Objective:

To assess objective cognitive measures in postural orthostatic tachycardia syndrome (POTS) patients with self-reported mental health correlates.

Background:

Patients with POTS frequently report cognitive symptoms. Few studies have investigated specific domains of cognitive performance in POTS. 

Design/Methods:

As part of a prospective NIH-funded multimodality phenotyping project, POTS patients (and age/sex-matched controls) underwent an in-person cognitive battery consisting of the Montreal Cognitive Assessment [MoCA], digit span (attention/working memory), Trails A (processing speed) and B (executive function), Controlled Oral Word Association Test [COWAT] (verbal fluency) and Dot-Counting Task [DCT] (validity). Raw values were converted to standardized scores (1-19) as reported in the Wechsler Adult Intelligence Scale – Fourth Edition (WAIS-IV) and Heaton norms, with higher values indicating better performance. Participants also reported their psychiatric diagnoses and completed validated health measures and the POTS Symptom Score (MAPS). 

Results:

101 POTS patients and 18 controls were included. Mean age was 27.6 years (SD: 7.2) and mostly White (97.0%), non-Hispanic (93.1%), and female (91.1%). Anxiety (49.5%), depression (30.7%), and ADHD (22.8%) were commonly reported conditions with POTS. On the MoCA, 30.7% scored below the normal cognition cutoff (<26/30) versus 11.8% of controls (p=0.19). POTS patients performed worse on Trails A (WAIS-IV score: 10.1 vs 12.3, p=0.003), COWAT (9.0 vs 10.8, p=0.03), and digit span (9.7 vs 11.2, p=0.043) compared to controls. After removing 13 POTS patients with poor validity on DCT, 25.7% still scored below the normal MOCA cutoff, and the statistically significant differences in Trails A and COWAT performance persisted. Worse MAPS was significantly but not meaningfully associated with worse performance on Trails A  (r2 = 0.04, p=0.04). Self-reported anxiety, depression, and ADHD were unassociated.  

Conclusions:

Cognitive complaints (“brain fog”) are common in POTS. Having POTS itself, irrespective of comorbid psychiatric conditions or magnitude of symptom awareness, may adversely impact cognitive performance.