Regional neurovascular coupling and cognitive performance in those with low blood pressure secondary to high-level spinal cord injury: improved by alpha-1 agonist midodrine hydrochloride.
Individuals with high-level spinal cord injury (SCI) experience low blood pressure (BP) and cognitive impairments. Such dysfunction may be mediated in part by impaired neurovascular coupling (NVC) (i.e., cerebral blood flow responses to neurologic demand). Ten individuals with SCI >T6 spinal segment, and 10 age- and sex-matched controls were assessed for beat-by-beat BP, as well as middle and posterior cerebral artery blood flow velocity (MCAv, PCAv) in response to a NVC test. Tests were repeated in SCI after 10 mg midodrine (alpha1-agonist). Verbal fluency was measured before and after midodrine in SCI, and in the control group as an index of cognitive function. At rest, mean BP was lower in SCI (70 ± 10 versus 92 ± 14 mm Hg; P<0.05); however, PCAv conductance was higher (0.56 ± 0.13 versus 0.39 ± 0.15 cm/second/mm Hg; P<0.05). Controls exhibited a 20% increase in PCAv during cognition; however, the response in SCI was completely absent (P<0.01). When BP was increased with midodrine, NVC was improved 70% in SCI, which was reflected by a 13% improved cognitive function (P<0.05). Improvements in BP were related to improved cognitive function in those with SCI (r(2)=0.52; P<0.05). Impaired NVC, secondary to low BP, may partially mediate reduced cognitive function in individuals with high-level SCI.
1] Cardiovascular Physiology and Rehabilitation Laboratory, Physical Activity Promotion and Chronic Disease Prevention Unit, University of British Columbia, Vancouver, British Columbia, Canada [2] Experimental Medicine Program, Faculty of Medicine, University of British Columbia, Vancouver, British Columbia, Canada [3] Centre for Heart, Lung and Vascular Health, School of Health and Exercise Sciences, Faculty of Health and Social Development, University of British Columbia Okanagan, Kelowna, British Columbia, Canada [4] International Collaboration on Repair Discoveries (ICORD), Department of Medicine, Division of Physical Medicine and Rehabilitation, University of British Columbia, and GF Strong Rehabilitation Centre, Vancouver Coastal Health, Vancouver, British Columbia, Canada.
Aaron A
AA
Phillips
1] Cardiovascular Physiology and Rehabilitation Laboratory, Physical Activity Promotion and Chronic Disease Prevention Unit, University of British Columbia, Vancouver, British Columbia, Canada [2] Experimental Medicine Program, Faculty of Medicine, University of British Columbia, Vancouver, British Columbia, Canada [3] International Collaboration on Repair Discoveries (ICORD), Department of Medicine, Division of Physical Medicine and Rehabilitation, University of British Columbia, and GF Strong Rehabilitation Centre, Vancouver Coastal Health, Vancouver, British Columbia, Canada.
Darren E R
DE
Warburton
Centre for Heart, Lung and Vascular Health, School of Health and Exercise Sciences, Faculty of Health and Social Development, University of British Columbia Okanagan, Kelowna, British Columbia, Canada.
Philip N
PN
Ainslie
1] Experimental Medicine Program, Faculty of Medicine, University of British Columbia, Vancouver, British Columbia, Canada [2] International Collaboration on Repair Discoveries (ICORD), Department of Medicine, Division of Physical Medicine and Rehabilitation, University of British Columbia, and GF Strong Rehabilitation Centre, Vancouver Coastal Health, Vancouver, British Columbia, Canada.
Andrei V
AV
Krassioukov
D000293:Adolescent; D058646:Adrenergic alpha-1 Receptor Agonists / Q000627:therapeutic use*; D000328:Adult; D001783:Blood Flow Velocity / Q000187:drug effects; D002560:Cerebrovascular Circulation / Q000187:drug effects; D003071:Cognition / Q000187:drug effects; D003072:Cognition Disorders / Q000188:drug therapy* / Q000209:etiology*; D005260:Female; D006801:Humans; D007022:Hypotension / Q000188:drug therapy* / Q000209:etiology*; D008297:Male; D008875:Middle Aged; D008879:Midodrine / Q000627:therapeutic use*; D013119:Spinal Cord Injuries / Q000150:complications* / Q000188:drug therapy*; D055815:Young Adult
D058646:Adrenergic alpha-1 Receptor Agonists; D008879:Midodrine