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

International Journal of Molecular Sciences, 2019 · DOI: 10.3390/ijms20102464 · Published: May 18, 2019

Spinal Cord Injury Cardiovascular Science Neurology

Simple Explanation

Cognitive impairment is a serious consequence of SCI, impacting rehabilitation, re-employment, reintegration into society and aging. Individuals with SCI are at a higher risk of cognitive impairment compared to able-bodied controls. Cardiovascular dysfunctions following SCI, such as orthostatic hypotension and autonomic dysreflexia, can lead to vascular cognitive impairment. These conditions cause dangerous fluctuations in blood pressure. Extreme BP lability can negatively impact cerebrovascular health, similar to the effects of chronic hypotension and hypertension in able-bodied individuals, emphasizing the need for additional research in the SCI population.

Study Duration

Not specified

Participants

Individuals with spinal cord injury

Evidence Level

Review

Key Findings

1
Individuals with SCI experience significant cardiovascular impairments, including drastic blood pressure fluctuations, which can lead to vascular cognitive impairment.
2
BP instability, characterized by both hypotensive and hypertensive episodes, exceeds the autoregulatory limit, predisposing individuals with SCI to ischemic or hemorrhagic stroke.
3
Cardiovascular and cerebrovascular disease progression is accelerated after SCI, increasing the risk of stroke and subsequent vascular cognitive impairment.

Research Summary

This review examines the impact of extreme blood pressure lability on vascular cognitive impairment (VCI) in individuals with spinal cord injury (SCI). It highlights the potential mechanisms by which chronic hypotension and hypertension, common in SCI patients, can lead to devastating impairments in cerebrovascular health, drawing comparisons with able-bodied individuals. The review concludes by discussing current and potential future therapies to manage blood pressure instability, possibly mitigating VCI in the SCI population.

Practical Implications

Clinical Management of BP Instability

Implement pharmacological and nonpharmacological strategies to manage autonomic dysreflexia and orthostatic hypotension, reducing cardiovascular disease burden and decelerating VCI trajectory.

Future Research Directions

Conduct further research to develop effective strategies for preventing or ameliorating cognitive impairment in persons with SCI, improving independence and quality of life.

Neuromodulation Therapies

Explore neuromodulation strategies like epidural or transcutaneous spinal cord stimulation to modulate blood pressure and mitigate VCI, pending further systematic exploration.

Study Limitations

1
Preliminary evidence linking repeated autonomic dysreflexia with cognitive impairment following SCI.
2
Current pharmacotherapies for BP management are slow-acting and may lead to undesirable cardiovascular effects.
3
Need for more research to understand the precise mechanisms involved in cardiovascular and cognitive impairments following SCI.

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