Autonomic Nervous System Dysfunction Following Spinal Cord Injury: Cardiovascular, Cerebrovascular, and Thermoregulatory Effects

Wecht, Jill M.; Fountaine, Michael F. La; Handrakis, John P.; West, Christopher R.; Phillips, Aaron A.; Ditor, David S.; Sharif, Hisham; Bauman, William A.; Krassioukov, Andrei V.

doi:10.1007/s40141-015-0093-2

Cited by 15 publications

(11 citation statements)

References 97 publications

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“…There are, however, many factors that contribute to the development of MCI after SCI [ 11 ]. These may include functional changes to the cardiovascular [ 38 – 40 ] and autonomic nervous system [ 41 ], psychological changes such as mood disturbances [ 42 ], medications [ 43 – 45 ], ageing [ 14 , 46 – 48 ], sleep disorder [ 49 , 50 ], fatigue [ 8 ], and social changes, such as the potential for decreased social participation [ 51 , 52 ]. Some of these risks (e.g., depression, polypharmacy) are transient, while others (e.g., brain injury, cardiovascular dysfunction) contribute to degenerative or long-term courses of cognitive impairment.…”

Section: Introductionmentioning

confidence: 99%

A prospective cohort study investigating contributors to mild cognitive impairment in adults with spinal cord injury: study protocol

et al. 2020

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Background Studies report rates of mild cognitive impairment (MCI) in spinal cord injury (SCI) range between 10 and 60%. This broad estimate of MCI in SCI is most likely a result of: (i) inconsistent operationalization of MCI; (ii) heterogeneity among individuals with SCI; (iii) failure to account for MCI subtypes, thereby adding to the heterogeneity of samples; and, (iv) poor control for traumatic brain injury (TBI) that obscures differentiation of MCI attributable to TBI versus other factors. There is a paucity of longitudinal studies following the course of MCI in SCI, and none that account for multiple predictors of MCI, including interactions among predictors. Methods An inception cohort longitudinal study will assess approximately 100 individuals aged 17–80 years with acute SCI, with measures taken at three timepoints (baseline, 3 months post-baseline, and 12 months post-injury). Data relevant to medical care received within the first 24–48 h of presentation to the emergency department will be analysed, as will measures of cognition, injury characteristics, medical history, personal factors, psychological status, psychosocial functioning, and quality of life. Latent class mixture modelling will determine trajectories for the primary outcome of interest, cognitive functioning and its subtypes, and secondary outcomes of interest such as depression. Multiple regression analyses will identify predictors of MCI and its subtypes. Discussion The prospective design will reveal change in cognitive functioning across time and unveil different outcome trajectories; thus addressing the lack of knowledge on trajectories of MCI and MCI subtypes in SCI. Through subtyping MCI, we hope to yield groups of cognitively impaired individuals with SCI that are potentially more homogenous and thereby stable and predictable. This is the first study to capture emergency department and acute care diagnostic evidence of mild TBI, which has been poorly controlled in previous studies. Our study will also be the first to distinguish the contribution of TBI from other factors to the development of MCI in individuals with SCI. Trial registration The study was prospectively registered with the Australian and New Zealand Clinical Trial Registry (ACTRN12619001702101) on 3rd December 2019.

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Section: Introductionmentioning

confidence: 99%

A prospective cohort study investigating contributors to mild cognitive impairment in adults with spinal cord injury: study protocol

et al. 2020

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“…Impaired ability to redistribute blood from peripheral to central compartments (and vice versa), due to altered vasomotor control of peripheral and splanchnic vascular beds is prevalent in persons with SCI at or above T6 48,49 and limits the ability to increase or decrease insulation in cold and hot environments, respectively. Hence, in persons with cervical and upper thoracic SCI, core body temperature is anticipated to be below the normal range (36.4-37.6°C) when exposed to ambient temperatures less than thermo-neutral (~25-27°C) and above the normal range when exposed to ambient temperatures above thermo-neutral.…”

Section: Assessment Recommendationsmentioning

confidence: 99%

International Standards to document Autonomic Function following SCI (ISAFSCI)

Wecht

Krassioukov

Alexander

et al. 2021

Topics in Spinal Cord Injury Rehabilitation

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“…Supraspinal control of sympathetic cardiovascular autonomic outflow is dramatically attenuated or fully ablated below the neurological level of the lesion (Wecht et al . ). Over time, this deficit of neural outflow contributes to a downregulation and reduction of α‐ and β‐adrenergic receptors in the sublesional vascular beds (Rodriguez et al .…”

Section: Introductionmentioning

confidence: 97%

“…Neuromotor and cardiovascular autonomic interruption after spinal cord injury (SCI) contributes to adverse changes in soft-tissue body composition and arterial vasculature adaptations that predispose individuals to the development of sublesional microcirculatory dysfunction (Olive et al 2003;West et al 2013). Supraspinal control of sympathetic cardiovascular autonomic outflow is dramatically attenuated or fully ablated below the neurological level of the lesion (Wecht et al 2015). Over time, this deficit of neural outflow contributes to a downregulation and reduction of αand β-adrenergic receptors in the sublesional vascular beds (Rodriguez et al 1986).…”

Section: Introductionmentioning

confidence: 99%

Cutaneous microvascular perfusion responses to insulin iontophoresis are differentially affected by insulin resistance after spinal cord injury

Fountaine

Cirnigliaro

Azarelo

et al. 2017

Experimental Physiology

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What is the central question of this study? What impact does insulin resistance have on cutaneous perfusion responses to insulin iontophoresis in vascular beds with markedly reduced or functionally ablated sympathetic nervous system vasomotor function resulting from spinal cord injury? What is the main finding and its importance? Persons with spinal cord injury have sublesional microvascular endothelial dysfunction, as indicated by a blunted cutaneous perfusion response to acetylcholine iontophoresis, and the presence of insulin resistance has a further confounding effect on endothelium-mediated changes to cutaneous perfusion in the lower extremities. Endothelium-mediated mechanisms that regulate skin blood flow might play an integral role in optimizing skin perfusion in vascular beds with sympathetic nervous system vasomotor impairment, such as in spinal cord injury (SCI). Insulin is a vasoactive hormone and second messenger of nitric oxide that facilitates endothelium-mediated dilatation. The effects of insulin resistance (IR) on sublesional cutaneous perfusion responses to insulin provocation have yet to be described in persons with SCI. Persons with SCI and an able-bodied (AB) cohort were divided into subgroups based upon fasting plasma insulin concentration cut-offs for IR (≥13.13 mIU ml ) or insulin sensitivity (IS; <13.13 mIU ml ), as follows: AB, IS (ABIS, n = 21); SCI, IS (SCIS, n = 21); AB, IR (ABIR, n = 9); and SCI, IR (SCIR, n = 11). Laser Doppler flowmetry characterized peak blood perfusion unit (BPU) responses (percentage change from baseline) to insulin, acetylcholine or placebo iontophoresis in the lower extremities; BPU responses were log transformed to facilitate comparisons, and the net insulin response (NetIns) BPU response was calculated (insulin minus placebo BPU response). The NetIns was significantly greater in both IS groups compared with their corresponding IR group. The acetylcholine-mediated BPU responses in the SCI subgroups were significantly lower than those in the ABIS group. The proportional BPU responses of NetIns to acetylcholine in the IS cohorts (i.e. ABIS and SCIS) were significantly greater (P < 0.05) than that of each IR subgroup. The presence of IR has a confounding effect on sublesional microvascular endothelium-mediated cutaneous perfusion responses to provocation. Preservation of endothelial sensitivity to its agonists appears to be an important modifiable risk factor to optimize cutaneous perfusion in the lower extremities of persons with SCI.

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Autonomic Nervous System Dysfunction Following Spinal Cord Injury: Cardiovascular, Cerebrovascular, and Thermoregulatory Effects

Cited by 15 publications

References 97 publications

A prospective cohort study investigating contributors to mild cognitive impairment in adults with spinal cord injury: study protocol

A prospective cohort study investigating contributors to mild cognitive impairment in adults with spinal cord injury: study protocol

International Standards to document Autonomic Function following SCI (ISAFSCI)

Cutaneous microvascular perfusion responses to insulin iontophoresis are differentially affected by insulin resistance after spinal cord injury

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