Clinical Autonomic Research

, Volume 16, Issue 2, pp 113–120 | Cite as

Cognitive functioning in orthostatic hypotension due to pure autonomic failure

  • Hannah C Heims
  • Hugo D. Critchley
  • Naomi H. Martin
  • H. Rolf Jäger
  • Christopher J. Mathias
  • Lisa Cipolotti
RESEARCH ARTICLE

Abstract

Psychophysiological science proposes close interactions between cognitive processes and autonomic responses, yet the consequences of autonomic failure on cognitive functioning have not been documented. This pilot study investigates, for the first time, the cognitive profile of 14 patients with Pure Autonomic Failure (PAF). Each patient was administered a comprehensive battery of neuropsychological tests and neuroimaging investigation. A number of patients (n = 6) presented with cognitive impairment. The two most frequent types of impairment were: deficits of speed and attention, and executive functioning. Impairments of free recall memory, intellectual functioning, nominal and calculation functions were also documented, albeit in a much lower frequency. These cognitive changes were not always associated with white matter abnormalities. We speculate that the cognitive impairments associated with PAF represent consequences of systemic hypotension with cerebral underperfusion. However, a failure in integrated bodily arousal responses during cognitive behaviours may also contribute to some of the observed deficits.

Key words

pure autonomic failure cognition orthostatic hypotension autonomic nervous system 

Preview

Unable to display preview. Download preview PDF.

Unable to display preview. Download preview PDF.

References

  1. 1.
    Baxter DM, Warrington EK (1994) Measuring dysgraphia: A graded difficulty spelling test. Beh Neurol 7:107–116Google Scholar
  2. 2.
    Bou-Holaigah P, Rowe C, Kan J, Calkins H (1995) The relationship between neurally mediated hypotension and the chronic fatigue syndrome. J Am Med Assoc 274:961–967CrossRefGoogle Scholar
  3. 3.
    Brun A, Englund EA (1986) White matter disorder in dementia of the Alzheimer type: a pathoanatomical study. Ann Neurol 19:253–262CrossRefPubMedGoogle Scholar
  4. 4.
    Burgess PW, Shallice T (1997) The Hayling and Brixton Tests. Thames Valley Test Company. Bury (UK)Google Scholar
  5. 5.
    Costa M, Stegagno L, Schandry R, Bitti PER (1998) Contingent negative variation and cognitive performance in hypotension. Psychophysiol 35:737–744CrossRefGoogle Scholar
  6. 6.
    Coughlan AK, Hollows AK (1985) The Adult Memory and Information Processing Battery. Leeds (UK)Google Scholar
  7. 7.
    Critchley HD, Mathias CJ, Dolan RJ (2001) Neuroanatomical basis for first and second-order representations of bodily states. Nat Neurosci 4:207–212CrossRefPubMedGoogle Scholar
  8. 8.
    Critchley HD, Mathias CJ, Josephs O, O’Doherty J, Zanini S, Dewar BK, Cipolotti L, Shallice T, Dolan RJl (2003) Human cingulate cortex and autonomic control: converging neuroimaging and clinical evidence. Brain 126:1–14CrossRefGoogle Scholar
  9. 9.
    DeCarli G (2003) Mild cognitive impairment: prevalence, prognosis, etiology. Lancet Neurology 2(1):15–21CrossRefPubMedGoogle Scholar
  10. 10.
    DeLuca J, Johnson SK, Ellis SP, Natelson BH (1997) Cognitive functioning is impaired in patients with chronic fatigue syndrome devoid of psychiatric disease. JNNP 62:151–155Google Scholar
  11. 11.
    Elmstahl S, Rosen I (1997) Postural hypotension and EEG variables predict cognitive decline: results from a 5-year follow-up of healthy elderly women. Dement Geriatr Cogn Disord 8(3):180–187PubMedGoogle Scholar
  12. 12.
    Fukuoka S, Hayashida K, Nishiooeda Y, Hirose Y, Miyashita K, Kawano S, Shimotsu Y, Ishida Y, Nishimura T (1996) Cerebral hypoperfusion in orthostatic hypotension with globally denervated myocardium. J Nucl Med 37:1824–1826PubMedGoogle Scholar
  13. 13.
    Glynn RJ, Beckett LA, Herbert LE, Morris MC, Scherr PA, Evans DA (1999) Current and remote blood pressure and cognitive decline. JAMA 281:438–445CrossRefPubMedGoogle Scholar
  14. 14.
    Grafman J, Schwartz V, Dale JK, Scheffers M, Houser C, Straus SE (1993) Analysis of neuropsychological functioning in patients with chronic fatigue syndrome. J Neurol Neurosurg Psychiatry 56:684–689PubMedCrossRefGoogle Scholar
  15. 15.
    Guo Z, Viitanen M, Fratiglioni L, Winbald B (1996) Low blood pressure and dementia in elderly people: the Kungsholmen project. Br Med J 312:805–808Google Scholar
  16. 16.
    Hoshikawa Y, Yamamoto Y (1997) Effects of stroop colour-word conflict test on the autonomic nervous system responses. Am J Physiol 272:H1113–H1121PubMedGoogle Scholar
  17. 17.
    Jackson M, Warrington EK (1986) Arithmetic skills in patients with unilateral cerebral lesions. Cortex 22:610–620Google Scholar
  18. 18.
    Jäger HR (2000) Diagnosis of stroke with advanced CT- and MR imaging. Br Med Bull 56:318–333CrossRefPubMedGoogle Scholar
  19. 19.
    Kapur N, Abbott P, Lowman A, Will RG (2003) The neuropsychological profile associated with variant Creutzfeldt-Jakob disease. Brain 126:2693–2702CrossRefPubMedGoogle Scholar
  20. 20.
    Kimber JR, Watson L, Mathias CJ (1997) Distinction of idiopathic Parkinson’s disease from multiple system atrophy by stimulation of growth hormone release with clonidine. Lancet 349:1877–1881CrossRefPubMedGoogle Scholar
  21. 21.
    Leuchter AF, Dunkin JJ, Lufkin RB, Anzai Y, Cook IA, Newton TF (1994) Effect of white matter disease on functional connections in the aging brain. JNNP 57:1347–1354Google Scholar
  22. 22.
    Manabe Y, Murakami T, Iwatsuki K, Narai H, Warita H, Hayashi T, Shoji M, Imai Y, Abe K (2001) Nocturnal blood pressure dip in CADASIL. J Neurol Sci 193:13–16CrossRefPubMedGoogle Scholar
  23. 23.
    Mathias CJ (2003) Autonomic diseases—Management. JNNP 74:42–47Google Scholar
  24. 24.
    Mathias CJ, Bannister R (2002) Investigation of autonomic disorders. In: Mathias CJ, Bannister R (eds) Autonomic Failure: A Textbook of Clinical Disorders of the Autonomic Nervous System. 4th ed. Oxford: Oxford University Press, pp 169–195Google Scholar
  25. 25.
    Mathias CJ, Mallipeddi R, Bleasdale-Barr K (1999) Symptoms associated with orthostatic hypotension in pure autonomic failure and multiple system atrophy. J Neurol 246:893–898CrossRefPubMedGoogle Scholar
  26. 26.
    McKenna P, Warrington EK (1980) The Graded Naming Test. NFER-Nelson, Windsor (UK)Google Scholar
  27. 27.
    Nelson H (1976) A modified card sorting test sensitive to frontal lobe defects. Cortex 12:313–324PubMedGoogle Scholar
  28. 28.
    Nelson HE (1982) The National Adult Reading Test. NFER-Nelson, Windsor (UK)Google Scholar
  29. 29.
    Osterreith RA (1944) Le test de copie d’une figure complexe. Arch de Psychol 30:206–356Google Scholar
  30. 30.
    Perlmuter LC, Greenberg JJ (1996) Do you mind standing? Cognitive changes in orthostasis. Exp Aging Res 22(4):325–341PubMedGoogle Scholar
  31. 31.
    Reidel-Heller SG, et al. (2001) Prevalence of dementia according to DSMIIIR and ICD-10. Brit J Psychiatry 179:250–254CrossRefGoogle Scholar
  32. 32.
    Sabri O, Ringelstein EB, Hellwig D, Schneider R, Schreckenberger M, Kaiser HJ, Mull M, Buell U (1999) Neuropsychological impairment correlates with hypoperfusion and hypometabolism but not with severity of white matter lesions on MRI in patients with cerebral microangiopathy. Stroke 30:556–566PubMedGoogle Scholar
  33. 33.
    Sassi RB, Brambilla P, Nicoletti M, Mallinger AG, Frank E, Kupfer DJ, Keshavan MS, Soares JC (2003) White matter hyperintensities in bipolar and unipolar patients with relatively mild-to-moderate illness severity. J Affect Disord 77:237–245CrossRefPubMedGoogle Scholar
  34. 34.
    Somsen RJM, Van der Molen MW, Jennings JR, Van Beek B (2000) Wisconsin card sorting in adolescents: analysis of performance, response times and heart rate. Acta Psychologica 104:227–252CrossRefPubMedGoogle Scholar
  35. 35.
    Spreen O, Strauss EA (1998) A compendium of neuropsychological tests. 2nd edition. Oxford University Press, New YorkGoogle Scholar
  36. 36.
    Stroop JR (1935) Studies of interference in serial verbal reactions. J Exp Psychol 19:643–662Google Scholar
  37. 37.
    Van Harskamp, N, Rudge P, Cipolotti L (2005) Cognitive and social impairments in patients with superficial siderosis. Brain 128:1082–1092CrossRefPubMedGoogle Scholar
  38. 38.
    Wahlund LO, Barkhof F, Fazekas F, Bronge L, Augustin M, Sjogren M, Wallin A, Ader H, Leys D, Pantoni L, Pasquier F, Erkinjuntti T, Scheltens P (2001) A new rating scale for age-related white matter changes applicable to MRI and CT. Stroke 32:1318–1322PubMedGoogle Scholar
  39. 39.
    War Department, Adjutant General’s Office (1944) Army individual test battery: manual and directions for scoring.Washington (DC): War Department, Adjutant General’s OfficeGoogle Scholar
  40. 40.
    Warrington EK (1984) The Recognition Memory Test. NFER-Nelson, Windsor (UK)Google Scholar
  41. 41.
    Warrington EK (1996) Camden Memory Tests. Psychology Press, Hove (UK)Google Scholar
  42. 42.
    Warrington EK, James M (1991) The Visual Object and Space Perception Battery. Thames Valley Test Company, Bury St Edmunds (UK)Google Scholar
  43. 43.
    Wechsler DA (1981) Wechsler Adult Intelligence Scale-Revised: Manual. Psychological Corporation, New YorkGoogle Scholar
  44. 44.
    Weisz N, Schandry R, Jacobs A, Mialet J, Duschek S (2002) Early contingent negative variation of the EEG and attentional flexibility are reduced in hypotension. Int J Psychophysiol 45:253–260CrossRefPubMedGoogle Scholar
  45. 45.
    Willison JR, Warrington EK (1991) Cognitive retardation in a patient with preservation of psychomotor speed. Beh Neurol 5:113–116Google Scholar
  46. 46.
    Ylikoski R, Ylikoski A, Erkinjuntti T, et al. (1993) White matter changes in healthy elderly persons correlate with attention and speed of mental processing. Arch Neurol 50:818–824PubMedGoogle Scholar
  47. 47.
    Zuccalà G, Onder G, Pedone C, Carosella L, Pahor M, Bernabei R, et al. (2001) Hypotension and cognitive impairment: selective association in patients with heart failure. Neurology 57:1986–1992PubMedGoogle Scholar

Copyright information

© Steinkopff-Verlag 2006

Authors and Affiliations

  • Hannah C Heims
    • 1
  • Hugo D. Critchley
    • 2
    • 3
  • Naomi H. Martin
    • 1
  • H. Rolf Jäger
    • 4
  • Christopher J. Mathias
    • 5
    • 6
    • 7
  • Lisa Cipolotti
    • 1
  1. 1.Dept. of Neuropsychology, BOX 37National Hospital for Neurology and NeurosurgeryLondon,WC1N 3BGUK
  2. 2.Dept. of NeuropsychiatryNational Hospital for Neurology and NeurosurgeryLondonUK
  3. 3.Institute of Cognitive NeuroscienceAlexandra HouseLondonUK
  4. 4.Lysholm Dept. of NeuroradiologyNational Hospital for Neurology and NeurosurgeryLondonUK
  5. 5.Autonomic UnitNational Hospital for Neurology and NeurosurgeryLondonUK
  6. 6.Institute of NeurologyUniversity College LondonLondonUK
  7. 7.Imperial College London at St. Mary’s HospitalLondonUK

Personalised recommendations