title: Cognitive dysfunction in postural tachycardia syndrome.
abstract: Mental clouding is an almost universal complaint among patients with postural tachycardia syndrome (POTS) but remains poorly understood. Thus, we have determined whether POTS patients exhibit deficits during neuropsychological testing relative to healthy subjects. A comprehensive battery of validated neuropsychological tests was administered to 28 female POTS patients and 24 healthy subjects in a semi-recumbent position. Healthy subjects were matched to POTS patients on age and gender. Selective attention, a primary outcome measure, and cognitive processing speed were reduced in POTS patients compared with healthy subjects (Ruff 2&7 Speed t-score: 40±9 compared with 49±8; P=0.009; Symbol Digit Modalities Test t-score: 45±12 compared with 51±8; P=0.011). Measures of executive function were also lower in POTS patients (Trails B t-score: 46±8 compared with 52±8; P=0.007; Stroop Word Color t-score: 45±10 compared with 56±8; P=0.001), suggesting difficulties in tracking and mental flexibility. Measures of sustained attention, psychomotor speed, memory function or verbal fluency were not significantly different between groups. The present study provides evidence for deficits in selective attention and cognitive processing in patients with POTS, in the seated position when orthostatic stress is minimized. In contrast, other measures of cognitive function, including memory assessments, were not impaired in these patients, suggesting selectivity in these deficits. These findings provide new insight into the profile of cognitive dysfunction in POTS and provide the basis for further studies to identify clinical strategies to better manage the mental clouding associated with this condition.
authors.affiliation: *Division of Clinical Pharmacology and Department of Medicine, Vanderbilt University School of Medicine, Nashville, TN 37232, U.S.A.
authors.forename: Amy C
authors.initials: AC
authors.lastname: Arnold
authors.affiliation: †Department of Psychiatry, Vanderbilt University School of Medicine, Nashville, TN 37232, U.S.A.
authors.forename: Kirsten
authors.initials: K
authors.lastname: Haman
authors.affiliation: *Division of Clinical Pharmacology and Department of Medicine, Vanderbilt University School of Medicine, Nashville, TN 37232, U.S.A.
authors.forename: Emily M
authors.initials: EM
authors.lastname: Garland
authors.affiliation: †Department of Psychiatry, Vanderbilt University School of Medicine, Nashville, TN 37232, U.S.A.
authors.forename: Vidya
authors.initials: V
authors.lastname: Raj
authors.affiliation: ‡Department of Biostatistics, Vanderbilt University School of Medicine, Nashville, TN 37232, U.S.A.
authors.forename: William D
authors.initials: WD
authors.lastname: Dupont
authors.forename: Italo
authors.initials: I
authors.lastname: Biaggioni
authors.forename: David
authors.initials: D
authors.lastname: Robertson
authors.forename: Satish R
authors.initials: SR
authors.lastname: Raj
mesh_terms: D000328:Adult; D001288:Attention; D016022:Case-Control Studies; D003072:Cognition Disorders / Q000209:etiology*; D056344:Executive Function; D005260:Female; D006801:Humans; D009483:Neuropsychological Tests; D054972:Postural Orthostatic Tachycardia Syndrome / Q000150:complications*; D011187:Posture; D011597:Psychomotor Performance; D057190:Stroop Test