Cognitive function in peripheral autonomic disorders

Pietro Guaraldi, Roberto Poda, Giovanna Calandra-Buonaura, Laura Solieri, Luisa Sambati, Roberto Gallassi, Pietro Cortelli, Pietro Guaraldi, Roberto Poda, Giovanna Calandra-Buonaura, Laura Solieri, Luisa Sambati, Roberto Gallassi, Pietro Cortelli

Abstract

Objective: aims of the current study were 1) to evaluate global cognitive function in patients with autonomic failure (AF) of peripheral origin and 2) to investigate the effect of a documented fall in blood pressure (BP) fulfilling the criteria for orthostatic hypotension (OH) on cognitive performances.

Methods: we assessed 12 consecutive patients (10 males, 68±7 years old) with pure AF (PAF) or autoimmune autonomic neuropathy (AAN) and 12 age- and gender-matched controls. All patients had no clinical signs of central nervous system involvement and normal brain CT/MRI scan. Cognitive function was assessed on two consecutive days in 3 conditions: on day 1, while sitting, by means of a comprehensive battery of neuropsychological tests; on day 2, while tilted (HUT) and during supine rest (supine) in a randomized manner. BP and heart rate (HR) were continuously recorded non-invasively for the whole duration of the examination.

Results: patients with PAF or AAN displayed a preserved global cognitive function while sitting. However, compared to supine assessment, during HUT patients scored significantly worse during the Trail Making Test A and B, Barrage test, Analogies test, Immediate Visual Memory, Span Forward and Span Backward test. Pathological scores, with regard to Italian normative range values, were observed only during HUT in the Barrage test and in the Analogies test in 3 and 6 patients respectively. On the contrary, in healthy controls, results to neuropsychological tests were not significantly different, during HUT compared to supine rest.

Conclusions: these data demonstrate that patients with PAF and AAN present a normal sitting global cognitive evaluation. However, their executive functions worsen significantly during the orthostatic challenge, possibly because of transient frontal lobes hypoperfusion.

Conflict of interest statement

Competing Interests: PG reports no competing interests. RP reports no competing interests. GCB has received honoraria for speaking engagements from Lundbeck (Italia) and UCB Pharma S.p.A. L.Solieri has received honoraria for experimental study participation by Chelsea Therapeutics. L.Sambati reports no competing interests. RG reports no competing interests. PC has received honoraria for speaking engagements or consulting activities with Allergan (Italia), Boehringer Ingelheim (Italia), Chelsea Therapeutics, GlaxoSmithKline S.p.A, Lundbeck (Italia), Merck Sharp & Dohme (Italia), Teva, UCB Pharma S.p.A, Chiesi Farmaceutici and AbbVie srl. This does not alter the authors′ adherence to all the PLOS ONE policies on sharing data and materials.

Figures

Figure 1. Results of the neuropsychological tests…
Figure 1. Results of the neuropsychological tests during the head-up tilt (HUT) and supine sessions (Supine) in patients (PTs) and controls (CNTRs).
* = p

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