Brain fog in postural tachycardia syndrome: An objective cerebral blood flow and neurocognitive analysis

Wells, Rachel; Paterson, Felix; Bacchi, Stephen; Page, Amanda J.; Baumert, Mathias; Lau, Dennis H.

doi:10.1002/joa3.12325

Cited by 12 publications

(11 citation statements)

References 13 publications

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“…This is evidenced by the increase in omissions made by patients during head-up tilt compared to when they were supine, indicating a decrease in working memory performance. Consistent with previous findings, only cognitive performance in the head-up tilt position was impaired compared to a healthy control group, thus confirming that cognitive dysfunction in POTS is a functional, and not an absolute deficit (Ocon et al, 2012;Stewart et al, 2015;Rodriguez et al, 2019;Wells et al, 2020). The exploratory correlation analyses showed that cognitive performance during head-up tilt correlated with symptom ratings.…”

Section: Discussionsupporting

confidence: 89%

“…A common and strongly disturbing symptom for patients is difficulty concentrating (Deb et al, 2015;Shaw et al, 2019). Patients often have problems to accurately describe their cognitive difficulties, and usually refer to them as "brain fog" or "mental clouding" (Ross et al, 2013;Wells et al, 2020). Ross et al conducted an online questionnaire-based study investigating the symptom of brain fog, and found that the most commonly used descriptors of brain fog were "forgetful, " "cloudy, " and "difficulty focusing, thinking and communicating" (Ross et al, 2013).…”

Section: Introductionmentioning

confidence: 99%

“…Initially, orthostatic cerebral hypoperfusion was assumed to be responsible for the occurrence of cognitive symptoms. This is highly unlikely since cerebral perfusion primarily depends on (i) mean arterial blood pressure, (ii) intracranial pressure and (iii) cerebral autoregulation (Le Roux et al, 2014;Hani et al, 2021), and all these factors are unaffected in POTS: first, the diagnostic criteria for POTS presuppose normal blood pressure regulation; second, the regulation of intracranial pressure in POTS is not affected by orthostasis (Cipriani et al, 2019); and third, patients with POTS have intact cerebral autoregulation (Schondorf et al, 2005;Endo et al, 2014;Wells et al, 2020). Other studies suggested that the impairment in cognitive performance in POTS may occur when attention is directed to somatic sensations due to increased internal vigilance when patients are symptomatic (Anderson et al, 2014;Owens et al, 2018a,b).…”

Section: Introductionmentioning

confidence: 99%

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Brain fog in neuropathic postural tachycardia syndrome may be associated with autonomic hyperarousal and improves after water drinking

et al. 2022

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BackgroundBrain fog is a common and highly disturbing symptom for patients with neuropathic postural tachycardia syndrome (POTS). Cognitive deficits have been measured exclusively in the upright body position and mainly comprised impairments of higher cognitive functions. The cause of brain fog is still unclear today. This study aimed to investigate whether increased autonomic activation might be an underlying mechanism for the occurrence of brain fog in neuropathic POTS. We therefore investigated cognitive function in patients with neuropathic POTS and a healthy control group depending on body position and in relation to catecholamine release as a sensitive indicator of acute stress. The second aim was to test the effect of water intake on cardiovascular regulation, orthostatic symptoms, cognitive function and catecholamine release.MethodsThirteen patients with neuropathic POTS and 15 healthy control subjects were included. All participants completed a total of four rounds of cognitive testing: two before and two after the intake of 500 ml still water, each first in the supine position and then during head-up tilt. At the end of each cognitive test, a blood sample was collected for determination of plasma catecholamines. After each head-up tilt phase participants were asked to rate their current symptoms on a visual analogue scale.ResultsWorking memory performance in the upright body position was impaired in patients, which was associated with self-reported symptom severity. Patients had elevated plasma norepinephrine independent of body position and water intake that increased excessively in the upright body position. The excessive increase of plasma norepinephrine was related to heart rate and symptom severity. Water intake in patients decreased norepinephrine concentrations and heart rate, and improved symptoms as well as cognitive performance.ConclusionBrain fog and symptom severity in neuropathic POTS are paralleled by an excessive norepinephrine secretion. Bolus water drinking down-regulates norepinephrine secretion and improves general symptom severity including brain fog.

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Section: Discussionsupporting

confidence: 89%

Section: Introductionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

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Brain fog in neuropathic postural tachycardia syndrome may be associated with autonomic hyperarousal and improves after water drinking

et al. 2022

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“…Ginkgo biloba extract also contains terpene lactones, which reduce blood viscosity and increase blood fl ow, resulting in improved cerebral blood fl ow [27]. It is predicted that brain fog will be partially improved by removing reactive oxygen species and improving cerebral blood fl ow in this way [26,28]. In addition to brain fog, cerebral blood fl ow decreases as blood vessels harden with age, which may lead to cognitive decline [29].…”

Section: Ginkgo Biloba Extractmentioning

confidence: 99%

Ginkgo biloba Extract Containing Plasmalogen May Improve Long COVID and Brain Fog: A Case Report

Kawakami

2022

J Biomed Res Environ Sci

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Other than pneumonia, Long COVID is currently cited as a problem with COVID-19. Among them, brain fog is a particular problem. Brain fog, as the name suggests, refers to a state in which the brain is foggy, and it is thought that there is a communication abnormality in the central nervous system, including fatigue. It has been pointed out that this may be caused by a cytokine storm, and since it lowers QOL (Quality of Life), countermeasures are urgently needed. In this study, we used plasmalogen containing Ginkgo biloba extract and found improvement in patients complaining of brain fog. As a result, we were able to confirm a case of excellent efficacy, which we report here.

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“…As a comparison, the authors remarked that this deficit was larger than the mean deficit of 512 people who indicated they had previously suffered a stroke and 1016 who reported learning disabilities [ 101 ]. “Brain fog”, i.e., confusion, forgetfulness, inability to focus, fatigue, and low mental energy [ 102 , 103 ] may be thus an emerging major sequela of COVID-19 infection ( Figure 1 ).…”

Section: Melatonin and Neuroprotectionmentioning

confidence: 99%

Can Melatonin Be a Potential “Silver Bullet” in Treating COVID-19 Patients?

2020

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The therapeutic potential of melatonin as a chronobiotic cytoprotective agent to counteract the consequences of COVID-19 infections has been advocated. Because of its wide-ranging effects as an antioxidant, anti-inflammatory, and immunomodulatory compound, melatonin could be unique in impairing the consequences of SARS-CoV-2 infection. Moreover, indirect evidence points out to a possible antiviral action of melatonin by interfering with SARS-CoV-2/angiotensin-converting enzyme 2 association. Melatonin is also an effective chronobiotic agent to reverse the circadian disruption of social isolation and to control delirium in severely affected patients. As a cytoprotector, melatonin serves to combat several comorbidities such as diabetes, metabolic syndrome, and ischemic and non-ischemic cardiovascular diseases, which aggravate COVID-19 disease. In view of evidence on the occurrence of neurological sequels in COVID-19-infected patients, another putative application of melatonin emerges based on its neuroprotective properties. Since melatonin is an effective means to control cognitive decay in minimal cognitive impairment, its therapeutic significance for the neurological sequels of SARS-CoV-2 infection should be considered. Finally, yet importantly, exogenous melatonin can be an adjuvant capable of augmenting the efficacy of anti-SARS-CoV-2 vaccines. We discuss in this review the experimental evidence suggesting that melatonin is a potential “silver bullet” in the COVID 19 pandemic.

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Brain fog in postural tachycardia syndrome: An objective cerebral blood flow and neurocognitive analysis

Cited by 12 publications

References 13 publications

Brain fog in neuropathic postural tachycardia syndrome may be associated with autonomic hyperarousal and improves after water drinking

Brain fog in neuropathic postural tachycardia syndrome may be associated with autonomic hyperarousal and improves after water drinking

Ginkgo biloba Extract Containing Plasmalogen May Improve Long COVID and Brain Fog: A Case Report

Can Melatonin Be a Potential “Silver Bullet” in Treating COVID-19 Patients?

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