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).

Jake W Anderson,Carolina I Sari,Murray D Esler,Gautam Vaddadi,Elisabeth A Lambert,Gavin W Lambert,Tye Dawood

doi:10.3389/fphys.2014.00230

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.

Highlights

It is estimated that the lifetime cumulative incidence of syncope is approximately 35% (Ganzeboom et al, 2006) and that syncope-related hospitalizations cost the US healthcare system upwards of $2.4 billion (Sun et al, 2005)
Patients with postural orthostatic tachycardia syndrome (POTS) commonly presented with symptoms of depression, elevated anxiety and increased anxiety sensitivity, and had a poorer subjective health related quality of life in both the physical and mental health domains
Acute changes in cognitive performance in response to head up tilt were evident in the POTS patients

Summary

Introduction

It is estimated that the lifetime cumulative incidence of syncope is approximately 35% (Ganzeboom et al, 2006) and that syncope-related hospitalizations cost the US healthcare system upwards of $2.4 billion (Sun et al, 2005). While most forms of orthostatic intolerance are associated with a reduction in blood pressure upon standing, one specific condition, the postural orthostatic tachycardia syndrome (POTS), is characterized by an excessive rise in heart rate (standing heart rate increases by 30 beats or more per min or exceeding 120 beats/min) and may be accompanied by presyncope or syncope in the absence of postural hypotension (Low et al, 1995; Jacob et al, 2000). The age of POTS patients is typically in the range 15–50 years, with women more likely to develop the disorder than men (Low et al, 1995). In addition to the obvious cardiovascular-related symptoms, patients with POTS may describe difficulty in concentration and experiencing distraction and transient memory deficits which intrudes on personal and work life. Repeated episodes of syncope may lead to distress and psychosocial dysfunction, seriously interfering with quality of life, and potentially increasing the incidence of mood or anxiety disorders

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