Cognitive function, health-related quality of life, and symptoms of depression and anxiety sensitivity are impaired in patients with the postural orthostatic tachycardia syndrome (POTS)

Abstract

The Postural Orthostatic Tachycardia Syndrome (POTS) is a condition in which heart rate increases abnormally when the individual assumes an upright position. In addition to the marked tachycardia, presyncope, and syncope, patients with POTS often complain of light-headedness, fatigue, and difficulty in concentrating. The present study assessed individuals with POTS for psychiatric comorbidity, anxiety sensitivity and health related quality of life and examined general cognitive ability. Data was obtained from patients with POTS (n = 15, 12 female, aged 30 ± 3 years) and age matched healthy subjects (n = 30, 21 female, aged 32 ± 2 years). Patients with POTS commonly presented with symptoms of depression, elevated anxiety and increased anxiety sensitivity, particularly with regards to cardiac symptoms, and had a poorer health related quality of life in both the physical and mental health domains. While patients with POTS performed worse in tests of current intellectual functioning (verbal and non-verbal IQ) and in measures of focused attention (digits forward) and short term memory (digits back), test results were influenced largely by years of education and the underlying level of depression and anxiety. Acute changes in cognitive performance in response to head up tilt were evident in the POTS patients. From results obtained, it was concluded that participants with POTS have an increased prevalence of depression and higher levels of anxiety. These underlying symptoms impact on cognition in patients with POTS, particularly in the cognitive domains of attention and short-term memory. Our results indicate that psychological interventions may aid in recovery and facilitate uptake and adherence of other treatment modalities in patients with POTS.

The face of postural tachycardia syndrome – insights from a large cross‐sectional online community‐based survey

“…The high prevalence of headaches identified is in keeping with a retrospective evaluation of symptoms in paediatric patients presenting to a POTS clinic . The autonomic symptoms associated with POTS can negatively impact many aspects of daily life including cognitive function, sleep, energy levels and the ability to exercise, work and attend school . A history of syncope was reported in only 36% of survey participants, which is much lower than that reported in the smaller POTS UK study (58%) .…”

“…When formally assessed, POTS patients have no increased lifetime prevalence of psychiatric disorders as compared to the general population, and POTS patients have mental health scores similar to national norms whether they have improved or not 5 years after diagnosis . However, other studies have also suggested that patients with POTS may have increased prevalence of depression and anxiety . It is unknown how much of the psychological health problems that exist in POTS patients may be due to living with a chronic medical illness or exacerbated by the stressful prolonged diagnostic process and misdiagnosis the majority of POTS patients experience.…”

Health-related quality of life and blood pressure 12 months after renal denervation

“…Interestingly, in this latter study, the level of depression was quite high, with a mean BDI score of 15. Although studies have shown that depression impacts negatively on cognitive performance and QoL in patients with orthostatic intolerance [39] and that the placebo effect on SF-36-MCS scores is substantially increased in patients with depression [32], we found no significant association between baseline symptoms of depression and the change in SF-36 MCS score.…”

Postural orthostatic tachycardia syndrome for the otolaryngologist

“…Some studies have demonstrated no differences in incidence for major depression, anxiety, or substance abuse disorders between POTS patients and the general population . On the other hand, Anderson et al noted significantly higher depression and anxiety scores in patients with POTS. These differences may be due to the differences in methodology employed in these assessments, requiring additional work to know if psychological conditions should also be routinely assessed in the POTS patient.…”