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Systemic and cerebral hemodynamics during cognitive testing

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Abstract

Objective

Cognitive deficits are reported in 10–60% of individuals with SCI, the primary etiology of these deficits is believed to be concomitant traumatic brain injury (TBI). We recently documented diminished memory and marginally deficient attention and processing speed in individuals with SCI discordant for hypotension but matched for TBI.

Methods

Twenty-nine individuals participated: 16 non-SCI controls, 6 paraplegic (T2–T10) and 7 tetraplegic (C4–C8). The Stroop test was used to measure cognitive function and transcranial Doppler ultrasound was used to measure cerebral blood flow (CBF) while resting (5 min) and continuously during cognitive testing. Mean arterial pressure (MAP) was calculated from three brachial blood pressures and cerebral vascular resistance index was calculated as: CVRi = MAP/CBF.

Results

The paraplegia group (54 ± 6) was marginally older than the non-SCI (42 ± 15; p = 0.06) and tetraplegic (42 ± 11; p = 0.09) groups. Compared to non-SCI group, normalized t-score on the Stroop Color (SC) task was significantly lower in the paraplegic group (p < 0.05). In the tetraplegic group, MAP was significantly lower (p < 0.05) than the non-SCI and paraplegic groups, and related to SC t-score (r 2 = 0.873; p < 0.01). In the paraplegic group, CBF was reduced (p < 0.05) and CVRi increased (p < 0.05) compared to the non-SCI group, and CVRi was increased compared to the tetraplegic group (p < 0.05). A significant inverse relationship was noted between change in CVRi and SC t-score in the non-SCI group.

Conclusion

Asymptomatic hypotension relates to cognitive performance in persons with tetraplegia; therefore, BP normalization should be considered. The inappropriate cerebral vascular response to cognitive testing and poor test performance should be investigated in persons with paraplegia.

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Acknowledgments

This research was supported by the Veterans Affairs Rehabilitation Research and Development Service (grant no. A6161W, B3203R and B4162C).

Conflict of interest

We certify that no party having a direct interest in the results of the research supporting this article has or will confer a benefit on us or on any organization with which we are associated AND, if applicable, we certify that all financial and material support for this research (e.g., NIH or NHS grants) and work are clearly identified in the title page of the manuscript.

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Authors and Affiliations

  1. Center of Excellence: Medical Consequences of Spinal Cord Injury, James J. Peters VA Medical Center, Rm. 7A-13, 130 West Kingsbridge Rd., Bronx, NY, 10468, USA

    Jill M. Wecht, Dwindally Rosado-Rivera, Adejoke Jegede, Christopher M. Cirnigliaro, Marley A. Jensen & William A. Bauman

  2. Medical Service, James J. Peters VAMC, Bronx, NY, USA

    Jill M. Wecht & William A. Bauman

  3. Department of Medicine, Mount Sinai School of Medicine, New York, NY, USA

    Jill M. Wecht & William A. Bauman

  4. Department of Rehabilitation Medicine, Mount Sinai School of Medicine, New York, NY, USA

    Jill M. Wecht & William A. Bauman

  5. Kessler Institute for Rehabilitation, West Orange, NJ, USA

    Christopher M. Cirnigliaro, Marley A. Jensen & Steve Kirshblum

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  1. Jill M. Wecht
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  2. Dwindally Rosado-Rivera
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Correspondence to Jill M. Wecht.

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Wecht, J.M., Rosado-Rivera, D., Jegede, A. et al. Systemic and cerebral hemodynamics during cognitive testing. Clin Auton Res 22, 25–33 (2012). https://doi.org/10.1007/s10286-011-0139-1

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