Diverse cognitive impairment after spinal cord injury is associated with orthostatic hypotension symptom burden

Tom E. Nightingale; Mei Mu Zi Zheng; Rahul Sachdeva; Aaron A. Phillips; Andrei V. Krassioukov

doi:10.1016/j.physbeh.2019.112742

Diverse cognitive impairment after spinal cord injury is associated with orthostatic hypotension symptom burden

Tom E. Nightingale, Mei Mu Zi Zheng, Rahul Sachdeva, Aaron A. Phillips, Andrei V. Krassioukov

Rehabilitation Medicine

Research output: Contribution to journal › Article › peer-review

39 Scopus citations

Abstract

This study: 1) compared cognitive functioning between individuals with chronic (>1 year) spinal cord injury (SCI) and non-injured controls and, 2) assessed associations between symptoms of autonomic dysreflexia and orthostatic hypotension with cognitive functioning in SCI participants with a history of unstable blood pressure (BP). Thirty-two individuals with SCI (C4–L2, American Spinal Injury Association Impairment Scale A-D) and thirty age, sex-matched non-injured controls participated in this study. Participants completed a motor-free neuropsychological test battery assessing 1) memory, 2) attention/concentration/psychomotor speed and, 3) executive function. Nineteen participants with SCI who had injuries ≥T6 and a history of unstable BP also completed the Autonomic Dysfunction Following Spinal Cord Injury (ADFSCI) questionnaire. Cognitive function was significantly lower in people with SCI across measures of memory and executive function compared to non-injured controls. Significant, moderate-to-large associations were observed between cumulative (frequency x severity) orthostatic hypotension and total BP instability symptoms scores, with measures of attention/concentration/psychomotor speed and executive function. These data demonstrate a 10 – 65% reduced performance across specific realms of cognitive functioning in individuals with SCI relative to non-injured controls. Furthermore, cumulative subjective scores for symptoms of unstable BP were associated with diverse cognitive deficits. These findings, in individuals without co-occurring traumatic brain injury, imply cardiovascular dysregulation plays a role in cognitive deficits observed in this population.

Original language	English
Article number	112742
Journal	Physiology and Behavior
Volume	213
DOIs	https://doi.org/10.1016/j.physbeh.2019.112742
State	Published - Jan 1 2020

Bibliographical note

Publisher Copyright:
© 2019

Funding

Dr. Tom E. Nightingale is supported by a Michael Smith Foundation for Health Research / International Collaboration On Repair Discoveries Trainee Award. Dr. Rahul Sachdeva is supported by Postdoctoral Fellowships from the Craig H. Neilsen Foundation , Canadian Institutes of Health Research and University of British Columbia (Bluma Tischler Postdoctoral Fellowship). The Phillips Lab is supported by the Wings for Life Foundation (Project Grant), Compute Canada (Resources for Research Groups), Natural Sciences and Engineering Research Council (Canada; Discovery Grant), the Canadian Institutes of Health Research (Project Grant), Alberta Innovates Health Solutions, Campus Alberta Neuroscience, the Libin Cardiovascular Institute of Alberta, the Hotchkiss Brain Institute, and the Rick Hansen Institute. Dr. Krassioukov's laboratory is supported by funds from the Canadian Institute for Health Research , Heart and Stroke Foundation, Canadian Foundation for Innovation , BC Knowledge Development Fund, and the Craig H. Neilsen Foundation . The study was funded by a Heart & Stroke Canada Foundation grant (# G-16-00012571 ). Dr. Tom E. Nightingale is supported by a Michael Smith Foundation for Health Research/ International Collaboration On Repair Discoveries Trainee Award. Dr. Rahul Sachdeva is supported by Postdoctoral Fellowships from the Craig H. Neilsen Foundation, Canadian Institutes of Health Research and University of British Columbia(Bluma Tischler Postdoctoral Fellowship). The Phillips Lab is supported by the Wings for Life Foundation (Project Grant), Compute Canada (Resources for Research Groups), Natural Sciences and Engineering Research Council (Canada; Discovery Grant), the Canadian Institutes of Health Research (Project Grant), Alberta Innovates Health Solutions, Campus Alberta Neuroscience, the Libin Cardiovascular Institute of Alberta, the Hotchkiss Brain Institute, and the Rick Hansen Institute. Dr. Krassioukov's laboratory is supported by funds from the Canadian Institute for Health Research, Heart and Stroke Foundation, Canadian Foundation for Innovation, BC Knowledge Development Fund, and the Craig H. Neilsen Foundation. The study was funded by a Heart & Stroke Canada Foundation grant (#G-16-00012571).

Funders	Funder number
Canadian Foundation for Innovation/BC Knowledge Development Fund
Canadian Foundation for Innovation
Canadian Foundation for Innovation/BC Knowledge Development Fund
Canadian Institute for Health Research, Heart and Stroke Foundation
Canadian Institute for Health Research, Heart and Stroke Foundation
Libin Cardiovascular Institute of Alberta
Craig H. Neilsen Foundation
Wings for Life Spinal Cord Research Foundation
Rick Hansen Institute
Compute Canada
Hotchkiss Brain Institute
Canadian Institutes of Health Research
Natural Sciences and Engineering Research Council of Canada
Alberta Innovates - Health Solutions
Heart and Stroke Foundation of Canada	G-16-00012571
Heart and Stroke Foundation of Canada
Michael Smith Foundation for Health Research

Keywords

Autonomic dysreflexia
Blood pressure
Cognition
Orthostatic hypotension
Spinal cord injuries

ASJC Scopus subject areas

Experimental and Cognitive Psychology
Behavioral Neuroscience

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10.1016/j.physbeh.2019.112742

Cite this

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abstract = "This study: 1) compared cognitive functioning between individuals with chronic (>1 year) spinal cord injury (SCI) and non-injured controls and, 2) assessed associations between symptoms of autonomic dysreflexia and orthostatic hypotension with cognitive functioning in SCI participants with a history of unstable blood pressure (BP). Thirty-two individuals with SCI (C4–L2, American Spinal Injury Association Impairment Scale A-D) and thirty age, sex-matched non-injured controls participated in this study. Participants completed a motor-free neuropsychological test battery assessing 1) memory, 2) attention/concentration/psychomotor speed and, 3) executive function. Nineteen participants with SCI who had injuries ≥T6 and a history of unstable BP also completed the Autonomic Dysfunction Following Spinal Cord Injury (ADFSCI) questionnaire. Cognitive function was significantly lower in people with SCI across measures of memory and executive function compared to non-injured controls. Significant, moderate-to-large associations were observed between cumulative (frequency x severity) orthostatic hypotension and total BP instability symptoms scores, with measures of attention/concentration/psychomotor speed and executive function. These data demonstrate a 10 – 65\% reduced performance across specific realms of cognitive functioning in individuals with SCI relative to non-injured controls. Furthermore, cumulative subjective scores for symptoms of unstable BP were associated with diverse cognitive deficits. These findings, in individuals without co-occurring traumatic brain injury, imply cardiovascular dysregulation plays a role in cognitive deficits observed in this population.",

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Diverse cognitive impairment after spinal cord injury is associated with orthostatic hypotension symptom burden

Abstract

Bibliographical note

Funding

Keywords

ASJC Scopus subject areas

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