Cognitive performance in hypotensive persons with spinal cord injury

Clin Auton Res, 2010 · DOI: 10.1007/s10286-009-0036-z · Published: February 1, 2010

Spinal Cord Injury Cardiovascular Science Neurology

Simple Explanation

Individuals with spinal cord injury (SCI), especially those with tetraplegia, often experience low blood pressure, particularly when upright, due to sympathetic de-centralization. This study aimed to assess cognitive function in SCI patients, comparing those with normal blood pressure to those with low blood pressure over a 24-hour period during their daily activities. The results indicated that individuals with chronic hypotension and SCI showed significant memory impairment and a trend toward slower attention and processing speed compared to those with normal blood pressure.

Study Duration

Not specified

Participants

20 individuals with chronic SCI

Evidence Level

Not specified

Key Findings

1
Memory was significantly impaired in the hypotensive group compared to the normotensive group (P<0.05).
2
There was a trend toward slowed attention and processing speed in the hypotensive group (P<0.06).
3
The proportion of individuals with tetraplegia (82%) was higher in the hypotensive group.

Research Summary

This study investigated the cognitive function of individuals with SCI, comparing hypotensive and normotensive subjects over a 24-hour period. The findings suggest that chronic hypotension in SCI patients is associated with deficits in memory, and potentially attention and processing speed. These cognitive deficits may be related to cerebral hypoperfusion or autonomic cardiovascular dysregulation due to chronic low blood pressure.

Practical Implications

Clinical Management of Hypotension

The study highlights the need for increased attention to the treatment and clinical management of hypotension in persons with SCI to potentially improve cognitive outcomes.

Further Research on Cerebral Blood Flow

Further studies are warranted to investigate the association between decrements in cerebral blood flow and cognitive function in hypotensive individuals with SCI.

Consideration of RAAS

Changes in cognitive performance in hypotensive individuals with SCI may be a consequence of increased dependence on the RAAS and the associated vascular degeneration compared to the normotensive cohort.

Study Limitations

1
The disproportionate number of individuals with tetraplegia in the hypotensive group may have influenced the cognitive findings.
2
Medication use with central nervous system action may have influenced the cognitive deficits reported herein.
3
Increased prevalence of sleep apnea in persons with tetraplegia resulting in episodic oxygen desaturation and hypoxemia.

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