Cognitive functioning in postural orthostatic tachycardia syndrome among different body positions: a prospective pilot study (POTSKog study)

Clinical Autonomic Research, vol. 33, pp. 459–468

Abstract

PURPOSE: Approximately 96% of patients with postural orthostatic tachycardia syndrome (PoTS) report cognitive complaints. We investigated whether cognitive function is impaired during sitting and active standing in 30 patients with PoTS compared with 30 healthy controls (HCs) and whether it will improve with the counter manoeuvre of leg crossing. METHODS: In this prospective pilot study, patients with PoTS were compared to HCs matched for age, sex, and educational level. Baseline data included norepinephrine plasma levels, autonomic testing and baseline cognitive function in a seated position [the Montreal Cognitive Assessment, the Leistungsprüfsystem (LPS) subtests 1 and 2, and the Test of Attentional Performance (TAP)]. Cognitive functioning was examined in a randomized order in supine, upright and upright legs crossed position. The primary outcomes were the cognitive test scores between HCs and patients with PoTS at baseline testing, and among the different body positions. RESULTS: Patients with PoTS had impaired attention (TAP median reaction time) in the seated position and impaired executive functioning (Stroop) while standing compared with HC. Stroop was influenced by position (supine versus upright versus upright legs crossed) only in the PoTS group. Leg crossing did not result in an improvement in executive function. In patients with PoTS, there was a negative correlation of Stroop with norepinephrine plasma levels while standing. CONCLUSION: Compared with HCs, PoTS participants showed impaired cognitive attention and executive function in the upright position that did not improve in the legs crossed position. Data provide further evidence for orthostatic cognitive deterioration in patients with PoTS. TRIAL REGISTRATION INFORMATION: The study was registered at ClinicalTrials.gov (NCT03681080).

Authors 6

1. Andrea Maier corresponding Aachen Department of Neurology, Medical Faculty

   RWTH Aachen University

   Affiliation as printed

   Department of Neurology, Medical Faculty RWTH Aachen University, Aachen, Germany. amaier@ukaachen.de

   Department of Neurology, Medical Faculty RWTH Aachen University, Aachen, Germany

2. Lena Schopen Aachen Department of Neurology, Medical Faculty

   RWTH Aachen University

   Affiliation as printed

   Department of Neurology, Medical Faculty RWTH Aachen University, Aachen, Germany

3. Joana C. Thiel Aachen Department of Neurology, Medical Faculty

   RWTH Aachen University

   Affiliation as printed

   Department of Neurology, Medical Faculty RWTH Aachen University, Aachen, Germany

4. Katharina Müller Aachen Department of Gynaecology, Medical Faculty Department of Neurology, Medical Faculty

   RWTH Aachen University

   Affiliation as printed

   Department of Gynaecology, Medical Faculty RWTH Aachen University, Aachen, Germany

   Department of Neurology, Medical Faculty RWTH Aachen University, Aachen, Germany

5. Bruno Fimm Aachen Department of Neurology, Medical Faculty

   RWTH Aachen University

   Affiliation as printed

   Department of Neurology, Medical Faculty RWTH Aachen University, Aachen, Germany

6. Jörg Bernhard Schulz Aachen Department of Neurology, Medical Faculty JARA Brain Institute Molecular Neuroscience and Neuroimaging (INM-11)

   RWTH Aachen University · Jülich Aachen Research Alliance

   Affiliation as printed

   Department of Neurology, Medical Faculty RWTH Aachen University, Aachen, Germany

   JARA-BRAIN Institute Molecular Neuroscience and Neuroimaging, Jülich Research Center GmbH and RWTH Aachen University, Aachen, Germany