data was obtained from eight patients with neuropathic POTS and eight healthy subjects of similar age and gender. All participants completed questionnaires that assessed health-related quality of life and depression and underwent four rounds of neuropsychological testing overall, each before and after the intake of 500 ml still mineral water and both in the supine and in the upright posture. Results: Postural tachycardia syndrome patients showed deficits in working memory (WM) exclusively in the upright position compared to healthy subjects, but no position-dependent impairments in alertness or divided attention. Rapid water ingestion had a beneficial effect on WM in the upright posture, lead to a decrease in HR increment and to an improvement of subjective symptom experience. Conclusion: The results provide support for the occurrence of purely orthostatic cognitive deficits in POTS, especially when increased executive control and cognitive resources are required and document a favorable effect of water intake on cognitive performance. These findings have important implications for the management of cognitive symptoms in POTS as high water intake is an easy and accessible strategy.

Evaluating the Impact of Orthostatic Syncope and Presyncope on Quality of Life: A Systematic Review and Meta-Analysis

“…Compared with control or reference populations, SF-36 and RAND-36 physical and mental health summary scores were significantly reduced in patients with VVS ( 10 , 28 ). In patients with POTS, one study using the SF-36 showed that both physical and mental health summary scores were reduced compared to healthy controls ( 46 ), while two others found only the physical component summary score to be impaired ( 41 , 43 ). In a study using the RAND-36, both physical and mental health composite scores were impaired in patients with POTS, however the deficits in the physical health composite score were much larger than in the mental health composite score ( 49 ).…”

“… Meta-analysis of SF-36 summary scores in patients with VVS and POTS compared to normative data. Physical (A) and mental (B) component summary scores are shown for patients with VVS ( 27 – 30 , 56 ) (red) and POTS ( 41 , 43 – 46 ) (blue). Data for each study are presented as the mean (circle) and standard deviation (whiskers) with the size of the circle proportional to the study sample size.…”

“…While both physical and mental health dimensions of quality of life are reported to be impaired in patients with POTS, several studies reported that quality of life deficits in POTS patients are more profound in physical health domains than mental health domains ( 9 , 41 , 43 , 49 ). The results of our meta-analysis are compatible with this finding.…”

Do astronauts get postural tachycardia syndrome? And other updates on recent autonomic research

“…However, it was still unclear whether improvements in classic OI symptoms translated to improvement in cognitive symptoms in patients with POTS. To address these questions, Rodriguez and colleagues recently published their study, "Orthostatic cognitive dysfunction in postural tachycardia syndrome after rapid water drinking," in Frontiers in Neuroscience [10]. To understand the degree of orthostatic cognitive impairment and its response to rapid water drinking, the researchers recruited eight patients with neuropathic POTS and compared them to eight age-and sex-matched healthy controls.…”

Tolerability of COVID-19 mRNA vaccines in patients with postural tachycardia syndrome: a cross-sectional study

“…1,2 Patients with POTS experience symptoms of orthostatic intolerance in the upright position such as lightheadedness, dizziness, palpitations, tremulousness, generalized weakness and leg pain, blurred vision, dyspnea, nausea, headache and cognitive dysfunction. [3][4][5][6] Many patients with POTS additionally report non-orthostatic symptoms of autonomic origin such as fatigue, gastrointestinal complaints, sleep disturbances, restless legs symptoms and exercise intolerance. 7,8 The exact etiology of POTS is still unknown, although in recent years evidence has accumulated that in a subset of patients with POTS the pathogenesis of dysautonomia may be immune-mediated.…”