Cognitive function in peripheral autonomic disorders.
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.
IRCCS, Institute of Neurological Sciences of Bologna, Bologna, Italy ; Department of Biomedical and Neuromotor Sciences, Alma Mater Studiorum, University of Bologna, Bologna, Italy.
Pietro
P
Guaraldi
IRCCS, Institute of Neurological Sciences of Bologna, Bologna, Italy ; Department of Biomedical and Neuromotor Sciences, Alma Mater Studiorum, University of Bologna, Bologna, Italy.
Roberto
R
Poda
IRCCS, Institute of Neurological Sciences of Bologna, Bologna, Italy ; Department of Biomedical and Neuromotor Sciences, Alma Mater Studiorum, University of Bologna, Bologna, Italy.
Giovanna
G
Calandra-Buonaura
IRCCS, Institute of Neurological Sciences of Bologna, Bologna, Italy ; Department of Biomedical and Neuromotor Sciences, Alma Mater Studiorum, University of Bologna, Bologna, Italy.
Laura
L
Solieri
IRCCS, Institute of Neurological Sciences of Bologna, Bologna, Italy ; Department of Biomedical and Neuromotor Sciences, Alma Mater Studiorum, University of Bologna, Bologna, Italy.
Luisa
L
Sambati
IRCCS, Institute of Neurological Sciences of Bologna, Bologna, Italy ; Department of Biomedical and Neuromotor Sciences, Alma Mater Studiorum, University of Bologna, Bologna, Italy.
Roberto
R
Gallassi
IRCCS, Institute of Neurological Sciences of Bologna, Bologna, Italy ; Department of Biomedical and Neuromotor Sciences, Alma Mater Studiorum, University of Bologna, Bologna, Italy.
Pietro
P
Cortelli
D000368:Aged; D001342:Autonomic Nervous System Diseases / Q000503:physiopathology*; D001794:Blood Pressure / Q000502:physiology; D003071:Cognition / Q000502:physiology*; D005260:Female; D006339:Heart Rate / Q000502:physiology; D006801:Humans; D008297:Male; D008875:Middle Aged; D009483:Neuropsychological Tests; D011187:Posture / Q000502:physiology