Skip to main content
Hauptrubriken
CME Facharzt-Training Webinare Zeitschriften Bücher e.Medpedia Podcast
Service
Jobbörse Info & Hilfe
Fachgebiete
Anästhesiologie Allgemeinmedizin Arbeitsmedizin Augenheilkunde Chirurgie Dermatologie Gynäkologie und Geburtshilfe HNO Innere Medizin Kardiologie Neurologie Onkologie und Hämatologie Orthopädie und Unfallchirurgie Pädiatrie Pathologie Psychiatrie Radiologie Rechtsmedizin Urologie Zahnmedizin
Themen
Klimawandel und Gesundheit Neues aus dem Markt COVID-19 Praxis und Beruf Seltene Erkrankungen GOÄ & EBM Panorama
Sammlungen
Kasuistiken Algorithmen & Infografiken Blickdiagnosen Arthropedia FlapFinder (für Dermatochirurgen) Videos Kongressberichterstattung Medizin für Apothekerinnen und Apotheker Für Ärztinnen und Ärzte in Weiterbildung Für Medizinstudierende
Erweiterte Suche
Anmelden
nach oben
Clinical Autonomic Research
Erschienen in: Clinical Autonomic Research 1/2010

01.02.2010 | Research Article

Cognitive performance in hypotensive persons with spinal cord injury

verfasst von: Adejoke B. Jegede, Dwindally Rosado-Rivera, William A. Bauman, Christopher P. Cardozo, Mary Sano, Jeremy M. Moyer, Monifa Brooks, Jill Maria Wecht

Erschienen in: Clinical Autonomic Research | Ausgabe 1/2010

Einloggen, um Zugang zu erhalten

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.
Literatur
1.
Anonymous (1978) Arterial hypertension. Report of a WHO expert committee. World Health Organ Tech Rep Ser 628:7–56
2.
Barrett-Connor E, Palinkas LA (1994) Low blood pressure and depression in older men: a population based study. BMJ 308:446–449PubMed
3.
Beck AT, Steer RA, Brown GK (1996) Manual for the Becks depression inventory—II. Psychological Co., San Antonio
4.
Benton AL, Hamsher K, Sivan AB (1994) Multilingual aphasia examination, 3rd edn. AJA Associates, Iowa
5.
Braun SR, Giovannoni R, Levin AB, Harvey RF (1982) Oxygen saturation during sleep in patients with spinal cord injury. Am J Phys Med 61:302–309PubMed
6.
Bruns B, Gentilello L, Elliott A, Shafi S (2008) Prehospital hypotension redefined. J Trauma 65:1217–1221CrossRefPubMed
7.
Cahill L, Alkire MT (2003) Epinephrine enhancement of human memory consolidation: interaction with arousal at encoding. Neurobiol Learn Mem 79:194–198CrossRefPubMed
8.
Cahill L, Prins B, Weber M, McGaugh JL (1994) Beta-adrenergic activation and memory for emotional events. Nature 371:702–704CrossRefPubMed
9.
Claydon VE, Krassioukov AV (2006) Orthostatic hypotension and autonomic pathways after spinal cord injury. J Neurotrauma 23:1713–1725CrossRefPubMed
10.
Claydon VE, Steeves JD, Krassioukov A (2006) Orthostatic hypotension following spinal cord injury: understanding clinical pathophysiology. Spinal Cord 44:341–351CrossRefPubMed
11.
Costa M, Stegagno L, Schandry R, Bitti PE (1998) Contingent negative variation and cognitive performance in hypotension. Psychophysiology 35:737–744CrossRefPubMed
12.
Daugherty A, Cassis L (2004) Angiotensin II-mediated development of vascular diseases. Trends Cardiovasc Med 14:117–120CrossRefPubMed
13.
Daugherty A, Manning MW, Cassis LA (2000) Angiotensin II promotes atherosclerotic lesions and aneurysms in apolipoprotein E-deficient mice. J Clin Invest 105:1605–1612CrossRefPubMed
14.
Davidoff GN, Roth EJ, Richards JS (1992) Cognitive deficits in spinal cord injury: epidemiology and outcome. Arch Phys Med Rehabil 73:275–284CrossRefPubMed
15.
Delis D, Kramer J, Kaplan E, Ober B (2000) California verbal learning: learning test (CVLT-II), 2nd edn. The Psychological Co., San Antonio
16.
Dowler RN, Harrington DL, Haaland KY, Swanda RM, Fee F, Fiedler K (1997) Profiles of cognitive functioning in chronic spinal cord injury and the role of moderating variables. J Int Neuropsychol Soc 3:464–472PubMed
17.
Dowler RN, O’Brien SA, Haaland KY, Harrington DL, Feel F, Fiedler K (1995) Neuropsychological functioning following a spinal cord injury. Appl Neuropsychol 2:124–129CrossRefPubMed
18.
Drummond JC (1997) The lower limit of autoregulation: time to revise our thinking? Anesthesiology 86:1431–1433CrossRefPubMed
19.
Duschek S, Dietel A, Schandry R, Reyes Del Paso GA (2008) Increased baroreflex sensitivity and reduced cardiovascular reactivity in individuals with chronic low blood pressure. Hypertens Res 31:1873–1878CrossRefPubMed
20.
Duschek S, Hadjamu M, Schandry R (2007) Enhancement of cerebral blood flow and cognitive performance following pharmacological blood pressure elevation in chronic hypotension. Psychophysiology 44:145–153CrossRefPubMed
21.
Duschek S, Matthias E, Schandry R (2005) Essential hypotension is accompanied by deficits in attention and working memory. Behav Med 30:149–158CrossRefPubMed
22.
Duschek S, Muckenthaler M, Werner N, del Paso GA (2009) Relationships between features of autonomic cardiovascular control and cognitive performance. Biol Psychol 81:110–117CrossRefPubMed
23.
Duschek S, Schandry R (2004) Cognitive performance and cerebral blood flow in essential hypotension. Psychophysiology 41:905–913CrossRefPubMed
24.
Duschek S, Schandry R (2007) Reduced brain perfusion and cognitive performance due to constitutional hypotension. Clin Auton Res 17:69–76CrossRefPubMed
25.
Duschek S, Weisz N, Schandry R (2003) Reduced cognitive performance and prolonged reaction time accompany moderate hypotension. Clin Auton Res 13:427–432PubMed
26.
Eastridge BJ, Salinas J, McManus JG, Blackburn L, Bugler EM, Cooke WH, Convertino VA, Wade CE, Holcomb JB (2007) Hypotension begins at 110 mm Hg: redefining “hypotension” with data. J Trauma 63:291–297 (Discussion 297–299)CrossRefPubMed
27.
Flavell H, Marshall R, Thornton AT, Clements PL, Antic R, McEvoy RD (1992) Hypoxia episodes during sleep in high tetraplegia. Arch Phys Med Rehabil 73:623–627PubMed
28.
Golden CaF S (1978) Stroop color word test. Stoelting Co., Chicago
29.
Handrakis JP, DeMeersman RE, Rosado-Rivera D, LaFountaine MF, Spungen AM, Bauman WA, Wecht JM (2009) Effect of hypotensive challenge on systemic hemodynamics and cerebral blood flow in persons with tetraplegia. Clin Auton Res 19:39–45CrossRefPubMed
30.
Jennings JR (2003) Autoregulation of blood pressure and thought: preliminary results of an application of brain imaging to psychosomatic medicine. Psychosom Med 65:384–395CrossRefPubMed
31.
Johnson RH, Park DM (1973) Effect of change of posture on blood pressure and plasma renin concentration in men with spinal transections. Clin Sci 44:539–546PubMed
32.
Krassioukov A, Claydon VE (2006) The clinical problems in cardiovascular control following spinal cord injury: an overview. Prog Brain Res 152:223–229CrossRefPubMed
33.
Larsen FS, Olsen KS, Hansen BA, Paulson OB, Knudsen GM (1994) Transcranial Doppler is valid for determination of the lower limit of cerebral blood flow autoregulation. Stroke 25:1985–1988PubMed
34.
Leduc BE, Dagher JH, Mayer P, Bellemare F, Lepage Y (2007) Estimated prevalence of obstructive sleep apnea–hypopnea syndrome after cervical cord injury. Arch Phys Med Rehabil 88:333–337CrossRefPubMed
35.
Low PA, Singer W (2008) Management of neurogenic orthostatic hypotension: an update. Lancet Neurol 7:451–458CrossRefPubMed
36.
Mathias CJ, Christensen NJ, Corbett JL, Frankel HL, Goodwin TJ, Peart WS (1975) Plasma catecholamines, plasma renin activity and plasma aldosterone in tetraplegic man, horizontal and tilted. Clin Sci Mol Med 49:291–299PubMed
37.
Mathias CJ, Christensen NJ, Frankel HL, Peart WS (1980) Renin release during head-up tilt occurs independently of sympathetic nervous activity in tetraplegic man. Clin Sci (Lond) 59:251–256
38.
Mathias CJ, Frankel HL (1983) Clinical manifestations of malfunctioning sympathetic mechanisms in tetraplegia. J Auton Nerv Syst 7:303–312CrossRefPubMed
39.
Morris MC, Scherr PA, Hebert LE, Bennett DA, Wilson RS, Glynn RJ, Evans DA (2002) Association between blood pressure and cognitive function in a biracial community population of older persons. Neuroepidemiology 21:123–130CrossRefPubMed
40.
Murray RF, Asghari A, Egorov DD, Rutkowski SB, Siddall PJ, Soden RJ, Ruff R (2007) Impact of spinal cord injury on self-perceived pre- and postmorbid cognitive, emotional and physical functioning. Spinal Cord 45:429–436CrossRefPubMed
41.
Olsen KS, Svendsen LB, Larsen FS (1996) Validation of transcranial near-infrared spectroscopy for evaluation of cerebral blood flow autoregulation. J Neurosurg Anesthesiol 8:280–285CrossRefPubMed
42.
Olsen KS, Svendsen LB, Larsen FS, Paulson OB (1995) Effect of labetalol on cerebral blood flow, oxygen metabolism and autoregulation in healthy humans. Br J Anaesth 75:51–54PubMed
43.
Pedersen-Bjergaard U, Thomsen CE, Hogenhaven H, Smed A, Kjaer TW, Holst JJ, Dela F, Hilsted L, Frandsen E, Pramming S, Thorsteinsson B (2008) Angiotensin-converting enzyme activity and cognitive impairment during hypoglycaemia in healthy humans. J Renin Angiotensin Aldosterone Syst 9:37–48CrossRefPubMed
44.
45.
Qiu C, Winblad B, Fratiglioni L (2005) The age-dependent relation of blood pressure to cognitive function and dementia. Lancet Neurol 4:487–499CrossRefPubMed
46.
Reist C, Duffy JG, Fujimoto K, Cahill L (2001) beta-Adrenergic blockade and emotional memory in PTSD. Int J Neuropsychopharmacol 4:377–383CrossRefPubMed
47.
Ricker J, Axelrod B, Houtler B (1994) Orals trails making test A and B. Assessment 1(1):47–51CrossRefPubMed
48.
Rosengren A, Tibblin G, Wilhelmsen L (1993) Low systolic blood pressure and self perceived wellbeing in middle aged men. BMJ 306:243–246CrossRefPubMed
49.
Sajkov D, Marshall R, Walker P, Mykytyn I, McEvoy RD, Wale J, Flavell H, Thornton AT, Antic R (1998) Sleep apnoea related hypoxia is associated with cognitive disturbances in patients with tetraplegia. Spinal Cord 36:231–239CrossRefPubMed
50.
Southwick SM, Davis M, Horner B, Cahill L, Morgan CA 3rd, Gold PE, Bremner JD, Charney DC (2002) Relationship of enhanced norepinephrine activity during memory consolidation to enhanced long-term memory in humans. Am J Psychiatry 159:1420–1422CrossRefPubMed
51.
Sudilovsky A, Turnbull B, Croog SH, Crook T (1987) Angiotensin converting enzyme and memory: preclinical and clinical data. Int J Neurol 21–22:145–162PubMed
52.
Verghese J, Lipton RB, Hall CB, Kuslansky G, Katz MJ (2003) Low blood pressure and the risk of dementia in very old individuals. Neurology 61:1667–1672PubMed
53.
Wechsler D (1999) Wechsler Abbreviated Scale of Intelligence (WASI). The Psychological Co, San Antonio
54.
Wechsler D (1997) Wechsler Adult Intelligence Scale-III. The Psychological Co, San Antonio
55.
Wechsler D (2001) Wechsler test of adult reading (WTAR). Harcourt Assessment, San Antonio
56.
Wecht JM, Radulovic M, Weir JP, Lessey J, Spungen AM, Bauman WA (2005) Partial angiotensin-converting enzyme inhibition during acute orthostatic stress in persons with tetraplegia. J Spinal Cord Med 28:103–108PubMed
57.
Wecht JM, Weir JP, Bauman WA (2006) Blunted heart rate response to vagal withdrawal in persons with tetraplegia. Clin Auton Res 16:378–383CrossRefPubMed
58.
Weisz N, Schandry R, Jacobs AM, Mialet JP, Duschek S (2002) Early contingent negative variation of the EEG and attentional flexibility are reduced in hypotension. Int J Psychophysiol 45:253–260CrossRefPubMed
59.
Wessely S, Nickson J, Cox B (1990) Symptoms of low blood pressure: a population study. BMJ 301:362–365CrossRefPubMed
60.
Yusuf S, Sleight P, Pogue J, Bosch J, Davies R, Dagenais G (2000) Effects of an angiotensin-converting-enzyme inhibitor, ramipril, on cardiovascular events in high-risk patients. The Heart Outcomes Prevention Evaluation Study Investigators. N Engl J Med 342:145–153CrossRefPubMed
Metadaten
Titel
Cognitive performance in hypotensive persons with spinal cord injury
verfasst von
Adejoke B. Jegede
Dwindally Rosado-Rivera
William A. Bauman
Christopher P. Cardozo
Mary Sano
Jeremy M. Moyer
Monifa Brooks
Jill Maria Wecht
Publikationsdatum
01.02.2010
Verlag
Springer-Verlag
Erschienen in
Clinical Autonomic Research / Ausgabe 1/2010
Print ISSN: 0959-9851
Elektronische ISSN: 1619-1560
DOI
https://doi.org/10.1007/s10286-009-0036-z

Weitere Artikel der Ausgabe 1/2010

Clinical Autonomic Research 1/2010 Zur Ausgabe

Research Article

Are the orthostatic fluid shifts to the calves augmented in autonomic failure?

Editorial

In search of the optimal measure for assessment of parasympathetic control of heart rate

Case Report

Unusual blood pressure response during standing therapy in tetraplegic man

Research Article

Benign paroxysmal positional vertigo and orthostatic hypotension

Research Article

The relationship between resting heart rate variability and heart rate recovery

Research Article

Cardiac autonomic modulation and cognitive status in Alzheimer’s disease

Neu in den Fachgebieten Neurologie und Psychiatrie

Niedriger diastolischer Blutdruck erhöht Risiko für schwere kardiovaskuläre Komplikationen

25.04.2024 Hypotonie Nachrichten

Wenn unter einer medikamentösen Hochdrucktherapie der diastolische Blutdruck in den Keller geht, steigt das Risiko für schwere kardiovaskuläre Ereignisse: Darauf deutet eine Sekundäranalyse der SPRINT-Studie hin.

Frühe Alzheimertherapie lohnt sich

25.04.2024 AAN-Jahrestagung 2024 Nachrichten

Ist die Tau-Last noch gering, scheint der Vorteil von Lecanemab besonders groß zu sein. Und beginnen Erkrankte verzögert mit der Behandlung, erreichen sie nicht mehr die kognitive Leistung wie bei einem früheren Start. Darauf deuten neue Analysen der Phase-3-Studie Clarity AD.

Viel Bewegung in der Parkinsonforschung

25.04.2024 Parkinson-Krankheit Nachrichten

Neue arznei- und zellbasierte Ansätze, Frühdiagnose mit Bewegungssensoren, Rückenmarkstimulation gegen Gehblockaden – in der Parkinsonforschung tut sich einiges. Auf dem Deutschen Parkinsonkongress ging es auch viel um technische Innovationen.

Demenzkranke durch Antipsychotika vielfach gefährdet

23.04.2024 Demenz Nachrichten

Wenn Demenzkranke aufgrund von Symptomen wie Agitation oder Aggressivität mit Antipsychotika behandelt werden, sind damit offenbar noch mehr Risiken verbunden als bislang angenommen.

Bildnachweise