Ignite Creation Date:
2024-05-06 @ 10:25 AM
Last Modification Date:
2024-10-26 @ 12:29 PM
Study NCT ID:
NCT03253120
Status:
COMPLETED
Last Update Posted:
2022-07-06
First Post:
2017-08-02
Brief Title:
Alterations of Attention in POTS Depending on Body Position and Hydration
Sponsor:
Insel Gruppe AG University Hospital Bern
Organization:
Insel Gruppe AG University Hospital Bern
Study Overview
Official Title:
Alterations of Attention in Patients With Postural Tachycardia Syndrome and Healthy Controls Depending on Body Position and Hydration
Status:
COMPLETED
Status Verified Date:
2022-07
Last Known Status:
None
Delayed Posting:
No
If Stopped, Why?:
Not Stopped
Has Expanded Access:
False
If Expanded Access, NCT#:
N/A
Has Expanded Access, NCT# Status:
N/A
Acronym:
None
Brief Summary:
The Postural Tachycardia-Syndrome POTS is a form of autonomic dysregulation typically accompanied by symptoms of orthostatic intolerance OI OI is defined by the inability to tolerate the upright position and is improved by lying down POTS is considered a syndrome that may include a number of several disorders Symptoms should be persistent for at least 6 months to reach a diagnosis It is characterized by a sustained heart rate HR increment of 30 beatsmin or more within 10 min of standing or head-up tilt HUT in adults in the absence of orthostatic hypotension and with the presence of symptoms of OI In children and adolescents a diagnosis requests a HR increment of at least 40 beatsmin The increment in HR when moving to an upright posture is often a response to a reduction in venous return causing excessive blood pooling in the lower limbs The symptoms present in POTS vary greatly Typical symptoms are lightheadedness dizziness blurred vision mental clouding brain fog or cognitive dysfunction Other symptoms may present as palpitations or chest pain Additional symptoms consist of postural headaches nausea sleep disturbances fatigue and gastrointestinal dysfunction The manifestation of symptoms in POTS varies in severity frequency and combination resulting in POTS being a very heterogenous and subjective disorder Symptoms can be severe and often make simple daily activities difficult to an extent that compromises the patients quality of life Typically symptoms exacerbate in the mornings after physical activity after eating and during menstruation
This study objective is to examine the occurrence mechanisms and causes of impaired attention in POTS as well as to test the effect of acute water ingestion for attention in POTS The investigators therefore conduct a study including patients with POTS and healthy volunteers
All participants will receive a dossier of five self-assessment questionnaires after giving informed consent Clinical examination includes 2 HUT-tests while standing for 15 minutes conventional measuring of blood pressure continuous recording of NIRS signals during testing determination of pupil size the diameter of the optic nerve and Neuropsychological testing Test of Attentional Performance mobility version TAP-M GoNoGo Test Divided Attention Test
This study objective is to examine the occurrence mechanisms and causes of impaired attention in POTS as well as to test the effect of acute water ingestion for attention in POTS The investigators therefore conduct a study including patients with POTS and healthy volunteers
All participants will receive a dossier of five self-assessment questionnaires after giving informed consent Clinical examination includes 2 HUT-tests while standing for 15 minutes conventional measuring of blood pressure continuous recording of NIRS signals during testing determination of pupil size the diameter of the optic nerve and Neuropsychological testing Test of Attentional Performance mobility version TAP-M GoNoGo Test Divided Attention Test
Detailed Description:
Background
Postural Tachycardia Syndrome POTS is a form of autonomic dysregulation typically accompanied by symptoms of orthostatic intolerance OI OI is defined by the inability to tolerate the upright position and is improved by lying down POTS is considered a syndrome that may include a number of several disorders Symptoms should be persistent for at least 6 months to reach a diagnosis It is characterized by a sustained heart rate HR increment of 30 beatsmin or more within 10 min of standing or head-up tilt HUT in adults in the absence of orthostatic hypotension and with the presence of symptoms of OI In children and adolescents diagnosis requests a HR increment of at least 40 beatsmin The increment in HR when moving to an upright posture is often caused by a reduction in venous return because of excessive blood pooling in the lower limbs Clinical symptoms present in POTS vary greatly Typical symptoms are palpitations lightheadedness dizziness blurred vision mental clouding brain fog or cognitive dysfunction Additional symptoms consist of postural headaches nausea but also non-orthostatic symptoms such as sleep disturbances fatigue and gastrointestinal dysfunction The manifestation of symptoms in POTS varies in severity frequency and combination resulting in POTS being a very heterogenous and subjective disorder Symptoms can be severe and make simple daily activities difficult Typically symptoms exacerbate in the mornings after physical activity after eating and during menstruation The onset of the syndrome is associated with a variety of possible causes eg a recent viral illness or autonomic neuropathy
As mentioned above some of the most frequent reported symptoms are concentration- and attentional problems so called brain fog or mental clouding Previous research indicates an actual deficit in cognitive functioning which is same as other POTS symptoms exclusive to the upright position However there is no overall accepted and recognized definition of what brain fog is or what components it consists of The majority of studies examined amongst other things aspects of attention and working memory Ross et al compared it to mental fatigue and showed that 67 of all POTS patients experience this symptom on a daily basis which indicates that routine daily activities and consequent quality of life are reduced even further
Conservative therapy in POTS consists in a high intake of water 2-3L and salt on a daily basis wearing compression stockings and regular endurance training Severely affected patients may profit from additional drug treatment A previous research group of the investigators unit showed in 2010 the improvement of OI in POTS after acute water and clear soup intake
Objective
The purpose of this study is to examine the occurrence mechanisms and causes of impaired attention in POTS as well as to test the effect of acute water ingestion for attention in POTS
The study consists of four different assessments
Methode
All participants will receive a dossier of five self-assessment questionnaires after giving informed consent The dossier consists of Becks Depression Inventory II BDI-II for assessing depression Short Form 36 Health Survey SF-36 for assessing health-related quality of life Pittsburgh Sleep Quality Index PSQI for assessing sleep quality International Physical Activity Questionnaire IPAQ for assessing personal physical activity and a questionnaire designed to measure specific symptoms in POTS POTS Questionnaire to assess and objectify the symptomatology of POTS patients The completion is expected to take approximately one hour
The study consists of four different assessments For the examination all POTS medication will be stopped prior to the examination All participants have no dietary restrictions during the days before the study but will have to ingest nil by mouth after midnight
For autonomic function testing beat-to-beat BP and HR are measured with the Finometer device At the beginning of each assessment intermittent brachial BP and HR values will be simultaneously recorded using an automated Dinamap Pro 100 sphygmomanometer on the right arm In addition continuous recording of NIRS signals during testing will be acquired
The study will start with a supine rest on an electrical tilt table for at least 10 minutes whilst BP and HR settle and sufficient correlation between Finometer and Dinamap readings are achieved A baseline assessment of attention in supine position follows before tilting the participants to a 60upright position In the upright position participants will again perform the same assessment of attention Patients will be at a tilt angle of 60 for a maximum of 20 minutes HUT will be terminated earlier in case of pre-syncope After a short recovery in the supine position participants will be asked to drink 5 dl of commercially available still mineral water within 5 minutes To facilitate rapid drinking the upper body will be transiently elevated for 45-60 After drinking participants will again be supine for 20 minutes before a second assessment of attention in the supine position Subsequently participants will again be tilted to 60 and complete the second assessment of attention in the upright posture HUT will be terminated earlier in case of pre-syncope The duration of tolerated HUT at baseline and after fluid ingestion will be noted
Patients will be asked to rate their experienced symptoms in the upright position both before and after the intake of water
Neuropsychological testing will consist of three subtests of the automated computer-based test battery Test of Attentional Performance mobility version TAP-M Second the investigators will use the GoNoGo task for assessing the specific ability of subjects to suppress undesired responses Reaction times and errors are recorded in a simple test with two stimuli Using the subtest of Divided Attention deficits of divided attention will be measured which are frequently diagnosed in neuropsychological practice This can be assessed in a dual-task paradigm in which two stimuli have to be attended to simultaneously The test battery is computer-based the screen will be placed in a distance of 30 cm from the participants face and the button for reaction responses will be held in the dominant hand For capturing a possible decrease in attentional performance participants will complete the sequence of the three subtests two times in two respective blocks resulting in a total duration time of 15 minutes
The diameter of the optic nerve is measured with a 7-15 MHz linear array transducer in transorbital B-mode ultrasound
The investigators expect a study duration of approximately four hours
Postural Tachycardia Syndrome POTS is a form of autonomic dysregulation typically accompanied by symptoms of orthostatic intolerance OI OI is defined by the inability to tolerate the upright position and is improved by lying down POTS is considered a syndrome that may include a number of several disorders Symptoms should be persistent for at least 6 months to reach a diagnosis It is characterized by a sustained heart rate HR increment of 30 beatsmin or more within 10 min of standing or head-up tilt HUT in adults in the absence of orthostatic hypotension and with the presence of symptoms of OI In children and adolescents diagnosis requests a HR increment of at least 40 beatsmin The increment in HR when moving to an upright posture is often caused by a reduction in venous return because of excessive blood pooling in the lower limbs Clinical symptoms present in POTS vary greatly Typical symptoms are palpitations lightheadedness dizziness blurred vision mental clouding brain fog or cognitive dysfunction Additional symptoms consist of postural headaches nausea but also non-orthostatic symptoms such as sleep disturbances fatigue and gastrointestinal dysfunction The manifestation of symptoms in POTS varies in severity frequency and combination resulting in POTS being a very heterogenous and subjective disorder Symptoms can be severe and make simple daily activities difficult Typically symptoms exacerbate in the mornings after physical activity after eating and during menstruation The onset of the syndrome is associated with a variety of possible causes eg a recent viral illness or autonomic neuropathy
As mentioned above some of the most frequent reported symptoms are concentration- and attentional problems so called brain fog or mental clouding Previous research indicates an actual deficit in cognitive functioning which is same as other POTS symptoms exclusive to the upright position However there is no overall accepted and recognized definition of what brain fog is or what components it consists of The majority of studies examined amongst other things aspects of attention and working memory Ross et al compared it to mental fatigue and showed that 67 of all POTS patients experience this symptom on a daily basis which indicates that routine daily activities and consequent quality of life are reduced even further
Conservative therapy in POTS consists in a high intake of water 2-3L and salt on a daily basis wearing compression stockings and regular endurance training Severely affected patients may profit from additional drug treatment A previous research group of the investigators unit showed in 2010 the improvement of OI in POTS after acute water and clear soup intake
Objective
The purpose of this study is to examine the occurrence mechanisms and causes of impaired attention in POTS as well as to test the effect of acute water ingestion for attention in POTS
The study consists of four different assessments
Methode
All participants will receive a dossier of five self-assessment questionnaires after giving informed consent The dossier consists of Becks Depression Inventory II BDI-II for assessing depression Short Form 36 Health Survey SF-36 for assessing health-related quality of life Pittsburgh Sleep Quality Index PSQI for assessing sleep quality International Physical Activity Questionnaire IPAQ for assessing personal physical activity and a questionnaire designed to measure specific symptoms in POTS POTS Questionnaire to assess and objectify the symptomatology of POTS patients The completion is expected to take approximately one hour
The study consists of four different assessments For the examination all POTS medication will be stopped prior to the examination All participants have no dietary restrictions during the days before the study but will have to ingest nil by mouth after midnight
For autonomic function testing beat-to-beat BP and HR are measured with the Finometer device At the beginning of each assessment intermittent brachial BP and HR values will be simultaneously recorded using an automated Dinamap Pro 100 sphygmomanometer on the right arm In addition continuous recording of NIRS signals during testing will be acquired
The study will start with a supine rest on an electrical tilt table for at least 10 minutes whilst BP and HR settle and sufficient correlation between Finometer and Dinamap readings are achieved A baseline assessment of attention in supine position follows before tilting the participants to a 60upright position In the upright position participants will again perform the same assessment of attention Patients will be at a tilt angle of 60 for a maximum of 20 minutes HUT will be terminated earlier in case of pre-syncope After a short recovery in the supine position participants will be asked to drink 5 dl of commercially available still mineral water within 5 minutes To facilitate rapid drinking the upper body will be transiently elevated for 45-60 After drinking participants will again be supine for 20 minutes before a second assessment of attention in the supine position Subsequently participants will again be tilted to 60 and complete the second assessment of attention in the upright posture HUT will be terminated earlier in case of pre-syncope The duration of tolerated HUT at baseline and after fluid ingestion will be noted
Patients will be asked to rate their experienced symptoms in the upright position both before and after the intake of water
Neuropsychological testing will consist of three subtests of the automated computer-based test battery Test of Attentional Performance mobility version TAP-M Second the investigators will use the GoNoGo task for assessing the specific ability of subjects to suppress undesired responses Reaction times and errors are recorded in a simple test with two stimuli Using the subtest of Divided Attention deficits of divided attention will be measured which are frequently diagnosed in neuropsychological practice This can be assessed in a dual-task paradigm in which two stimuli have to be attended to simultaneously The test battery is computer-based the screen will be placed in a distance of 30 cm from the participants face and the button for reaction responses will be held in the dominant hand For capturing a possible decrease in attentional performance participants will complete the sequence of the three subtests two times in two respective blocks resulting in a total duration time of 15 minutes
The diameter of the optic nerve is measured with a 7-15 MHz linear array transducer in transorbital B-mode ultrasound
The investigators expect a study duration of approximately four hours
Study Oversight
Has Oversight DMC:
None
Is a FDA Regulated Drug?:
False
Is a FDA Regulated Device?:
False
Is an Unapproved Device?:
None
Is a PPSD?:
None
Is a US Export?:
None
Is an FDA AA801 Violation?:
None