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The Blood Pressure Pendulum following Spinal Cord Injury: Implications for Vascular Cognitive Impairment

Rahul Sachdeva1,2, Tom E Nightingale3,4, Andrei V Krassioukov5,6,7

  • 1International Collaboration on Repair Discoveries (ICORD), University of British Columbia, Vancouver, BC V5Z 1M9, Canada. sachdeva@icord.org.

International Journal of Molecular Sciences
|May 22, 2019
PubMed

Insights

Spinal cord injury (SCI) can cause cognitive impairment due to blood pressure instability. Managing blood pressure fluctuations may help prevent vascular cognitive impairment (VCI) in SCI patients.

Area of Science:

  • Neuroscience
  • Cardiovascular Science
  • Rehabilitation Medicine

Background:

  • Cognitive impairment is a significant concern following spinal cord injury (SCI).
  • Cardiovascular dysfunction, particularly blood pressure (BP) lability, is a major contributor to cognitive decline in SCI.
  • Conditions like orthostatic hypotension and autonomic dysreflexia cause extreme BP fluctuations in SCI individuals.

Purpose of the Study:

  • To review the impact of extreme BP lability on vascular cognitive impairment (VCI) in SCI.
  • To draw mechanistic comparisons between SCI and able-bodied populations regarding BP and VCI.
  • To highlight potential therapies for BP instability to mitigate VCI in SCI.

Main Methods:

  • Literature review of studies on SCI, cardiovascular dysfunction, and cognitive impairment.
  • Analysis of mechanisms linking BP variability to cerebrovascular health.
  • Comparison of findings in SCI populations with existing data from able-bodied cohorts.

Main Results:

  • Evidence suggests chronic BP instability (hypotension and hypertension) impairs cerebrovascular health and leads to VCI in the general population.
  • Similar mechanisms are hypothesized to affect VCI in SCI, though specific research is limited.
  • BP lability is a significant risk factor for VCI in SCI patients.

Conclusions:

  • Extreme blood pressure fluctuations in SCI patients may significantly contribute to vascular cognitive impairment.
  • Further research is needed to understand SCI-specific mechanisms of cognitive impairment.
  • Therapeutic strategies targeting BP instability hold promise for mitigating VCI in the SCI population.

Keywords:
autonomic dysreflexiacerebrovascular healthorthostatic hypotensionspinal cord injuryvascular cognitive impairment

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