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Cheng Y, Lin L, Huang P, Zhang J, Wang Y, Pan X. Hypotension with neurovascular changes and cognitive dysfunction: An epidemiological, pathobiological, and treatment review. Chin Med J (Engl) 2025; 138:405-418. [PMID: 38785189 PMCID: PMC11845194 DOI: 10.1097/cm9.0000000000003103] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/06/2023] [Indexed: 05/25/2024] Open
Abstract
ABSTRACT Hypotension is a leading cause of age-related cognitive impairment. The available literature evidences that vascular factors are associated with dementia and that hypotension alters cerebral perfusion flow and can aggravate the neurodegeneration of Alzheimer's disease (AD). Despite the discovery of biomarkers and the recent progress made in neurovascular biology, epidemiology, and brain imaging, some key issues remain largely unresolved: the potential mechanisms underlying the neural deterioration observed in AD, the effect of cerebrovascular alterations on cognitive deficits, and the positive effects of hypotension treatment on cognition. Therefore, further well-designed studies are needed to unravel the potential association between hypotension and cognitive dysfunction and reveal the potential benefits of hypotension treatment for AD patients. Here, we review the current epidemiological, pathobiological, and treatment-related literature on neurovascular changes and hypotension-related cognitive dysfunction and highlight the unsettled but imminent issues that warrant future research endeavors.
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Affiliation(s)
- Yingzhe Cheng
- Department of Neurology, Center for Cognitive Neurology, Fujian Medical University Union Hospital, Fuzhou, Fujian 350001, China
- Fujian Institute of Geriatrics, Fujian Medical University Union Hospital, Fuzhou, Fujian 350001, China
- Institute of Clinical Neurology, Fujian Medical University, Fuzhou, Fujian 350001, China
- Fujian Key Laboratory of Molecular Neurology, Fujian Medical University, Fuzhou, Fujian 350001, China
| | - Lin Lin
- Department of Neurology, Center for Cognitive Neurology, Fujian Medical University Union Hospital, Fuzhou, Fujian 350001, China
- Fujian Institute of Geriatrics, Fujian Medical University Union Hospital, Fuzhou, Fujian 350001, China
- Institute of Clinical Neurology, Fujian Medical University, Fuzhou, Fujian 350001, China
- Fujian Key Laboratory of Molecular Neurology, Fujian Medical University, Fuzhou, Fujian 350001, China
| | - Peilin Huang
- Department of Neurology, Center for Cognitive Neurology, Fujian Medical University Union Hospital, Fuzhou, Fujian 350001, China
- Fujian Institute of Geriatrics, Fujian Medical University Union Hospital, Fuzhou, Fujian 350001, China
- Institute of Clinical Neurology, Fujian Medical University, Fuzhou, Fujian 350001, China
- Fujian Key Laboratory of Molecular Neurology, Fujian Medical University, Fuzhou, Fujian 350001, China
| | - Jiejun Zhang
- Department of Neurology, Center for Cognitive Neurology, Fujian Medical University Union Hospital, Fuzhou, Fujian 350001, China
- Fujian Institute of Geriatrics, Fujian Medical University Union Hospital, Fuzhou, Fujian 350001, China
- Institute of Clinical Neurology, Fujian Medical University, Fuzhou, Fujian 350001, China
- Fujian Key Laboratory of Molecular Neurology, Fujian Medical University, Fuzhou, Fujian 350001, China
- Center for Geriatrics, Hainan General Hospital, Haikou, Hainan 570311, China
| | - Yanping Wang
- Department of Endocrinology, Fujian Medical University Union Hospital, Fuzhou, Fujian 350001, China
| | - Xiaodong Pan
- Department of Neurology, Center for Cognitive Neurology, Fujian Medical University Union Hospital, Fuzhou, Fujian 350001, China
- Fujian Institute of Geriatrics, Fujian Medical University Union Hospital, Fuzhou, Fujian 350001, China
- Institute of Clinical Neurology, Fujian Medical University, Fuzhou, Fujian 350001, China
- Fujian Key Laboratory of Molecular Neurology, Fujian Medical University, Fuzhou, Fujian 350001, China
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Reyes Del Paso GA, Montoro CI, Daydov DM, Duschek S. The cardiac, vasomotor and myocardial branches of the baroreflex in hypotension: indications of reduced venous return to the heart. Clin Auton Res 2025; 35:87-99. [PMID: 39417947 PMCID: PMC11937168 DOI: 10.1007/s10286-024-01076-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/12/2024] [Accepted: 10/01/2024] [Indexed: 10/19/2024]
Abstract
PURPOSE Alterations of autonomic cardiovascular control are implicated in the origin of chronic low blood pressure (BP) (hypotension), but comprehensive analysis of baroreflex function is still lacking. This study explored baroreflex function in its cardiac, vascular and myocardial branches METHODS: Continuous BP was recorded at rest and during a mental arithmetic task in 40 hypotensive and 40 normotensive participants. Assessed cardiovascular variables included stroke volume (SV) (calculated by the Modelflow method), heart rate (HR), cardiac output (CO), total peripheral resistance (TPR) and heart rate variability (HRV). Baroreflex sensitivity (BRS) was calculated using the spontaneous sequence method. RESULTS Hypotensive participants exhibited greater BRS in the three baroreflex branches, in addition to lower SV, HR and CO and higher HRV and TPR. Reactivity for BP, HRV and CO during the stress task was reduced in hypotensive individuals. The greater cardiac BRS can explain the lower HR and higher HRV observed in hypotension, suggestive of increased vagal cardiac influences. The higher vasomotor BRS may contribute to the greater TPR observed in the hypotensive participants. Abnormal associations between myocardial BRS and SV arose, suggesting aberrant autonomic control of myocardial contractility in hypotension. CONCLUSION The results indicate that hemodynamic deficits in hypotension are related to preload factors, probably triggered by hypovolemia and reduced unstressed blood reserves, resulting in lower venous return, ventricular preload and SV. In contrast, afterload mechanisms seem to work appropriately.
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Affiliation(s)
| | | | - Dmitry M Daydov
- Department of Psychology, University of Jaén, 23070, Jaén, Spain
| | - Stefan Duschek
- Institute of Psychology, UMIT Tirol-University of Health Sciences and Technology, Hall in Tirol, Austria
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Ji W, Nightingale TE, Zhao F, Fritz NE, Phillips AA, Sisto SA, Nash MS, Badr MS, Wecht JM, Mateika JH, Panza GS. The Clinical Relevance of Autonomic Dysfunction, Cerebral Hemodynamics, and Sleep Interactions in Individuals Living With SCI. Arch Phys Med Rehabil 2024; 105:166-176. [PMID: 37625532 DOI: 10.1016/j.apmr.2023.08.006] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/31/2023] [Revised: 07/25/2023] [Accepted: 08/06/2023] [Indexed: 08/27/2023]
Abstract
A myriad of physiological impairments is seen in individuals after a spinal cord injury (SCI). These include altered autonomic function, cerebral hemodynamics, and sleep. These physiological systems are interconnected and likely insidiously interact leading to secondary complications. These impairments negatively influence quality of life. A comprehensive review of these systems, and their interplay, may improve clinical treatment and the rehabilitation plan of individuals living with SCI. Thus, these physiological measures should receive more clinical consideration. This special communication introduces the under investigated autonomic dysfunction, cerebral hemodynamics, and sleep disorders in people with SCI to stakeholders involved in SCI rehabilitation. We also discuss the linkage between autonomic dysfunction, cerebral hemodynamics, and sleep disorders and some secondary outcomes are discussed. Recent evidence is synthesized to make clinical recommendations on the assessment and potential management of important autonomic, cerebral hemodynamics, and sleep-related dysfunction in people with SCI. Finally, a few recommendations for clinicians and researchers are provided.
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Affiliation(s)
- Wenjie Ji
- Department of Rehabilitation Science, School of Public Health and Health Professions, University at Buffalo, Buffalo, NY
| | - Tom E Nightingale
- School of Sport, Exercise and Rehabilitation Sciences, University of Birmingham, Birmingham, UK; Centre for Trauma Science Research, University of Birmingham, Birmingham, UK; International Collaboration on Repair Discoveries (ICORD), University of British Columbia, Vancouver, Canada
| | - Fei Zhao
- Department of Health Care Sciences, Program of Occupational Therapy, Wayne State University, Detroit, MI; John D. Dingell VA Medical Center, Research and Development, Detroit, MI
| | - Nora E Fritz
- Department of Health Care Sciences, Program of Physical Therapy, Detroit, MI; Department of Neurology, Wayne State University, Detroit, MI
| | - Aaron A Phillips
- Department of Physiology and Pharmacology, Cardiac Sciences, Clinical Neurosciences, Biomedical Engineering, Libin Cardiovascular institute, Hotchkiss Brain Institute, Cumming School of Medicine, Calgary, AB, Canada; RESTORE.network, University of Calgary, Calgary, AB, Canad
| | - Sue Ann Sisto
- Department of Rehabilitation Science, School of Public Health and Health Professions, University at Buffalo, Buffalo, NY
| | - Mark S Nash
- Department of Neurological Surgery, Physical Medicine & Rehabilitation Physical Therapy, Miami, FL; Miami Project to Cure Paralysis, University of Miami Miller School of Medicine, Miami, FL
| | - M Safwan Badr
- John D. Dingell VA Medical Center, Research and Development, Detroit, MI; Departments of Physiology and Internal Medicine, Wayne State University, Detroit, MI
| | - Jill M Wecht
- James J Peters VA Medical Center, Department of Spinal Cord Injury Research, Bronx, NY; Icahn School of Medicine Mount Sinai, Departments of Rehabilitation and Human Performance, and Medicine Performance, and Medicine, New York, NY
| | - Jason H Mateika
- John D. Dingell VA Medical Center, Research and Development, Detroit, MI; Departments of Physiology and Internal Medicine, Wayne State University, Detroit, MI
| | - Gino S Panza
- Department of Health Care Sciences, Program of Occupational Therapy, Wayne State University, Detroit, MI; John D. Dingell VA Medical Center, Research and Development, Detroit, MI.
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Abstract
PURPOSE To review the recent developments on the effect of chronic high mean arterial blood pressure (MAP) on cerebral blood flow (CBF) autoregulation and supporting the notion that CBF autoregulation impairment has connection with chronic cerebral diseases. Method: A narrative review of all the relevant papers known to the authors was conducted. Results: Our understanding of the connection between cerebral perfusion impairment and chronic high MAP and cerebral disease is rapidly evolving, from cerebral perfusion impairment being the result of cerebral diseases to being the cause of cerebral diseases. We now better understand the intertwined impact of hypertension and Alzheimer's disease (AD) on cerebrovascular sensory elements and recognize cerebrovascular elements that are more vulnerable to these diseases. Conclusion: We conclude with the suggestion that the sensory elements pathology plays important roles in intertwined mechanisms of chronic high MAP and AD that impact cerebral perfusion.
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Affiliation(s)
- Noushin Yazdani
- College of Public Health, University of South Florida , Tampa, FL, USA
| | - Mark S Kindy
- Department of Pharmaceutical Sciences, College of Pharmacy, University of South Florida , Tampa, FL, USA.,Biomedical Research, James A. Haley VA Medical Center , Tampa, FL, USA
| | - Saeid Taheri
- Department of Pharmaceutical Sciences, College of Pharmacy, University of South Florida , Tampa, FL, USA.,Byrd Neuroscience Institute, University of South Florida , Tampa, FL, USA
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Ciacciarelli A, Sette G, Giubilei F, Orzi F. Chronic cerebral hypoperfusion: An undefined, relevant entity. J Clin Neurosci 2020; 73:8-12. [PMID: 31948882 DOI: 10.1016/j.jocn.2020.01.026] [Citation(s) in RCA: 41] [Impact Index Per Article: 8.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/17/2019] [Accepted: 01/06/2020] [Indexed: 01/11/2023]
Abstract
Despite the large body of data available, chronic cerebral hypoperfusion lacks an operative definition. In a tautological way, the term hypoperfusion is being referred to conditions of "inadequate blood flow", "defects of perfusion" or "dysfunction of autoregulation". The chronicity refers to sustained conditions or wavering states characterized by repeated phases of inefficient functional hyperemia. The phenomenon may affect the whole brain or defined areas. A few defined clinical disorders, including heart failure, hypotension, atherosclerosis of large or small vessels and carotid stenosis are thought to cause progressive brain disorders due to chronic hypoperfusion. The clinical relevance manifests mostly as neurocognitive disorders associated with neuroimaging changes.The available data support a conceptual framework that considerschronic cerebral hypoperfusiona likely, relevant pathogenic mechanism for the neurodegeneration-like progression of the neurocognitive disorders. The relationship between neuropathology, cerebral perfusion, and symptoms progression is, however, elusive for several aspects. Typical microangiopathy findings, such as MRI white matter hyperintensities, may appear in individuals without any cerebrovascular risk or vascular lesions. Pathology features of the MRI changes, such as demyelination and gliosis, may result from dysfunction of the neuro-vascular unit not directly associated withvascular mechanisms. In this review, we aim to overview the most common clinical conditions thought to reflect chronic hypoperfusion.
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Affiliation(s)
- Antonio Ciacciarelli
- Department of Neuroscience, Mental Health and Sensory Organs (NESMOS), "SAPIENZA" University of Rome, Sant'Andrea University Hospital, Rome, Italy.
| | - Giuliano Sette
- Department of Neuroscience, Mental Health and Sensory Organs (NESMOS), "SAPIENZA" University of Rome, Sant'Andrea University Hospital, Rome, Italy
| | - Franco Giubilei
- Department of Neuroscience, Mental Health and Sensory Organs (NESMOS), "SAPIENZA" University of Rome, Sant'Andrea University Hospital, Rome, Italy
| | - Francesco Orzi
- Department of Neuroscience, Mental Health and Sensory Organs (NESMOS), "SAPIENZA" University of Rome, Sant'Andrea University Hospital, Rome, Italy
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Sachdeva R, Nightingale TE, Krassioukov AV. The Blood Pressure Pendulum following Spinal Cord Injury: Implications for Vascular Cognitive Impairment. Int J Mol Sci 2019; 20:ijms20102464. [PMID: 31109053 PMCID: PMC6567094 DOI: 10.3390/ijms20102464] [Citation(s) in RCA: 29] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/26/2019] [Revised: 05/15/2019] [Accepted: 05/16/2019] [Indexed: 12/15/2022] Open
Abstract
Cognitive impairment following spinal cord injury (SCI) has received considerable attention in recent years. Among the various systemic effects of SCI that contribute towards cognitive decline in this population, cardiovascular dysfunction is arguably one of the most significant. The majority of individuals with a cervical or upper-thoracic SCI commonly experience conditions called orthostatic hypotension and autonomic dysreflexia, which are characterized by dangerous fluctuations in systemic blood pressure (BP). Herein, we review the potential impact of extreme BP lability on vascular cognitive impairment (VCI) in individuals with SCI. Albeit preliminary in the SCI population, there is convincing evidence that chronic hypotension and hypertension in able-bodied individuals results in devastating impairments in cerebrovascular health, leading to VCI. We discuss the pertinent literature, and while drawing mechanistic comparisons between able-bodied cohorts and individuals with SCI, we emphasize the need for additional research to elucidate the mechanisms of cognitive impairment specific to the SCI population. Lastly, we highlight the current and potential future therapies to manage and treat BP instability, thereby possibly mitigating VCI in the SCI population.
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Affiliation(s)
- Rahul Sachdeva
- International Collaboration on Repair Discoveries (ICORD), University of British Columbia, Vancouver, BC V5Z 1M9, Canada.
- Department of Medicine, Division of Physical Medicine and Rehabilitation, University of British Columbia, Vancouver, BC V5Z 1M9, Canada.
| | - Tom E Nightingale
- International Collaboration on Repair Discoveries (ICORD), University of British Columbia, Vancouver, BC V5Z 1M9, Canada.
- Department of Medicine, Division of Physical Medicine and Rehabilitation, University of British Columbia, Vancouver, BC V5Z 1M9, Canada.
| | - Andrei V Krassioukov
- International Collaboration on Repair Discoveries (ICORD), University of British Columbia, Vancouver, BC V5Z 1M9, Canada.
- Department of Medicine, Division of Physical Medicine and Rehabilitation, University of British Columbia, Vancouver, BC V5Z 1M9, Canada.
- GF Strong Rehabilitation Center, Vancouver Coastal Health, Vancouver, BC V5Z 2G9, Canada.
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Duschek S, Hoffmann A, Montoro CI, Reyes del Paso GA. Autonomic Cardiovascular Dysregulation at Rest and During Stress in Chronically Low Blood Pressure. J PSYCHOPHYSIOL 2019. [DOI: 10.1027/0269-8803/a000204] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/08/2023]
Abstract
Abstract. Chronic low blood pressure (hypotension) is accompanied by symptoms such as fatigue, reduced drive, faintness, dizziness, cold limbs, and concentration difficulties. The study explored the involvement of aberrances in autonomic cardiovascular control in the origin of this condition. In 40 hypotensive and 40 normotensive subjects, impedance cardiography, electrocardiography, and continuous blood pressure recordings were performed at rest and during stress induced by mental calculation. Parameters of cardiac sympathetic control (i.e., stroke volume, cardiac output, pre-ejection period, total peripheral resistance), parasympathetic control (i.e., heart rate variability), and baroreflex function (i.e., baroreflex sensitivity) were obtained. The hypotensive group exhibited markedly lower stroke volume, heart rate, and cardiac output, as well as higher pre-ejection period and baroreflex sensitivity than the control group. Hypotension was furthermore associated with a smaller blood pressure response during stress. No group differences arose in total peripheral resistance and heart rate variability. While reduced beta-adrenergic myocardial drive seems to constitute the principal feature of the autonomic impairment that characterizes chronic hypotension, baroreflex-related mechanisms may also contribute to this state. Insufficient organ perfusion due to reduced cardiac output and deficient cardiovascular adjustment to situational requirements may be involved in the manifestation of bodily and mental symptoms.
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Affiliation(s)
- Stefan Duschek
- UMIT – University of Health Sciences Medical informatics and Technology, Institute of Psychology, Hall in Tirol, Austria
| | - Alexandra Hoffmann
- UMIT – University of Health Sciences Medical informatics and Technology, Institute of Psychology, Hall in Tirol, Austria
| | - Casandra I. Montoro
- UMIT – University of Health Sciences Medical informatics and Technology, Institute of Psychology, Hall in Tirol, Austria
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Duschek S, Hoffmann A, Montoro CI, Bair A, Reyes Del Paso GA, Ettinger U. Cerebral blood flow modulations during antisaccade preparation in chronic hypotension. Psychophysiology 2018; 56:e13305. [PMID: 30456801 DOI: 10.1111/psyp.13305] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/29/2018] [Revised: 10/19/2018] [Accepted: 10/21/2018] [Indexed: 01/11/2023]
Abstract
In addition to symptoms including fatigue, dizziness, reduced drive, or mood disturbance, individuals with chronic low blood pressure (hypotension) frequently report cognitive complaints. While attentional deficits have been empirically confirmed, it is still unknown whether the impairments also encompass executive functions. This study investigated cerebral blood flow modulations in hypotension during a precued antisaccade/prosaccade task requiring the executive function of proactive inhibition in addition to preparatory attention. Using functional transcranial Doppler sonography, bilateral blood flow velocities in the middle cerebral arteries (MCA) were recorded in 39 hypotensive and 40 normotensive participants. In the task, a stimulus appeared left or right of a fixation point 5 s after a cuing stimulus; subjects had to move their gaze to the mirror image position of the stimulus (antisaccade) or toward it (prosaccade control condition). Video-based eye tracking was used for ocular recording. A right dominant MCA blood flow increase arose during task preparation, which was smaller in hypotensive than normotensive participants. In addition, hypotensive participants exhibited lower peak velocity of the saccadic response. The extent of the reductions in blood flow and task performance in hypotension did not differ between antisaccade and prosaccade conditions. The smaller MCA flow increase may reflect reduced activity in the dorsolateral prefrontal and inferior parietal cortices during proactive inhibition and preparatory attention in hypotension. Given that group differences in blood flow and performance arose independent of task complexity and executive function load, hypotension may be characterized by basic attentional impairments rather than particular executive function deficits.
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Affiliation(s)
- Stefan Duschek
- UMIT-University of Health Sciences Medical Informatics and Technology, Institute of Psychology, Hall in Tirol, Austria
| | - Alexandra Hoffmann
- UMIT-University of Health Sciences Medical Informatics and Technology, Institute of Psychology, Hall in Tirol, Austria
| | - Casandra I Montoro
- UMIT-University of Health Sciences Medical Informatics and Technology, Institute of Psychology, Hall in Tirol, Austria
| | - Angela Bair
- UMIT-University of Health Sciences Medical Informatics and Technology, Institute of Psychology, Hall in Tirol, Austria
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Duschek S, Hoffmann A, Bair A, Reyes Del Paso GA, Montoro CI. Cerebral blood flow modulations during proactive control in chronic hypotension. Brain Cogn 2018; 125:135-141. [PMID: 29990703 DOI: 10.1016/j.bandc.2018.06.008] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/30/2017] [Revised: 06/24/2018] [Accepted: 06/27/2018] [Indexed: 10/28/2022]
Abstract
In addition to complaints including fatigue, mood disturbance, dizziness or cold limbs, chronic low blood pressure (hypotension) is associated with reduced cognitive performance. Deficiencies in cerebral blood flow regulation may contribute to this impairment. This study investigated cerebral blood flow modulations during proactive control in hypotension. Proactive control refers to cognitive processes during anticipation of a behaviourally relevant event that allow optimization of readiness to react. Using functional transcranial Doppler sonography, bilateral blood flow velocities in the middle cerebral arteries were recorded in 40 hypotensive and 40 normotensive participants during a precued Stroop task. Hypotensive participants exhibited smaller bilateral blood flow increases during response preparation and longer response time. The group differences in blood flow and response time did not vary by executive function load, i.e. congruent vs. incongruent trials. Over the total sample, the flow increase correlated negatively with response time in trials with a higher executive function load. The findings indicate reduced cerebral blood flow adjustment during both the basic and more complex requirements of proactive control in hypotension. They also suggest a general deficit in attentional function and processing speed due to low blood pressure and cerebral hemodynamic dysregulations rather than particular impairments in executive functions.
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Affiliation(s)
- Stefan Duschek
- UMIT - University of Health Sciences Medical Informatics and Technology, Institute of Psychology, Eduard-Wallnöfer-Zentrum 1, 6060 Hall in Tirol, Austria.
| | - Alexandra Hoffmann
- UMIT - University of Health Sciences Medical Informatics and Technology, Institute of Psychology, Eduard-Wallnöfer-Zentrum 1, 6060 Hall in Tirol, Austria.
| | - Angela Bair
- UMIT - University of Health Sciences Medical Informatics and Technology, Institute of Psychology, Eduard-Wallnöfer-Zentrum 1, 6060 Hall in Tirol, Austria.
| | | | - Casandra I Montoro
- UMIT - University of Health Sciences Medical Informatics and Technology, Institute of Psychology, Eduard-Wallnöfer-Zentrum 1, 6060 Hall in Tirol, Austria.
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Andrianopoulos V, Gloeckl R, Vogiatzis I, Kenn K. Cognitive impairment in COPD: should cognitive evaluation be part of respiratory assessment? Breathe (Sheff) 2017; 13:e1-e9. [PMID: 29184593 PMCID: PMC5702891 DOI: 10.1183/20734735.001417] [Citation(s) in RCA: 48] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/31/2017] [Accepted: 02/13/2017] [Indexed: 11/09/2022] Open
Abstract
Cognitive impairment is highly prevalent in patients with COPD and demonstrates multiple detrimental effects on many aspects of patient state and therapeutic outcomes. It is attributed to several overlapping pathophysiological factors, with the most common being the low level of oxygen saturation due to respiratory insufficiency. Despite the impact of cognitive impairment on clinical outcomes, the screening for coexisting cognitive deficits which may interfere with the successful progress of respiratory treatment is yet neglected. There is a special consideration that cognitive deficits should be taken into account when developing respiratory therapy plans. Cognitively impaired patients are likely to require more support and have need of an individualised respiratory care plan which can also be beneficial for their cognitive deficits. Pulmonary rehabilitation as a multidisciplinary approach could be prioritised for COPD patients with cognitive impairment. EDUCATIONAL AIMS To illustrate the common signs of cognitive impairment and define potential associations between lung and cognitive dysfunction.To illustrate the potential influence of cognitive deficits on the optimal progress of respiratory therapy.To illustrate the importance of cognitive evaluation as part of a comprehensive clinical assessment for patients suspected of suffering cognitive impairment.
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Affiliation(s)
- Vasileios Andrianopoulos
- Dept of Respiratory Medicine and Pulmonary Rehabilitation, Schön Klinik Berchtesgadener Land, Schönau am Königssee, Germany
| | - Rainer Gloeckl
- Dept of Respiratory Medicine and Pulmonary Rehabilitation, Schön Klinik Berchtesgadener Land, Schönau am Königssee, Germany
- Dept for Prevention, Rehabilitation and Sports Medicine, Klinikum Rechts der Isar, Technische Universität München, Munich, Germany
| | - Ioannis Vogiatzis
- Dept of Physical Education and Sport Sciences, National and Kapodistrian University of Athens, Athens, Greece
- Dept of Health and Life Sciences, Northumbria University, Newcastle-upon-Tyne, United Kingdom
| | - Klaus Kenn
- Dept of Respiratory Medicine and Pulmonary Rehabilitation, Schön Klinik Berchtesgadener Land, Schönau am Königssee, Germany
- Dept of Pulmonary Rehabilitation, Philipps University Marburg, Marburg, Germany
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11
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Autonomic Cardiovascular Control and Executive Function in Chronic Hypotension. Ann Behav Med 2016; 51:442-453. [DOI: 10.1007/s12160-016-9868-7] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022] Open
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Frances A, Sandra O, Lucy U. Vascular cognitive impairment, a cardiovascular complication. World J Psychiatry 2016; 6:199-207. [PMID: 27354961 PMCID: PMC4919258 DOI: 10.5498/wjp.v6.i2.199] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/16/2015] [Revised: 01/14/2016] [Accepted: 02/16/2016] [Indexed: 02/05/2023] Open
Abstract
Over the past two decades, the term vascular cognitive impairment (VCI) has been used to refer to a spectrum of cognitive decline characterized by executive dysfunction, associated with vascular pathology. With 30% of stroke survivors showing cognitive impairments, it is regarded as the most common cause of cognitive impairment. This is a narrative review of available literature citing sources from PubMed, MEDLINE and Google Scholar. VCI has a high prevalence both before and after a stroke and is associated with great economic and caregiver burden. Despite this, there is no standardized diagnostic criteria for VCI. Hypertension has been identified as a risk factor for VCI and causes changes in cerebral vessel structure and function predisposing to lacuna infarcts and small vessel haemorrhages in the frontostriatal loop leading to executive dysfunction and other cognitive impairments. Current trials have shown promising results in the use of antihypertensive medications in the management of VCI and prevention of disease progression to vascular dementia. Prevention of VCI is necessary in light of the looming dementia pandemic. All patients with cardiovascular risk factors would therefore benefit from cognitive screening with screening instruments sensitive to executive dysfunction as well as prompt and adequate control of hypertension.
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Scheuren R, Duschek S, Schulz A, Sütterlin S, Anton F. Blood pressure and the perception of illusive pain. Psychophysiology 2016; 53:1282-91. [DOI: 10.1111/psyp.12658] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/07/2015] [Accepted: 03/11/2016] [Indexed: 01/03/2023]
Affiliation(s)
- Raymonde Scheuren
- Institute for Health and Behavior, Integrative Research Unit on Social and Individual Development (INSIDE), University of Luxembourg; Luxembourg Luxembourg
| | - Stefan Duschek
- Institute of Psychology, UMIT-University for Health Sciences, Medical Informatics and Technology; Hall in Tirol Austria
| | - André Schulz
- Institute for Health and Behavior, Integrative Research Unit on Social and Individual Development (INSIDE), University of Luxembourg; Luxembourg Luxembourg
| | - Stefan Sütterlin
- Section of Psychology, Lillehammer University College; Lillehammer Norway
- Department of Psychosomatic Medicine, Division of Surgery and Clinical Neuroscience; Oslo University Hospital-Rikshospitalet; Oslo Norway
| | - Fernand Anton
- Institute for Health and Behavior, Integrative Research Unit on Social and Individual Development (INSIDE), University of Luxembourg; Luxembourg Luxembourg
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Hypotension and environmental noise: a replication study. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2014; 11:8661-88. [PMID: 25162707 PMCID: PMC4198985 DOI: 10.3390/ijerph110908661] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 06/11/2014] [Revised: 07/21/2014] [Accepted: 08/12/2014] [Indexed: 01/21/2023]
Abstract
Up to now, traffic noise effect studies focused on hypertension as health outcome. Hypotension has not been considered as a potential health outcome although in experiments some people also responded to noise with decreases of blood pressure. Currently, the characteristics of these persons are not known and whether this down regulation of blood pressure is an experimental artifact, selection, or can also be observed in population studies is unanswered. In a cross-sectional replication study, we randomly sampled participants (age 20–75, N = 807) from circular areas (radius = 500 m) around 31 noise measurement sites from four noise exposure strata (35–44, 45–54, 55–64, >64 Leq, dBA). Repeated blood pressure measurements were available for a smaller sample (N = 570). Standardized information on socio-demographics, housing, life style and health was obtained by door to door visits including anthropometric measurements. Noise and air pollution exposure was assigned by GIS based on both calculation and measurements. Reported hypotension or hypotension medication past year was the main outcome studied. Exposure-effect relationships were modeled with multiple non-linear logistic regression techniques using separate noise estimations for total, highway and rail exposure. Reported hypotension was significantly associated with rail and total noise exposure and strongly modified by weather sensitivity. Reported hypotension medication showed associations of similar size with rail and total noise exposure without effect modification by weather sensitivity. The size of the associations in the smaller sample with BMI as additional covariate was similar. Other important cofactors (sex, age, BMI, health) and moderators (weather sensitivity, adjacent main roads and associated annoyance) need to be considered as indispensible part of the observed relationship. This study confirms a potential new noise effect pathway and discusses potential patho-physiological routes of actions.
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Duschek S, Wörsching J, Reyes Del Paso GA. Autonomic cardiovascular regulation and cortical tone. Clin Physiol Funct Imaging 2014; 35:383-92. [PMID: 25080269 DOI: 10.1111/cpf.12174] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/13/2013] [Accepted: 05/09/2014] [Indexed: 11/28/2022]
Abstract
This study aimed to investigate interactions between tonic cortical arousal and features of autonomic cardiovascular regulation. In 50 healthy subjects, the power spectrum of the spontaneous EEG was obtained at resting state. Concurrently, respiratory sinus arrhythmia (RSA), baroreflex sensitivity (BRS) and R-wave to pulse interval (RPI) were recorded as indices of cardiovascular control. At the bivariate level, only a negative correlation between beta power recorded at frontal electrode positions and RPI was found. However, when common variance of BRS and RSA was controlled for in multiple regression analyses, a positive association between alpha power and RSA, and an inverse relationship with BRS, also arose. The findings concerning RPI and RSA are suggestive of a relationship between higher levels of cortical tone and increased sympathetic and reduced vagal cardiac influences. The inverse association between BRS and alpha activity may reflect bottom-up modulation of cortical arousal by baroreceptor afferents.
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Affiliation(s)
- Stefan Duschek
- Institute of Applied Psychology, UMIT - University for Health Sciences, Medical Informatics and Technology, Hall in Tirol, Austria
| | - Jana Wörsching
- Department of Psychology, University of Munich, Munich, Germany
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Covassin N, de Zambotti M, Cellini N, Sarlo M, Stegagno L. Cardiovascular down-regulation in essential hypotension: Relationships with autonomic control and sleep. Psychophysiology 2013; 50:767-76. [DOI: 10.1111/psyp.12055] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/04/2012] [Accepted: 03/26/2013] [Indexed: 11/30/2022]
Affiliation(s)
- Naima Covassin
- Department of General Psychology; University of Padova; Padova; Italy
| | | | - Nicola Cellini
- Department of General Psychology; University of Padova; Padova; Italy
| | - Michela Sarlo
- Department of General Psychology; University of Padova; Padova; Italy
| | - Luciano Stegagno
- Department of General Psychology; University of Padova; Padova; Italy
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A Review of the Etiology, Asssociated Comorbidities, and Treatment of Orthostatic Hypotension. Am J Ther 2013; 20:279-91. [DOI: 10.1097/mjt.0b013e31828bfb7f] [Citation(s) in RCA: 38] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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Duschek S, Wörsching J, Reyes del Paso GA. Interactions between autonomic cardiovascular regulation and cortical activity: a CNV study. Psychophysiology 2013; 50:388-97. [PMID: 23351157 DOI: 10.1111/psyp.12026] [Citation(s) in RCA: 29] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/05/2012] [Accepted: 12/08/2012] [Indexed: 12/11/2022]
Abstract
The study investigated interactions between autonomic cardiovascular regulation and cortical activity. In 54 healthy subjects, baroreflex sensitivity (BRS) and respiratory sinus arrhythmia (RSA) were assessed at resting conditions. As an EEG indicator of cortical excitability, the contingent negative variation (CNV) was induced using a constant foreperiod reaction time task. At bivariate level, only RSA showed a moderate positive correlation with the CNV recorded at frontal electrodes. However, when common variance of BRS and RSA was controlled for in multiple regression analysis, an inverse association between BRS and the frontal CNV also arose. The inverse association between BRS and the CNV is discussed as reflecting bottom-up modulation of cortical excitability by baroreceptor afferents. The positive correlation between RSA and the CNV may relate to the interplay between prefrontal processing and cardiac vagal tone.
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Affiliation(s)
- Stefan Duschek
- UMIT-University for Health Sciences, Medical Informatics and Technology, Hall in Tirol, Austria.
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Nocturnal cardiovascular activity in essential hypotension: evidence of differential autonomic regulation. Psychosom Med 2012; 74:952-60. [PMID: 23107844 DOI: 10.1097/psy.0b013e318272db69] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Abstract
OBJECTIVE Essential hypotension represents a form of chronic low blood pressure (BP) not explained by medical or orthostatic conditions. The pathogenesis of essential hypotension may involve sympathetic hypoactivation and other forms of autonomic dysregulation. The aim of the current study was to investigate autonomic and cardiovascular activity during sleep in individuals with essential hypotension. METHODS A case-control study was conducted in 14 individuals with essential hypotension (mean [standard error] = 23.4 [0.6] years, all women) and 14 controls (mean [standard error] age = 22.2 [0.4] years, all women). The following measures were collected over a night of sleep: BP, heart rate (HR), stroke volume, cardiac output (CO), preejection period (PEP), total peripheral resistance, and time-domain measures of HR variability. RESULTS Hypotensive participants had consistently lower BP, HR, and CO than did normotensives. Cardiac autonomic variables revealed enhanced parasympathetic tone (proportion of adjacent normal-to-normal intervals that differed in length by more than 50 milliseconds = 40.8 [6.3] versus 23.4 [4.5], p = .03) and reduced sympathetic drive in hypotensives (PEP = 99.4 [3.6] versus 86.1 [4.3], p = .02). Analysis of temporal profiles showed that HR, stroke volume, and CO decreased throughout the night in both groups, whereas PEP and HR variability increased. Unlike controls, BP remained essentially unchanged in hypotensives, as the decrease in CO was counterbalanced by a parallel rise in total peripheral resistance. CONCLUSIONS These findings suggest that nocturnal cardiac sympathetic withdrawal combined with vagal hyperactivity is a characteristic of the autonomic regulation in essential hypotension.
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de Zambotti M, Covassin N, Cellini N, Sarlo M, Stegagno L. Cardiac autonomic profile during rest and working memory load in essential hypotensive women. Int J Psychophysiol 2012; 85:200-5. [DOI: 10.1016/j.ijpsycho.2012.05.002] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/13/2011] [Revised: 05/04/2012] [Accepted: 05/07/2012] [Indexed: 10/28/2022]
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Casavant V, Chae C, Sherwani A, Perlmuter LC. Subclinical orthostatic pulse pressure confirms mothers' ratings of ADHD in preschoolers. Psychophysiology 2012; 49:708-12. [DOI: 10.1111/j.1469-8986.2012.01351.x] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/09/2011] [Accepted: 11/17/2011] [Indexed: 11/27/2022]
Affiliation(s)
- Vanessa Casavant
- Department of Psychology; Rosalind Franklin University of Medicine and Science; North Chicago; Illinois; USA
| | - Christina Chae
- The Chicago Medical School; Rosalind Franklin University of Medicine and Science; North Chicago; Illinois; USA
| | - Afsheen Sherwani
- The Chicago Medical School; Rosalind Franklin University of Medicine and Science; North Chicago; Illinois; USA
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Impaired cerebral and systemic hemodynamics under cognitive load in young hypotensives: a transcranial Doppler study. J Behav Med 2012; 36:134-42. [DOI: 10.1007/s10865-012-9410-8] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/16/2011] [Accepted: 02/15/2012] [Indexed: 01/19/2023]
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Duschek S, Dietel A, Schandry R, Paso GAR. Increased sensitivity to heat pain in chronic low blood pressure. Eur J Pain 2012; 13:28-34. [DOI: 10.1016/j.ejpain.2008.02.007] [Citation(s) in RCA: 44] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/03/2008] [Revised: 02/06/2008] [Accepted: 02/20/2008] [Indexed: 11/12/2022]
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A review of orthostatic blood pressure regulation and its association with mood and cognition. Clin Auton Res 2011; 22:99-107. [PMID: 21948454 DOI: 10.1007/s10286-011-0145-3] [Citation(s) in RCA: 38] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/11/2010] [Accepted: 08/24/2011] [Indexed: 10/17/2022]
Abstract
AIMS This paper will review literature that examines the psychological and neuropsychological correlates of orthostatic blood pressure regulation. RESULTS The pattern of change in systolic blood pressure in response to the shift from supine to upright posture reflects the adequacy of orthostatic regulation. Orthostatic integrity involves the skeletal muscle pump, neurovascular compensation, neurohumoral effects and cerebral flow regulation. Various physiological states and disease conditions may disrupt these mechanisms. Clinical and subclinical orthostatic hypotension has been associated with impaired cognitive function, decreased effort, reduced motivation and increased hopelessness as well as dementia, diabetes mellitus, and Parkinson's disease. Furthermore, inadequate blood pressure regulation in response to orthostasis has been linked to increased depression and anxiety as well as to intergenerational behavioral sequalae. CONCLUSIONS Identifying possible causes and consequences of subclinical and clinical OH are critical in improving quality of life for both children and older adults.
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Matsumoto S, Sakuma H. Contingent negative variation under competitive situations. Percept Mot Skills 2009; 108:693-704. [PMID: 19725306 DOI: 10.2466/pms.108.3.693-704] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
Participants high and low in competitiveness completed a reaction-time task with a warning stimulus designed to elicit contingent negative variation, competing on reaction speed with a visible or invisible opponent to identify what affects contingent negative variation amplitude under more critical competitive situations. For participants low in competitiveness, contingent negative variation was larger and reaction time (RT) was shorter when winning a trial and competing with a visible opponent. For those high in competitiveness, contingent negative variation was larger under competitive situations with a visible opponent than with an invisible one, although no difference was found in RT. These findings suggest that contingent negative variation amplitude under competitive situations reflects not only motor preparation but also other psychological processes such as awareness of an opponent.
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Affiliation(s)
- Sayaka Matsumoto
- Department of Human Sciences, Graduate School of Human Culture, Nara Women's University, Japan.
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Duschek S, Heiss H, Werner N, Reyes del Paso GA. Modulations of autonomic cardiovascular control following acute alpha-adrenergic treatment in chronic hypotension. Hypertens Res 2009; 32:938-43. [DOI: 10.1038/hr.2009.115] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
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NIU K, HOZAWA A, AWATA S, GUO H, KURIYAMA S, SEKI T, OHMORI-MATSUDA K, NAKAYA N, EBIHARA S, WANG Y, TSUJI I, NAGATOMI R. Home Blood Pressure Is Associated with Depressive Symptoms in an Elderly Population Aged 70 Years and Over: A Population-Based, Cross-Sectional Analysis. Hypertens Res 2008; 31:409-16. [DOI: 10.1291/hypres.31.409] [Citation(s) in RCA: 33] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
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Abstract
There is broad evidence for a functional interaction between the cardiovascular and pain regulatory systems. One result of this interaction is the reduced sensitivity to acute pain in individuals with elevated blood pressure, which has been established in numerous studies. In contrast to this, possible alterations in pain perception related to the lower range of blood pressure have not yet been investigated. In the present study pain sensitivity was assessed in 30 hypotensive women (mean blood pressure 95/56 mmHg) and 30 normotensive control persons (mean blood pressure 119/77 mmHg) based on a cold pressor test. Possible effects on pain perception of hypotension-related impairment of subjective state were controlled for by including a mood-scale. The hypotensive as compared to the normotensive group displayed lower pain threshold and pain tolerance levels, as well as increased sensory and affective experiences of pain. Moreover, a slight negative correlation was found, both in hypotensive and control persons, between pain sensitivity and the degree of blood pressure increase during the execution of the cold pressor test. In accordance with the previous findings on hypertension-related hypoalgesia, the present results suggest an inverse relationship between blood pressure and pain sensitivity across the total blood pressure spectrum. Different degrees of pain attenuation through afferent input from the arterial baroreceptor system are discussed as a physiological mechanism mediating this relationship.
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Duschek S, Hadjamu M, Schandry R. Dissociation between cortical activation and cognitive performance under pharmacological blood pressure elevation in chronic hypotension. Biol Psychol 2007; 75:277-85. [PMID: 17481800 DOI: 10.1016/j.biopsycho.2007.03.007] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/17/2006] [Revised: 03/20/2007] [Accepted: 03/30/2007] [Indexed: 11/29/2022]
Abstract
The present study explored the impact of pharmacological blood pressure elevation on cortical activation and reaction time in chronic hypotension. Effects of the sympathomimetic etilefrine were investigated in 50 hypotensive persons based on a randomized, placebo-controlled double blind design. As an indicator of cortical excitability, the contingent negative variation (CNV), induced by a constant foreperiod reaction time task, was assessed at frontal (F3, Fz, F4) and central (C3, Cz, C4) scalp sites. Etilefrine provoked a decrease in the frontal and central CNV. In contrast, shorter reaction times were observed following drug administration. The degree of pharmacologically induced blood pressure elevation was correlated to CNV attrition as well as to performance enhancement. Inhibitory effects of baroreceptor activation on cortical excitability and enhanced cerebral blood flow are considered to be involved in mediating the effects of blood pressure elevation on cerebral functioning. Implications for the treatment of chronic hypotension are discussed.
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Duschek S, Schandry R. Reduced brain perfusion and cognitive performance due to constitutional hypotension. Clin Auton Res 2007; 17:69-76. [PMID: 17106628 PMCID: PMC1858602 DOI: 10.1007/s10286-006-0379-7] [Citation(s) in RCA: 117] [Impact Index Per Article: 6.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/11/2006] [Accepted: 10/18/2006] [Indexed: 11/27/2022]
Abstract
This review article includes a systematic evaluation of the empirical data concerning deficits in mental ability, brain perfusion, and cerebral functioning due to chronically low blood pressure. A number of studies have provided strong evidence for reduced cognitive performance in hypotension, particularly in the domains of attention and memory. EEG studies have demonstrated that the hypotension-related poorer mental ability is also reflected in diminished cortical activity. Contrary to convention, more recent research has suggested a deficient regulation of cerebral blood flow in persons with low blood pressure. In addition to reduced tonic brain perfusion, studies demonstrated insufficient adjustment of blood flow to cognitive requirements. Altogether, these findings suggest that more attention should be allocated to chronic hypotension in both research and clinical practice.
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Affiliation(s)
- Stefan Duschek
- Dept of Psychology, Ludwig-Maximilians-Universität München, München, Germany.
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Stegagno L, Patritti D, Duschek S, Herbert B, Schandry R. Cerebral blood flow in essential hypotension during emotional activation. Psychophysiology 2007; 44:226-32. [PMID: 17343706 DOI: 10.1111/j.1469-8986.2007.00507.x] [Citation(s) in RCA: 15] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Abstract
Variations of blood flow velocity in the left and right middle cerebral arteries (MCA) were measured in 20 hypotensive women and 20 normotensive control subjects during emotional stimulation using functional transcranial Doppler sonography (fTDS). The emotional stimuli were composed of three series (neutral, pleasant, and unpleasant) of 20 pictures from the International Affective Picture System (IAPS). Both groups exhibited greater increases in right than left MCA blood flow during emotional stimulation. However hypotensive subjects showed smaller increases in blood flow than did normotensive controls. Furthermore hypotensives exhibited lower MCA blood flow velocity in both hemispheres at rest than did normotensives. Nevertheless the hypotensive group rated the emotional pictures as more arousing than did the control group. Results suggest a decreased blood flow, in addition to peripheral, in the central nervous system (CNS) of hypotensives, which was associated with normal emotional responses for both valence and hemispherical asymmetry, but also with a general increase of arousal levels. This dissociation might be related to an increase in anterior cerebral arteries (ACA) blood flow and/or to hypotension-mediated baroreceptors' up-regulation to the reticular system.
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