Regional Neurovascular Coupling and Cognitive Performance in Those with Low Blood Pressure Secondary to High-Level Spinal Cord Injury: Improved by Alpha-1 Agonist Midodrine Hydrochloride

• Published in: Journal of cerebral blood flow and metabolism Vol. 34; no. 5; pp. 794 - 801
• Main Authors: Phillips, Aaron A, Warburton, Darren ER, Ainslie, Philip N, Krassioukov, Andrei V
• Format: Journal Article
• Language: English
• Published: London, England SAGE Publications 01.05.2014; Sage Publications Ltd; Nature Publishing Group
• Subjects: Adolescent; Adrenergic alpha-1 Receptor Agonists - therapeutic use; Adult; Blood Flow Velocity - drug effects; Cerebrovascular Circulation - drug effects; Cognition - drug effects; Cognition Disorders - drug therapy; Cognition Disorders - etiology; Female; Humans; Hypotension - drug therapy; Hypotension - etiology; Male; Middle Aged; Midodrine - therapeutic use; Original; Spinal Cord Injuries - complications; Spinal Cord Injuries - drug therapy; Young Adult; cognition; brain blood flow; tetraplegia
• ISSN: 0271-678X; 1559-7016
• DOI: 10.1038/jcbfm.2014.3

Individuals with high-level spinal cord injury (SCI) experience low blood pressure (BP) and cognitive impairments. Such dysfunction may be mediated in part by impaired neurovascular coupling (NVC) (i.e., cerebral blood flow responses to neurologic demand). Ten individuals with SCI > T6 spinal segment, and 10 age- and sex-matched controls were assessed for beat-by-beat BP, as well as middle and posterior cerebral artery blood flow velocity (MCAv, PCAv) in response to a NVC test. Tests were repeated in SCI after 10 mg midodrine (alpha1-agonist). Verbal fluency was measured before and after midodrine in SCI, and in the control group as an index of cognitive function. At rest, mean BP was lower in SCI (70 ± 10 versus 92 ± 14 mm Hg; P<0.05); however, PCAv conductance was higher (0.56 ± 0.13 versus 0.39 ± 0.15 cm/second/mm Hg; P<0.05). Controls exhibited a 20% increase in PCAv during cognition; however, the response in SCI was completely absent (P<0.01). When BP was increased with midodrine, NVC was improved 70% in SCI, which was reflected by a 13% improved cognitive function (P<0.05). Improvements in BP were related to improved cognitive function in those with SCI (r2 = 0.52; P<0.05). Impaired NVC, secondary to low BP, may partially mediate reduced cognitive function in individuals with high-level SCI.