Neurocognitive functioning of paediatric patients with postural orthostatic tachycardia syndrome (POTS)

Abstract

Background: Self-reported cognitive difficulties are common among adolescents with POTS. The few studies including objective measurement of neurocognitive functioning suggest orthostatic challenge negatively affects patients’ attention and working memory. However, findings don’t differentially support an explanatory mechanism (inadequate cerebral perfusion, perceived threat of POTS symptoms interrupting attention, or co-occurring depression/anxiety). This study will determine the prevalence of objectively measured neurocognitive weaknesses among adolescents with POTS and evaluate the effects of physiological/psychological contributors to neurocognitive functioning. Methods: We are conducting a retrospective medical record review of 100 adolescents (ages 12-18) with POTS. Eligibility criteria include tilt table test confirmation of POTS, and completion of neurocognitive assessment (WASI/WASI-II, WRAML-2, CAVLT-2) and self-report measures of POTS symptom severity (COMPASS-31), depression (CES-DC), and anxiety (SCAS). Percentages of patients demonstrating objective weaknesses in working memory, visual-spatial memory, and/or verbal memory will be reported. Multiple regression analyses will determine the unique abilities of tilt table results, COMPASS-31, CES-DC, and SCAS to predict performance on neurocognitive tasks. Expected results: The majority of patients will demonstrate objectively measured neurocognitive weaknesses. Comparing the relative contributions of tilt table results, COMPASS-31, CES-DC, and SCAS to the prediction of neurocognitive performance will provide an empirical basis for evaluating the three mechanisms proposed to explain patients’ worsened neurocognitive performance. Current stage of work: Conducting medical record reviews. Discussion: Characterising the prevalence and domains of neurocognitive weaknesses experienced by adolescents with POTS can inform health/paediatric psychologists’ recommendations regarding home and school accommodations. Understanding physiological/psychological factors contributing to neurocognitive weaknesses can inform interdisciplinary interventions.