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Open Access 01-04-2007 | REVIEW ARTICLE

Reduced brain perfusion and cognitive performance due to constitutional hypotension

Authors: Stefan Duschek, Rainer Schandry

Published in: Clinical Autonomic Research | Issue 2/2007

Abstract

This review article includes a systematic evaluation of the empirical data concerning deficits in mental ability, brain perfusion, and cerebral functioning due to chronically low blood pressure. A number of studies have provided strong evidence for reduced cognitive performance in hypotension, particularly in the domains of attention and memory. EEG studies have demonstrated that the hypotension-related poorer mental ability is also reflected in diminished cortical activity. Contrary to convention, more recent research has suggested a deficient regulation of cerebral blood flow in persons with low blood pressure. In addition to reduced tonic brain perfusion, studies demonstrated insufficient adjustment of blood flow to cognitive requirements. Altogether, these findings suggest that more attention should be allocated to chronic hypotension in both research and clinical practice.

The cited findings [3, 7‐9, 11‐16] were revealed in large epidemiological studies. All included samples across the total blood pressure spectra and did not explicitly define hypotension according to the WHO criteria [4].

Duschek S, Schandry R (2006) Antriebsschwäche und beeinträchtigte Hirnleistungen: neue Perspektiven zum chronisch niedrigen Blutdruck. Deut Med Wochenschr 131:272–277CrossRef

Duschek S, Schandry R (2006) Increased pain sensitivity in low blood pressure. Abstract of the 5th Congress of the Spanish Society of Psychophysiology (SEPF). Granada, Spain, September 28–30, 2006. J Psychophysiol 20:235

Pilgrim JA, Stansfeld S, Marmot M (1992) Low blood pressure, low mood? Brit Med J 304:75–78PubMed

WHO (1978) Arterial hypertension. Technical Report Series No. 628. World Health Organisation, Genova

Chillon JM, Baumbach GL (1995) Autoregulation of cerebral blood flow. In: Welch KMA, Caplan LR, Reis DJ, Siesjö BK, Weir B (eds) Primer on cerebrovascular diseases. Academic Press, San Diego, pp 51–54

Tonkin A (2004) Low blood pressure and low energy: (how) are they related? J Hypertens 22:671–673PubMedCrossRef

Wessely S, Nickson J, Cox B (1990) Symptoms of low blood pressure: a population study. Brit Med J 301:362–365PubMed

Rosengren A, Tibblin G, Wilhelmsen L (1993) Low systolic blood pressure and self perceived wellbeing in middle aged men. Brit Med J 306:243–246PubMed

Barrett-Connor E, Palinkas LA (1994) Low blood pressure and depression in men: a population based study. Brit Med J 308:446–449PubMed

10.

Ng PH, Walters WA (1992) The effect of chronic maternal hypotension during pregnancy. Aust NZ J Obstet Gyn 32:14–16

11.

Hestad K, Kveberg B, Engedal K (2005) Low blood pressure is a better predictor of cognitive deficits than the apolipoprotein e4 allele in the oldest old. Acta Neurol Scand 111:323–328PubMedCrossRef

12.

Morris MC, Scherr PA, Hebert LE, Bennett DA, Wilson RS, Glynn RJ, Evans DA (2000) The cross-sectional association between blood pressure and Alzheimer’s disease in a biracial community population of older persons. J Gerontol A-Biol 55:M130–M136

13.

Qiu C, Winblad B, Fratiglioni L (2005) The age-dependent relation of blood pressure to cognitive function and dementia. Lancet Neurol 4:487–499PubMedCrossRef

14.

Zuccala G, Onder G, Pedone C, Carosella L, Pahor M, Bernabei R, Cocchi A (2001) Hypotension and cognitive impairment: selective association in patients with heart failure. Neurology 57:1986–1992PubMed

15.

Heijer T, Skoog I, Oudkerk M, de Leeuw FE, de Groot JC, Hofman A, Breteler MM (2003) Association between blood pressure levels over time and brain atrophy in the elderly. Neurobiol Aging 24:307–313PubMedCrossRef

16.

Ruitenberg A, Skoog I, Ott A, Aevarsson O, Witteman JC, Lernfelt B, van Harskamp F, Hofman A, Breteler M (2001) Blood pressure and risk of dementia. Results from the Rotterdam study and the Gothenburg H-70 study. Dement Geriatr Cogn 12:33–39CrossRef

17.

Duschek S, Schandry R (2005) Subjektive Beschwerden und kognitive Minderleistungen bei essentieller Hypotonie. VT&VM 26:5–31

18.

Richter-Heinrich E, Borys M, Sprung H, Läuter J (1971) Psychophysiologische Reaktionsprofile von Hypo- und Hypertonikern. Deut Gesundheitswes 32:1481–1489

19.

Cadalbert B (1997) Die Psychophysiologie des niedrigen Blutdrucks: Kreislaufregulation, Lebensgewohnheiten und Beschwerden. Peter Lang, Frankfurt a.M

20.

Bismarck M, Rust G (1982) Erste Erfahrungen mit dem Antihypotonikum Thomasin (=Etilefrin) unter ambulanten Bedingungen (eine Doppelblindstudie). Z Ärztliche Fortb 76:153–156

21.

Schandry R (1999) Die Verbesserung der subjektiven Befindlichkeit bei orthostatischer Hypotonie unter dem Einfluss blutdrucksteigernder Therapie. Med Welt 50:160–165

22.

Weisz N, Schandry R, Jacobs A, Mialet J, Duschek S (2002) Early contingent negative variation of the EEG and attentional flexibility are reduced in hypotension. Int J Psychophysiol 45:253–260PubMedCrossRef

23.

Dembowsky K, Seller H (1995) Arterial baroreceptor reflexes. In: Vaitl D, Schandry R (eds) From the heart to the brain: the psychophysiology of circulation–brain interaction. Europäischer Verlag der Wissenschaften, Frankfurt a.M., pp 35–60

24.

Igler FO, Donegan JH, Hoo KC, Korns ME, Kampine JP (1981) Chronic localized hypotension and resetting of carotid sinus baroreceptors. Electrophy- siological and histological studies in the dog. Circ Res 49:649–654PubMed

25.

Abels D (1954) K-V-T. Konzentrations-Verlaufs-Test. Hogrefe, Göttingen

26.

Stegagno L, Angrilli A, Costa M, Palomba D (1996) Deficit cognitivi e ipotensione arteriosa: Un indagine cronopsycofisiologica. G Ital Psicol 23:837–859

27.

Wechsler D (1962) Wechsler memory scale. Forma I. Adattazione Italaliana di E. Cimino. Organizzazioni Speciali, Firence

28.

Baddeley A (1982) Your memory. A user’s guide. Multimedia Publications, London

29.

Costa M, Stegagno L, Schandry R, Bitti PER (1998) Contingent negative variation and cognitive performance in hypotension. Psychophysiology 35:737–744PubMedCrossRef

30.

Brickenkamp R (1994) Test d2, Aufmerksamkeits-Belastungs-Test. Hogrefe, Göttingen

31.

Oswald WD, Roth E (1987) Der Zahlen-Verbindungs-Test (ZVT) – Ein sprachfreier Intelligenz-Test zur Messung der “kognitiven Leistungsgeschwindigkeit”. Hogrefe, Göttingen

32.

Morris MC, Scherr PA, Hebert LE, Bennett DA, Wilson RS, Glynn RJ, Evans DA (2002) Association between blood pressure and cognitive function in a biracial community population of older persons. Neuroepidemiology 21:123–130PubMedCrossRef

33.

Albert M (1993) Neuropsychological changes in healthy adult humans across the age range. Neurobiol Aging 14:623–625PubMedCrossRef

34.

Smith A (1984) Symbol digit modalities test. Manual – Revised. Western Psychological, Los Angeles

35.

Folstein MF, Folstein SE, McHugh PR (1975) Mini mental state. A practical method for grading the cognitive state of patients for the clinician. J Psychiat Res 12:189–198PubMedCrossRef

36.

Mialet JP, Jacobs A, Bisserbe JC (1995) Computerized attentional and cognitive efficiency battery: preliminary results. Eur J Psychol Assess 11(suppl. 1):111

37.

Duschek S, Weisz N, Schandry R (2003) Reduced cognitive performance and prolonged reaction time accompany moderate hypotension. Clin Auton Res 13:427–432PubMed

38.

Duschek S, Matthias E, Schandry R (2005) Essential hypotension is accompanied by deficits in attention and working memory. Behav Med 30:149–158PubMedCrossRef

39.

Zimmermann P, Fimm B (2002) Testbatterie zur Aufmerksamkeitsprüfung (TAP). Version 1.7. Handbuch Teile 1 und 2. Psytest, Herzogenrath

40.

Schoppe KJ (1974) Das MLS-Gerät. Ein neuer Testapparat zur Messung feinmotorischer Leistungen. Diagnostica 20:43–46

41.

Von Zerssen D (1976) Klinische Selbstbeurteilungs-Skalen aus dem Münchner Psychiatrischen Informations-System (PSYCHIS) München. Die Befindlichkeitsskala, Beltz, Weinheim

42.

Critchley HD, Mathias CJ (2003) Blood pressure, attention and cognition: drivers and air traffic controllers. Clin Auton Res 13:399–401PubMed

43.

Shapiro D, Miller RE, King HE, Ginchereau EH, Fitzgibbon K (1982) Behavioral consequences of mild hypertension. Hypertension 4:355–360PubMed

44.

Waldstein SR, Ryan CM, Manuck SB, Parkinson DK, Bromet EJ (1991) Learning and memory function in men with untreated blood pressure elevation. J Consult Clin Psychol 59:513–517PubMedCrossRef

45.

Pandav R, Dodge HH, DeKosky ST, Ganguli M (2003) Blood pressure and cognitive impairment in India and the United States: a cross-national epidemiological study. Arch Neurol 60:1123–1128PubMedCrossRef

46.

Waldstein SR, Giggey PP, Thayer JF, Zonderman AB (2005) Nonlinear relations of blood pressure to cognitive function: the Baltimore Longitudinal Study of Aging. Hypertension 45:374–379PubMedCrossRef

47.

Duschek S, Meinhardt J, Schandry R (2006) Reduced cortical activity due to chronic low blood pressure: an EEG study. Biol Psychol 72:241–250PubMedCrossRef

48.

Tecce JJ, Cattanach L (1993) Contingent negative variation. In: Niedermeyer E, Lopes da Silva F (ed) Electroencephalography: basic principles clinical applications, and related fields. Urban & Schwarzenberg, Baltimore, pp 657–679

49.

Coons HW, Peloquin LJ, Klorman R, Bauer LO, Ryan RM, Perlmutter RA, Salzman LF (1981) Effect of methylphenidate on young adult’s vigilance and event-related potentials. Electroen Clin Neuro 51:373–387CrossRef

50.

Fattaposta F, Floris R, Sanarelli L, Terribile P, Tilia G (1984) Changes in slow cerebral potentials (CNV) subsequent to midazolam administration. Double-blind study. Riv Neurol 54:289–298PubMed

51.

Chao LL, Meyerhoff DJ, Cardenas VA, Rothlind JC, Weiner MW (2003) Abnormal CNV in chronic heavy drinkers. Clin Neurophysiol 114:2081–2095PubMedCrossRef

52.

Claverie B, Brun A, Nizard A, Brenot P, Paty J (1984) Multiparametric outlines with CNV: applications to depressive syndromes. In: Karrer R, Cohen J, Tueting P (eds) Brain and information: event-related potentials. New York Academy of Sciences, New York, pp 556–564

53.

Andreassi JL (2000) Human behavior and physiological response. Lawrence Erlbaum, London

54.

Davidson RJ, Jackson DC, Larson CL (2000) Human electroencephalography. In: Cacioppo JT, Tassinary LG, Berntson GG (eds) Handbook of psychophysiology. Cambridge University Press, New York, pp 27–52

55.

Goldstein MA, Silverman ME (2006) Autonomics and cognition. Clin Auton Res 16:86–89PubMedCrossRef

56.

Heims HC, Critchley HD, Martin NH, Jäger HR, Mathias CJ, Cipolotti L (2006) Cognitive functioning in orthostatic hypotension due to pure autonomic failure. Clin Auton Res 16:113–120PubMedCrossRef

57.

Vaitl D, Gruppe H (1991) Baroreceptor stimulation and changes in EEG and vigilance. In: Perssons PB, Kirchheim HR (eds) Baroreceptor reflexes: integrative functions and clinical aspects. Springer, Berlin, pp 293–313

58.

Craig AD (2003) Interoception: the sense of the physiological condition of the body. Curr Opin Neurobiol 13:500–505PubMedCrossRef

59.

Gómez CM, Vaquero E, Vázquez-Marrufo M (2004) A neurocognitive model of short-term sensory and motor preparatory activity in humans. Psicológica 25:217–229

60.

Sturm W, de Simone A, Krause BJ, Specht K, Hesselmann V, Radermacher I, Herzog H, Tellmann L, Muller-Gartner HW, Willmes K (1999) Functional anatomy of intrinsic alertness: evidence for a fronto-parietal-thalamic-brainstem network in the right hemisphere. Neuropsychologia 37:797–805PubMedCrossRef

61.

Posner MI, Petersen SE (1990) The attention system of the human brain. Annu Rev Neurosci 13:25–42PubMedCrossRef

62.

Carlson NR (2004) Physiology of behavior. Pearson Education, Harlow

63.

Jennings JR (2003) Autoregulation of blood pressure and thought: preliminary results of an application of brain imaging to psychosomatic medicine. Psychosom Med 65:384–395PubMedCrossRef

64.

Paulson OB (2002) Blood–brain barrier, brain metabolism and cerebral blood flow. Eur Neuropsychopharm 12:495–501CrossRef

65.

Duschek S, Schandry R (2004) Cognitive performance and cerebral blood flow in essential hypotension. Psychophysiology 41:905–913PubMedCrossRef

66.

Duschek S, Schandry R (2003) Functional transcranial Doppler sonography as a tool in psychophysiological research. Psychophysiology 40:436–454PubMedCrossRef

67.

Duschek S, Schandry R (2006) Deficient adjustment of cerebral blood flow to cognitive activity due to chronically low blood pressure. Biol Psychol 72:311–317PubMedCrossRef

68.

McHenry LC, West JW, Cooper ES, Goldberg HI, Jaffe ME (1974) Cerebral autoregulation in man. Stroke 5:695–706PubMed

69.

Olesen J (1973) Quantitative evaluation of normal and pathologic cerebral blood flow regulation to perfusion pressure. Changes in man. Arch Neurol (Chicago) 28:143–148

70.

Strandgaard S (1976) Autoregulation of cerebral blood flow in hypertensive patients. The modifying influence of prolonged antihypertensive treatment on the tolerance to acute, drug-induced hypotension. Circulation 53:720–727PubMed

71.

Strandgaard S, Olesen J, Skinhoj E, Lassen NA (1973) Autoregulation of brain circulation in severe arterial hypertension. Brit Med J 1:507–510PubMedCrossRef

72.

Lennox WG, Gibbs EL (1932) The blood flow in the brain and the leg of man and the changes induced by alternation of blood gases. J Clin Invest 11:1155–1177PubMedCrossRef

73.

Larsen FS, Olsen KS, Hansen BA, Paulson OB, Knudsen GM (1994) Transcranial Doppler is valid for determination of the lower limit of cerebral blood flow autoregulation. Stroke 25:1985–1988PubMed

74.

Olsen KS, Svenden LB, Larsen FS, Paulson OB (1995) Effect of labetalol on cerebral blood flow, oxygen metabolism and autoregulation in healthy humans. Br J Anaesth 75:51–54PubMed

75.

Olsen KS, Svendsen LB, Larsen FS (1996) Validation of transcranial near-infrared spectroscopy for evaluation of cerebral blood flow autoregulation. J Neurosurg Anaesth 8:280–285

76.

Drummond JC (1997) The lower limit of autoregulation: time to revise our thinking? Anesthesiology 86:1431–143PubMedCrossRef

77.

Waldemar G, Schmidt JF, Andersen AR, Vorstrup S, Ibsen H, Paulson OB (1989) Angiotensin converting enzyme inhibition and cerebral blood flow autoregulation in normotensive and hypertensive man. J Hypertens 7:229–235PubMedCrossRef

78.

Kuschinsky W (1991) Coupling of function, metabolism, and blood flow in the brain. Neurosurg Rev 14:163–168PubMedCrossRef

79.

Duschek S, Hadjamu M, Schandry R (2006) Enhancement of cerebral blood flow and cognitive performance due to pharmacological blood pressure elevation in chronic hypotension. Psychophysiology 44:(in press)

Title: Reduced brain perfusion and cognitive performance due to constitutional hypotension
Authors: Stefan Duschek
Rainer Schandry
Publication date: 01-04-2007
Publisher: Steinkopff-Verlag
Published in: Clinical Autonomic Research / Issue 2/2007
Print ISSN: 0959-9851
Electronic ISSN: 1619-1560
DOI: https://doi.org/10.1007/s10286-006-0379-7

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Reduced brain perfusion and cognitive performance due to constitutional hypotension

Abstract

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