Key result
Acute ingestion of 500 ml of water in patients with neuropathic POTS significantly reduced plasma norepinephrine concentrations during head-up tilt and improved cognitive performance and symptom severity.
Why the study?
The cause of brain fog in neuropathic POTS remains unclear, prompting investigation into whether increased autonomic activation is an underlying mechanism and whether water intake affects cardiovascular regulation, symptoms, cognitive function, and catecholamine release.
Does intake of 500 ml water improve cognitive function, symptoms, and catecholamine release in patients with neuropathic POTS during orthostatic stress?
Does intake of 500 ml water improve cognitive function, symptoms, and catecholamine release in patients with neuropathic POTS during orthostatic stress?
Bolus water drinking down-regulates excessive norepinephrine secretion and improves orthostatic symptoms and cognitive performance (brain fog) in patients with neuropathic POTS.
Brain fog in neuropathic POTS may relate to autonomic hyperarousal; leaves open whether targeting norepinephrine or water intake alters symptoms.
Background: Brain fog is a common and highly disturbing symptom for patients with neuropathic postural tachycardia syndrome (POTS). Cognitive deficits have been measured exclusively in the upright body position and mainly comprised impairments of higher cognitive functions. The cause of brain fog is still unclear today. This study aimed to investigate whether increased autonomic activation might be an underlying mechanism for the occurrence of brain fog in neuropathic POTS. We therefore investigated cognitive function in patients with neuropathic POTS and a healthy control group depending on body position and in relation to catecholamine release as a sensitive indicator of acute stress. The second aim was to test the effect of water intake on cardiovascular regulation, orthostatic symptoms, cognitive function and catecholamine release. Methods: Thirteen patients with neuropathic POTS and 15 healthy control subjects were included. All participants completed a total of four rounds of cognitive testing: two before and two after the intake of 500 ml still water, each first in the supine position and then during head-up tilt. At the end of each cognitive test, a blood sample was collected for determination of plasma catecholamines. After each head-up tilt phase participants were asked to rate their current symptoms on a visual analogue scale. Results: Working memory performance in the upright body position was impaired in patients, which was associated with self-reported symptom severity. Patients had elevated plasma norepinephrine independent of body position and water intake that increased excessively in the upright body position. The excessive increase of plasma norepinephrine was related to heart rate and symptom severity. Water intake in patients decreased norepinephrine concentrations and heart rate, and improved symptoms as well as cognitive performance. Conclusion: Brain fog and symptom severity in neuropathic POTS are paralleled by an excessive norepinephrine secretion. Bolus water drinking down-regulates norepinephrine secretion and improves general symptom severity including brain fog.
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Rodriguez et al. (2022) studied Neuropathic postural tachycardia syndrome (POTS) (n=28). Water drinking vs. Before water intake was evaluated on Plasma norepinephrine concentration during head-up tilt (nmol/l) (p=<0.001). Acute ingestion of 500 ml of water in patients with neuropathic POTS significantly reduced plasma norepinephrine concentrations during head-up tilt and improved cognitive performance and symptom severity.
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