1
|
Wang Z, Irving BA, Spielmann G, Johannsen N, Greenway F, Dalecki M. A single exposure to 100% normo-baric oxygen therapy appears to improve sequence learning processes by increasing prefrontal cortex oxygen saturation. Brain Res 2024; 1837:148962. [PMID: 38670479 DOI: 10.1016/j.brainres.2024.148962] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/09/2023] [Revised: 02/23/2024] [Accepted: 04/24/2024] [Indexed: 04/28/2024]
Abstract
Previously, we showed that a normo-baric 100 % oxygen treatment (NbOxTr) enhances motor learning processes, e.g., visuomotor adaptation (VMA) and sequence learning (SL). However, this work was limited to behavioral outcomes and did not identify the physiological mechanistic underpinnings of these improvements. Here, we expand on this research to investigate the effects of a NbOxTr on the oxygen tissue saturation index (TSI) level of the prefrontal cortex (PFC) when performing a SL task and whether potential SL improvements relate to increased TSI levels in the PFC. Twenty four right-handed young, healthy adults were randomly assigned to a NbOxTr group (normo-baric 100 % oxygen, n = 12) or a control group (normal air, n = 12). They received their respective treatments via a nasal cannula during the experiment. Oxygen TSI levels of the right and left PFC were measured via near-infrared spectroscopy (NIRS) throughout different SL task phases (Baseline, Training, Testing). The NbOxTr increased the TSI of the PFC in the Training phase (p < 0.01) and positively affected SL retention in the Testing phase (p < 0.05). We also found a positive correlation between TSI changes in the right PFC during the gas treatment phase (3.4 % increase) and response time (RT) improvements in the SL task training and retention phase (all p < 0.05). Our results suggest that a simple NbOxTr increases the oxygenated hemoglobin availability in the PFC, which appears to mediate the retention of acquired SL improvements in healthy young adults. Future studies should examine treatment-related oxygenation changes in other brain areas involved and their relation to enhanced learning processes. Whether this NbOxTr improves SL in neurologically impaired populations should also be examined.
Collapse
Affiliation(s)
- Zheng Wang
- School of Kinesiology, Louisiana State University, Baton Rouge, LA, USA; Department of Orthopedic Surgery, Mayo Clinic, Rochester, MN, USA.
| | - Brian A Irving
- School of Kinesiology, Louisiana State University, Baton Rouge, LA, USA; Pennington Biomedical Research Center, Baton Rouge, LA, USA
| | - Guillaume Spielmann
- School of Kinesiology, Louisiana State University, Baton Rouge, LA, USA; Pennington Biomedical Research Center, Baton Rouge, LA, USA
| | - Neil Johannsen
- School of Kinesiology, Louisiana State University, Baton Rouge, LA, USA; Pennington Biomedical Research Center, Baton Rouge, LA, USA
| | - Frank Greenway
- Pennington Biomedical Research Center, Baton Rouge, LA, USA
| | - Marc Dalecki
- School of Kinesiology, Louisiana State University, Baton Rouge, LA, USA; German University of Health and Sports, Berlin, Germany
| |
Collapse
|
2
|
Shali RK, Setarehdan SK, Seifi B. Functional near-infrared spectroscopy based blood pressure variations and hemodynamic activity of brain monitoring following postural changes: A systematic review. Physiol Behav 2024; 281:114574. [PMID: 38697274 DOI: 10.1016/j.physbeh.2024.114574] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/19/2023] [Revised: 04/03/2024] [Accepted: 04/26/2024] [Indexed: 05/04/2024]
Abstract
Postural change from supine or sitting to standing up leads to displacement of 300 to 1000 mL of blood from the central parts of the body to the lower limb, which causes a decrease in venous return to the heart, hence decrease in cardiac output, causing a drop in blood pressure. This may lead to falling down, syncope, and in general reducing the quality of daily activities, especially in the elderly and anyone suffering from nervous system disorders such as Parkinson's or orthostatic hypotension (OH). Among different modalities to study brain function, functional near-infrared spectroscopy (fNIRS) is a neuroimaging method that optically measures the hemodynamic response in brain tissue. Concentration changes in oxygenated hemoglobin (HbO2) and deoxygenated hemoglobin (HHb) are associated with brain neural activity. fNIRS is significantly more tolerant to motion artifacts compared to fMRI, PET, and EEG. At the same time, it is portable, has a simple structure and usage, is safer, and much more economical. In this article, we systematically reviewed the literature to examine the history of using fNIRS in monitoring brain oxygenation changes caused by sudden changes in body position and its relationship with the blood pressure changes. First, the theory behind brain hemodynamics monitoring using fNIRS and its advantages and disadvantages are presented. Then, a study of blood pressure variations as a result of postural changes using fNIRS is described. It is observed that only 58 % of the references concluded a positive correlation between brain oxygenation changes and blood pressure changes. At the same time, 3 % showed a negative correlation, and 39 % did not show any correlation between them.
Collapse
Affiliation(s)
- Roya Kheyrkhah Shali
- School of Electrical and Computer Engineering, College of Engineering, University of Tehran, Tehran, Iran.
| | - Seyed Kamaledin Setarehdan
- School of Electrical and Computer Engineering, College of Engineering, University of Tehran, Tehran, Iran
| | - Behjat Seifi
- Faculty of Medical Science, University of Tehran, Tehran, Iran
| |
Collapse
|
3
|
Klop M, Claassen JAHR, Floor-Westerdijk MJ, van Wezel RJA, Maier AB, Meskers CGM. Home-based monitoring of cerebral oxygenation in response to postural changes using near-infrared spectroscopy. GeroScience 2024:10.1007/s11357-024-01241-w. [PMID: 38890204 DOI: 10.1007/s11357-024-01241-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/07/2024] [Accepted: 06/04/2024] [Indexed: 06/20/2024] Open
Abstract
Orthostatic hypotension (OH) is prevalent in older adults and can cause falls and hospitalization. Diagnostic intermittent blood pressure (BP) measurements are only a proxy for cerebral perfusion and do not reflect daily-life BP fluctuations. Near-infrared spectroscopy (NIRS)-measured cerebral oxygenation potentially overcomes these drawbacks. This study aimed to determine feasibility, face validity, and reliability of NIRS in the home environment. Ten participants with OH (2 female, mean age 77, SD 3.7) and 11 without OH (5 female, mean age 78, SD 6.7) wore a NIRS sensor at home on two different days for 10-11 h per day. Preceded by a laboratory-situated test, cerebral oxygenation was measured during three standardized supine-stand tests per day and during unsupervised daily life activities. Data availability, quality, and user experience were assessed (feasibility), as well as differences in posture-related oxygenation responses between participants with and without OH and between symptomatic (dizziness, light-headedness, blurred vision) and asymptomatic postural changes (face validity). Reliability was assessed through repetitive supine-stand tests. Up to 80% of the standardized home-based supine-stand tests could be analyzed. Oxygenation recovery values were lower for participants with OH (p = 0 .03-0.15); in those with OH, oxygenation showed a deeper maximum drop for symptomatic than asymptomatic postural changes (p = 0.04). Intra-class correlation coefficients varied from 0.07 to 0.40, with no consistent differences over measurements. This proof-of-concept study shows feasibility and face validity of at-home oxygenation monitoring using NIRS, confirming its potential value for diagnosis and monitoring in OH and OH-related symptoms. Further data are needed for conclusions about reliability.
Collapse
Affiliation(s)
- Marjolein Klop
- Department of Neurobiology, Donders Institute for Brain, Cognition and Behaviour, Radboud University, Nijmegen, The Netherlands.
- Department of Geriatric Medicine, Radboud University Medical Center, Nijmegen, The Netherlands.
| | - Jurgen A H R Claassen
- Department of Geriatric Medicine, Radboud University Medical Center, Nijmegen, The Netherlands
- Department of Cardiovascular Sciences, University of Leicester, Leicester, UK
| | | | - Richard J A van Wezel
- Department of Neurobiology, Donders Institute for Brain, Cognition and Behaviour, Radboud University, Nijmegen, The Netherlands
- OnePlanet Research Center, Radboud University, Nijmegen, The Netherlands
- Department of Biomedical Signals and Systems, Technical Medical Centre, University of Twente, Enschede, The Netherlands
| | - Andrea B Maier
- Healthy Longevity Translational Research Program, Yong Loo Lin School of Medicine, National University of Singapore, Singapore, Singapore
- Centre for Healthy Longevity, @AgeSingapore, National University Health System, Singapore, Singapore
- Department of Human Movement Sciences, @AgeAmsterdam, Faculty of Behavioural and Movement Sciences, Amsterdam Movement Sciences, Vrije Universiteit Amsterdam, Amsterdam, The Netherlands
| | - Carel G M Meskers
- Department of Rehabilitation Medicine, Amsterdam UMC Location Vrije Universiteit Amsterdam, Amsterdam Movement Sciences, Amsterdam, The Netherlands
| |
Collapse
|
4
|
Min JY, Kim JB, Jeon JP, Chung MY, Kim YH, Kim CJ. Assessing different brain oxygenation components in elderly patients under propofol or sevoflurane anesthesia: A randomized controlled study. J Clin Anesth 2024; 97:111519. [PMID: 38870700 DOI: 10.1016/j.jclinane.2024.111519] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/06/2024] [Revised: 04/07/2024] [Accepted: 06/04/2024] [Indexed: 06/15/2024]
Abstract
STUDY OBJECTIVE Elderly patients undergoing pathophysiological changes necessitate clinical tools for cerebral monitoring. This prospective randomized controlled study aimed to explore how cerebral monitoring using Δo2Hbi, ΔHHbi, and ΔcHbi manifests in elderly patients under either propofol or sevoflurane anesthesia. DESIGN Single-center, prospective, randomization. SETTING A single tertiary hospital (Eunpyeong St. Mary's Hospital, College of Medicine, The Catholic University of Korea). PATIENTS Enrolled 100 patients scheduled for urologic surgery under general anesthesia. Inclusion criteria were (a) age 70-80 years, (b) American Society of Anesthesiologists (ASA) physical status I-II. INTERVENTION Patients were double-blind randomized to receive propofol-based or sevoflurane anesthesia. Cerebral oximetry-related parameters were measured at 5, 10, 15, 20, and 30 min in a setting devoid of surgery-related factors. MEASUREMENTS The primary outcome focused on the Δo2Hbi pattern in the left and right sides within the propofol and sevoflurane groups. MAIN RESULTS We analyzed 100 patients, 50 patients in each group. In the propofol group, the left Δo2Hbi decreased from 1.4 (3.7) at 5 min to -0.1 (1.8) at 30 min (P < 0.0001), and the right Δo2Hbi decreased from 2.9 (4.2) at 5 min to -0.06 (2.3) at 30 min (P < 0.0001). In the sevoflurane group, the left Δo2Hbi decreased from 1.1 (3.4) at 5 min to -1.4 (4.4) at 30 min (P < 0.0001), and the right Δo2Hbi decreased from 2.0 (3.2) at 5 min to -1.2 (3.9) at 30 min (P < 0.0001). There were no significant differences between the two groups. ΔHHbi did not exhibit significant changes after an initial decrease at 5 min and showed no significant differences between the two groups. CONCLUSIONS In cerebral oximetry, Δo2Hbi and ΔHHbi could emerge as a valuable approach for discerning changes in the underlying baseline status of the brain in elderly patients during anesthesia.
Collapse
Affiliation(s)
- Ji Young Min
- Department of Anesthesiology and Pain Medicine, Eunpyeong St. Mary's Hospital, College of Medicine, The Catholic University of Korea, 1021 Tongil-ro, Eunpyeong-gu, Seoul 03312, Republic of Korea
| | - Joong Baek Kim
- Department of Anesthesiology and Pain Medicine, Eunpyeong St. Mary's Hospital, College of Medicine, The Catholic University of Korea, 1021 Tongil-ro, Eunpyeong-gu, Seoul 03312, Republic of Korea
| | - Joon Pyo Jeon
- Department of Anesthesiology and Pain Medicine, Eunpyeong St. Mary's Hospital, College of Medicine, The Catholic University of Korea, 1021 Tongil-ro, Eunpyeong-gu, Seoul 03312, Republic of Korea
| | - Mee Young Chung
- Department of Anesthesiology and Pain Medicine, Eunpyeong St. Mary's Hospital, College of Medicine, The Catholic University of Korea, 1021 Tongil-ro, Eunpyeong-gu, Seoul 03312, Republic of Korea
| | - Yoon Hee Kim
- Department of Anesthesiology and Pain Medicine, Chungnam National Hospital, College of Medicine, The Chungnam National University of Korea, 282, Munhwa-ro, Jung-gu, Daejeon 35015, Republic of Korea.
| | - Chang Jae Kim
- Department of Anesthesiology and Pain Medicine, Eunpyeong St. Mary's Hospital, College of Medicine, The Catholic University of Korea, 1021 Tongil-ro, Eunpyeong-gu, Seoul 03312, Republic of Korea.
| |
Collapse
|
5
|
Klop M, de Heus RAA, Maier AB, van Alphen A, Floor-Westerdijk MJ, Bronkhorst M, Melis RJF, Meskers CGM, Claassen JAHR, van Wezel RJA. Capturing postural blood pressure dynamics with near-infrared spectroscopy-measured cerebral oxygenation. GeroScience 2023; 45:2643-2657. [PMID: 37041313 PMCID: PMC10651596 DOI: 10.1007/s11357-023-00791-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/20/2023] [Accepted: 03/31/2023] [Indexed: 04/13/2023] Open
Abstract
Orthostatic hypotension (OH) is highly prevalent in older adults and associated with dizziness, falls, lower physical and cognitive function, cardiovascular disease, and mortality. OH is currently diagnosed in a clinical setting with single-time point cuff measurements. Continuous blood pressure (BP) devices can measure OH dynamics but cannot be used for daily life monitoring. Near-infrared spectroscopy (NIRS) has potential diagnostic value in measuring cerebral oxygenation continuously over a longer time period, but this needs further validation. This study aimed to compare NIRS-measured (cerebral) oxygenation with continuous BP and transcranial Doppler-measured cerebral blood velocity (CBv) during postural changes. This cross-sectional study included 41 participants between 20 and 88 years old. BP, CBv, and cerebral (long channels) and superficial (short channels) oxygenated hemoglobin (O2Hb) were measured continuously during various postural changes. Pearson correlations between BP, CBv, and O2Hb were calculated over curves and specific characteristics (maximum drop amplitude and recovery). BP and O2Hb only showed good curve-based correlations (0.58-0.75) in the initial 30 s after standing up. Early (30-40 s) and 1-min BP recovery associated significantly with O2Hb, but no consistent associations were found for maximum drop amplitude and late (60-175 s) recovery values. Associations between CBv and O2Hb were poor, but stronger for long-channel than short-channel measurements. BP associated well with NIRS-measured O2Hb in the first 30 s after postural change. Stronger associations for CBv with long-channel O2Hb suggest that long-channel NIRS specifically reflects cerebral blood flow during postural transitions, necessary to better understand the consequences of OH such as intolerance symptoms.
Collapse
Affiliation(s)
- Marjolein Klop
- Department of Biophysics, Donders Institute for Brain, Cognition and Behaviour, Radboud University, Nijmegen, the Netherlands.
- Department of Geriatric Medicine, Radboud University Medical Center, Nijmegen, the Netherlands.
| | - Rianne A A de Heus
- Department of Geriatric Medicine, Radboud University Medical Center, Nijmegen, the Netherlands
- Department of Primary and Community Care, Radboud University Medical Center, Nijmegen, the Netherlands
| | - Andrea B Maier
- Department of Human Movement Sciences, @AgeAmsterdam, Amsterdam Movement Sciences, Vrije Universiteit Amsterdam, Amsterdam, the Netherlands
- Healthy Longevity Translational Research Program, Yong Loo Lin School of Medicine, National University of Singapore, Singapore, Singapore
- Centre for Healthy Longevity, @AgeSingapore, National University Health System, Singapore, Singapore
| | - Anne van Alphen
- Department of Geriatric Medicine, Radboud University Medical Center, Nijmegen, the Netherlands
| | | | | | - René J F Melis
- Department of Geriatric Medicine, Radboud University Medical Center, Nijmegen, the Netherlands
| | - Carel G M Meskers
- Department of Rehabilitation Medicine, Amsterdam Movement Sciences, Amsterdam University Medical Center, Amsterdam, the Netherlands
| | - Jurgen A H R Claassen
- Department of Geriatric Medicine, Radboud University Medical Center, Nijmegen, the Netherlands
- Department of Cardiovascular Sciences, University of Leicester, Leicester, UK
| | - Richard J A van Wezel
- Department of Biophysics, Donders Institute for Brain, Cognition and Behaviour, Radboud University, Nijmegen, the Netherlands
- Department of Biomedical Signals and Systems, Technical Medical Centre, University of Twente, Enschede, the Netherlands
| |
Collapse
|
6
|
Lv H, Xiong C, Wu B, Lan Z, Xu D, Duan D, Huang X, Guo J, Yu S. Effects of targeted mild hypercapnia versus normocapnia on cerebral oxygen saturation in patients undergoing laparoscopic hepatectomy under low central venous pressure: a prospective, randomized controlled study. BMC Anesthesiol 2023; 23:257. [PMID: 37525100 PMCID: PMC10388477 DOI: 10.1186/s12871-023-02220-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/06/2023] [Accepted: 07/26/2023] [Indexed: 08/02/2023] Open
Abstract
BACKGROUND Laparoscopic hepatectomy under low central venous pressure (LCVP) is associated with intraoperative organ hypoperfusion, including cerebral hypoperfusion. We hypothesized that a ventilation strategy designed to achieve targeted mild hypercapnia (TMH) (end-tidal carbon dioxide partial pressure [PetCO2] of 45 ± 5 mmHg) rather than targeted normocapnia (TN) (PetCO2 of 30 ± 5 mmHg) would increase regional cerebral oxygen saturation (rSO2) during laparoscopic hepatectomy under LCVP. METHODS Eighty patients undergoing laparoscopic hepatectomy under LCVP were randomly divided into the TMH group (n = 40) and the TN group (n = 40). Mechanical ventilation was adjusted to maintain the PetCO2 within the relevant range. Cerebral oxygenation was monitored continuously using the FORE-SIGHT system before anesthetic induction until the patient left the operating room. Patient and surgical characteristics, rSO2, intraoperative hemodynamic parameters (CVP, mean artery blood pressure [MAP], and heart rate), PetCO2, intraoperative blood gas analysis results, and postoperative complications were recorded. RESULTS No significant differences were observed in CVP, MAP, and heart rate between the two groups during surgery. The rSO2 was significantly lower in the TN group on both the left and right sides during the intraoperative period (P < 0.05), while the TMH group had a stable rSO2. In the TN group, the mean rSO2 decreased most during liver parenchymal transection when compared with the baseline value (P < 0.05). The mean (standard deviation) percentage change in rSO2 from baseline to parenchymal transection was - 7.5% (4.8%) on the left and - 7.1% (4.6%) on the right. The two groups had a similar incidence of postoperative complications (P > 0.05). CONCLUSION Our findings demonstrate that rSO2 is better maintained during laparoscopic hepatectomy under LCVP when patients are ventilated to a PetCO2 of 45 ± 5 mmHg (TMH) than a PetCO2 of 30 ± 5 mmHg (TN). TRIAL REGISTRATION ChiCTR2100051130(14/9/2021).
Collapse
Affiliation(s)
- Huayan Lv
- Department of Anesthesiology, Jinhua Hospital Affiliated to Zhejiang University School of Medicine, Jinhua, Zhejiang Province, People's Republic of China
| | - Chang Xiong
- Department of Anesthesiology, Jinhua Hospital Affiliated to Zhejiang University School of Medicine, Jinhua, Zhejiang Province, People's Republic of China
| | - Bo Wu
- Department of Hepatological Surgery, Jinhua Hospital Affiliated to Zhejiang University School of Medicine, Jinhua, Zhejiang Province, People's Republic of China
| | - Zhijian Lan
- Department of Anesthesiology, Jinhua Hospital Affiliated to Zhejiang University School of Medicine, Jinhua, Zhejiang Province, People's Republic of China
| | - Duojia Xu
- Department of Anesthesiology, Jinhua Hospital Affiliated to Zhejiang University School of Medicine, Jinhua, Zhejiang Province, People's Republic of China
| | - Dingnan Duan
- Department of Anesthesiology, Jinhua Hospital Affiliated to Zhejiang University School of Medicine, Jinhua, Zhejiang Province, People's Republic of China
| | - Xiaoxia Huang
- Department of Anesthesiology, Jinhua Hospital Affiliated to Zhejiang University School of Medicine, Jinhua, Zhejiang Province, People's Republic of China
| | - Jun Guo
- Department of Anesthesiology, Jinhua Hospital Affiliated to Zhejiang University School of Medicine, Jinhua, Zhejiang Province, People's Republic of China.
| | - Shian Yu
- Department of Hepatological Surgery, Jinhua Hospital Affiliated to Zhejiang University School of Medicine, Jinhua, Zhejiang Province, People's Republic of China.
| |
Collapse
|
7
|
Pérez-Denia L, Claffey P, O'Reilly A, Delgado-Ortet M, Rice C, Kenny RA, Finucane C. Cerebral Oxygenation Responses to Standing in Young Patients with Vasovagal Syncope. J Clin Med 2023; 12:4202. [PMID: 37445237 DOI: 10.3390/jcm12134202] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/13/2023] [Revised: 06/05/2023] [Accepted: 06/07/2023] [Indexed: 07/15/2023] Open
Abstract
Vasovagal syncope (VVS) is common in young adults and is attributed to cerebral hypoperfusion. However, during active stand (AS) testing, only peripheral and not cerebral hemodynamic responses are measured. We sought to determine whether cerebral oxygenation responses to an AS test were altered in young VVS patients when compared to the young healthy controls. A sample of young healthy adults and consecutive VVS patients attending a Falls and Syncope unit was recruited. Continuous beat-to-beat blood pressure (BP), heart rate, near-infrared spectroscopy (NIRS)-derived tissue saturation index (TSI), and changes in concentration of oxygenated/deoxygenated Δ[O2Hb]/Δ[HHb] hemoglobin were measured. BP and NIRS-derived features included nadir, peak, overshoot, trough, recovery rate, normalized recovery rate, and steady-state. Multivariate linear regression was used to adjust for confounders and BP. In total, 13 controls and 27 VVS patients were recruited. While no significant differences were observed in the TSI and Δ[O2Hb], there was a significantly smaller Δ[HHb] peak-to-trough and faster Δ[HHb] recovery rate in VVS patients, independent of BP. A higher BP steady-state was observed in patients but did not remain significant after multiple comparison correction. Young VVS patients demonstrated a similar cerebral circulatory response with signs of altered peripheral circulation with respect to the controls, potentially due to a hyper-reactive autonomic nervous system. This study sets the grounds for future investigations to understand the role of cerebral regulation during standing in VVS.
Collapse
Affiliation(s)
- Laura Pérez-Denia
- School of Medicine, Trinity College Dublin, D02 K6K6 Dublin, Ireland
- Mercer's Institute for Successful Ageing, St. James's Hospital Dublin, D08 TYF3 Dublin, Ireland
- Department of Medical Physics, Mercer's Institute for Successful Ageing, St. James's Hospital Dublin, D08 C9X2 Dublin, Ireland
| | - Paul Claffey
- School of Medicine, Trinity College Dublin, D02 K6K6 Dublin, Ireland
- Mercer's Institute for Successful Ageing, St. James's Hospital Dublin, D08 TYF3 Dublin, Ireland
| | - Ailbhe O'Reilly
- Mercer's Institute for Successful Ageing, St. James's Hospital Dublin, D08 TYF3 Dublin, Ireland
- Department of Bioengineering, School of Mechanical Engineering, Trinity College Dublin, D02 PN40 Dublin, Ireland
| | | | - Ciara Rice
- Mercer's Institute for Successful Ageing, St. James's Hospital Dublin, D08 TYF3 Dublin, Ireland
| | - Rose Anne Kenny
- School of Medicine, Trinity College Dublin, D02 K6K6 Dublin, Ireland
- Mercer's Institute for Successful Ageing, St. James's Hospital Dublin, D08 TYF3 Dublin, Ireland
| | - Ciarán Finucane
- School of Medicine, Trinity College Dublin, D02 K6K6 Dublin, Ireland
- Mercer's Institute for Successful Ageing, St. James's Hospital Dublin, D08 TYF3 Dublin, Ireland
- Department of Medical Physics, Mercer's Institute for Successful Ageing, St. James's Hospital Dublin, D08 C9X2 Dublin, Ireland
| |
Collapse
|
8
|
Calderone A, Jarry S, Couture EJ, Brassard P, Beaubien-Souligny W, Momeni M, Liszkowski M, Lamarche Y, Shaaban-Ali M, Matta B, Rochon A, Lebon JS, Ayoub C, Martins MR, Courbe A, Deschamps A, Denault AY. Early Detection and Correction of Cerebral Desaturation With Noninvasive Oxy-Hemoglobin, Deoxy-Hemoglobin, and Total Hemoglobin in Cardiac Surgery: A Case Series. Anesth Analg 2022; 135:1304-1314. [PMID: 36097147 DOI: 10.1213/ane.0000000000006155] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/20/2023]
Abstract
Regional cerebral oxygen saturation (rS o2 ) obtained from near-infrared spectroscopy (NIRS) provides valuable information during cardiac surgery. The rS o2 is calculated from the proportion of oxygenated to total hemoglobin in the cerebral vasculature. Root O3 cerebral oximetry (Masimo) allows for individual identification of changes in total (ΔcHbi), oxygenated (Δ o2 Hbi), and deoxygenated (ΔHHbi) hemoglobin spectral absorptions. Variations in these parameters from baseline help identify the underlying mechanisms of cerebral desaturation. This case series represents the first preliminary description of Δ o2 Hbi, ΔHHbi, and ΔcHbi variations in 10 cardiac surgical settings. Hemoglobin spectral absorption changes can be classified according to 3 distinct variations of cerebral desaturation. Reduced cerebral oxygen content or increased cerebral metabolism without major blood flow changes is reflected by decreased Δ o2 Hbi, unchanged ΔcHbi, and increased ΔHHbi Reduced cerebral arterial blood flow is suggested by decreased Δ o2 Hbi and ΔcHbi, with variable ΔHHbi. Finally, acute cerebral congestion may be suspected with increased ΔHHbi and ΔcHbi with unchanged Δ o2 Hbi. Cerebral desaturation can also result from mixed mechanisms reflected by variable combination of those 3 patterns. Normal cerebral saturation can occur, where reduced cerebral oxygen content such as anemia is balanced by a reduction in cerebral oxygen consumption such as during hypothermia. A summative algorithm using rS o2 , Δ o2 Hbi, ΔHHbi, and ΔcHbi is proposed. Further explorations involving more patients should be performed to establish the potential role and limitations of monitoring hemoglobin spectral absorption signals.
Collapse
Affiliation(s)
- Alexander Calderone
- From the Department of Anesthesiology, Montreal Heart Institute, Université de Montréal, Montreal, Quebec, Canada
| | - Stéphanie Jarry
- From the Department of Anesthesiology, Montreal Heart Institute, Université de Montréal, Montreal, Quebec, Canada
| | - Etienne J Couture
- Departments of †Anesthesiology.,Medicine, Division of Intensive Care Medicine, Institut Universitaire de Cardiologie et de Pneumologie de Québec, Quebec, Quebec, Canada.,Institut Universitaire de Cardiologie et de Pneumologie de Quebec, Université Laval, Quebec, Quebec, Canada
| | - Patrice Brassard
- Institut Universitaire de Cardiologie et de Pneumologie de Quebec, Université Laval, Quebec, Quebec, Canada.,Department of Kinesiology, Faculty of Medicine, Université Laval, Quebec, Quebec, Canada
| | - William Beaubien-Souligny
- Department of Medicine, Division of Nephrology, Centre Hospitalier de l'Université de Montréal, Montreal, Quebec, Canada
| | - Mona Momeni
- Department of Acute Medicine, Cardiothoracic and Vascular Anesthesia Section, Cliniques Universitaires Saint-Luc, UC Louvain, Brussels, Belgium
| | - Mark Liszkowski
- Department of Medicine, Cardiology Division, Montreal Heart Institute, Université de Montréal, Montreal, Quebec, Canada.,Critical Care Division, Montreal Heart Institute, Université de Montréal, Montreal, Quebec, Canada
| | - Yoan Lamarche
- Critical Care Division, Montreal Heart Institute, Université de Montréal, Montreal, Quebec, Canada.,Department of Cardiac Surgery, Montreal Heart Institute, Université de Montréal, Montreal, Quebec, Canada
| | - Mohamed Shaaban-Ali
- Critical Care Division, Montreal Heart Institute, Université de Montréal, Montreal, Quebec, Canada
| | - Basil Matta
- Neurosciences Critical Care Unit, Addenbrooke's Hospital, Cambridge University Hospitals NHS Foundation Trust, Cambridge, United Kingdom
| | - Antoine Rochon
- From the Department of Anesthesiology, Montreal Heart Institute, Université de Montréal, Montreal, Quebec, Canada
| | - Jean-Sébastien Lebon
- From the Department of Anesthesiology, Montreal Heart Institute, Université de Montréal, Montreal, Quebec, Canada
| | - Christian Ayoub
- From the Department of Anesthesiology, Montreal Heart Institute, Université de Montréal, Montreal, Quebec, Canada
| | - Maria Rosal Martins
- From the Department of Anesthesiology, Montreal Heart Institute, Université de Montréal, Montreal, Quebec, Canada
| | - Athanase Courbe
- From the Department of Anesthesiology, Montreal Heart Institute, Université de Montréal, Montreal, Quebec, Canada
| | - Alain Deschamps
- From the Department of Anesthesiology, Montreal Heart Institute, Université de Montréal, Montreal, Quebec, Canada
| | - André Y Denault
- From the Department of Anesthesiology, Montreal Heart Institute, Université de Montréal, Montreal, Quebec, Canada.,Critical Care Division, Montreal Heart Institute, Université de Montréal, Montreal, Quebec, Canada
| |
Collapse
|
9
|
Somech N, Mizrahi T, Caspi Y, Axelrod V. Functional near-infrared spectroscopy imaging of the prefrontal cortex during a naturalistic comedy movie. Front Neurosci 2022; 16:913540. [PMID: 36161175 PMCID: PMC9493198 DOI: 10.3389/fnins.2022.913540] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/05/2022] [Accepted: 08/12/2022] [Indexed: 11/16/2022] Open
Abstract
Naturalistic stimulation (i.e., movies and auditory narratives of some minutes' length) has been a powerful approach to bringing more real-life experiences into laboratory experiments. Data-driven, intersubject correlation (ISC) analysis permits examining to what extent activity in a specific brain region correlates across participants during exposure to a naturalistic stimulus, as well as testing whether neural activity correlates with behavioral measures. Notably, most of the previous research with naturalistic stimuli was conducted using functional fMRI (fMRI). Here, we tested whether a naturalistic approach and the ISC are feasible using functional near-infrared spectroscopy (fNIRS) - the imaging method particularly suited for populations of patients and children. Fifty-three healthy adult participants watched twice a 3-min segment of a Charlie Chaplin movie while we recorded the brain activity on the surface of their prefrontal cortex using fNIRS. In addition, an independent group of 18 participants used a continuous scoring procedure to rate the extent to which they felt that different parts of the movie fragment were funny. Our two findings were as follows. First, we found higher-than-zero ISC in fNIRS signals in the prefrontal cortex lobes, a result that was particularly high in the oxygenated channels during the first repetition of the movie. Second, we found a significant negative correlation between oxygenated brain signals and ratings of the movie's humorousness. In a series of control analyses we demonstrated that this latter correlation could not be explained by various non-humor-related movie sensory properties (e.g., auditory volume and image brightness). The key overall outcome of the present study is that fNIRS in combination with the naturalistic paradigms and the ISC might be a sensitive and powerful research method to explore cognitive processing. Our results also suggest a potential role of the prefrontal cortex in humor appreciation.
Collapse
Affiliation(s)
- Noam Somech
- The Gonda Multidisciplinary Brain Research Center, Bar-Ilan University, Ramat Gan, Israel
| | - Tamar Mizrahi
- The Gonda Multidisciplinary Brain Research Center, Bar-Ilan University, Ramat Gan, Israel
- Head Injuries Rehabilitation Department, Sheba Medical Center, Ramat Gan, Israel
| | - Yael Caspi
- Department of Psychology, Bar-Ilan University, Ramat Gan, Israel
| | - Vadim Axelrod
- The Gonda Multidisciplinary Brain Research Center, Bar-Ilan University, Ramat Gan, Israel
| |
Collapse
|
10
|
Newman L, O'Connor JD, Nolan H, Reilly RB, Kenny RA. Age and sex related differences in orthostatic cerebral oxygenation: Findings from 2764 older adults in the Irish Longitudinal Study on Ageing (TILDA). Exp Gerontol 2022; 167:111903. [PMID: 35902001 DOI: 10.1016/j.exger.2022.111903] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/24/2021] [Revised: 04/29/2022] [Accepted: 07/19/2022] [Indexed: 11/18/2022]
Abstract
AIMS Cerebral hypoperfusion is implicated in the pathogenesis of associations between orthostatic hypotension and adverse outcome such as falls, cognitive impairment, depression, and mortality. Although the blood pressure response to orthostasis has been well studied there is a lack of information on orthostatic cerebrovascular responses in older populations. METHODS AND RESULTS We measured cerebral hemodynamics, utilizing near infrared spectroscopy, coupled with peripheral blood pressure during an active stand in a large population of well-phenotyped older adults (N = 2764). Multi-level mixed effect models were utilized to investigate associations with age and sex, as well as confounders including anti-hypertensive medications. Normative cerebral oxygenation responses were also modelled utilizing generalized additive models for location, scale, and shape (GAMLSS). Older age groups experienced larger initial drops in oxygenation and a slower recovery, and responses also differed by sex. The drop after standing ranged from -1.85 % (CI: -2.02 to -1.68) in the males aged 54-59 years vs -1.15 % (CI: -1.31 to -1.00 %) in females aged 54-59 years, to -2.67 % (CI: -3.01 to -2.33) in males aged ≥ 80 years vs -1.97 % (CI: -2.32 to -1.62) females aged ≥ 80 years. Reduced oxygenation levels were also evident in those taking anti-hypertensive medications. CONCLUSION Cerebral autoregulation is impaired with age, particularly in older women and those taking anti-hypertensives. SBP during the stand explained some of the age gradient in the late recovery stage of the stand for the oldest age group. Reported orthostatic symptoms did not correlate with hypoperfusion. Therefore, measures of orthostatic cerebral flow should be assessed in addition to peripheral BP in older patients irrespective of symptoms. Further studies are required to investigate the relationship between NIRS measurements and clinical outcomes such as falls, cognitive impairment and depression.
Collapse
Affiliation(s)
- Louise Newman
- The Irish Longitudinal Study on Ageing, Trinity College Dublin, Dublin 2, Ireland.
| | - John D O'Connor
- The Irish Longitudinal Study on Ageing, Trinity College Dublin, Dublin 2, Ireland
| | - Hugh Nolan
- The Irish Longitudinal Study on Ageing, Trinity College Dublin, Dublin 2, Ireland
| | - Richard B Reilly
- Trinity Centre for Biomedical Engineering, Trinity College Dublin, Dublin 2, Ireland
| | - Rose Anne Kenny
- The Irish Longitudinal Study on Ageing, Trinity College Dublin, Dublin 2, Ireland; Mercer's Institute for Successful Ageing, St James's Hospital, Dublin, Ireland
| |
Collapse
|
11
|
Desanlis J, Gordon D, Calveyrac C, Cottin F, Gernigon M. Intra- and Inter-Day Reliability of the NIRS Portamon Device after Three Induced Muscle Ischemias. SENSORS (BASEL, SWITZERLAND) 2022; 22:5165. [PMID: 35890846 PMCID: PMC9317239 DOI: 10.3390/s22145165] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 06/18/2022] [Revised: 07/06/2022] [Accepted: 07/07/2022] [Indexed: 06/15/2023]
Abstract
(1) Background: Near-infrared spectroscopy (NIRS) is an innovative and non-invasive technology used to investigate muscular oxygenation. The aim of this study is to assess the within- and between-session reliability of the NIRS Portamon (Artinis, Elst, Netherlands) device following three sets of induced muscle ischemia. (2) Methods: Depending on the experimental group (G1, G2 or G3), a cuff was inflated three times on the left upper arm to 50 mmHg (G1), systolic blood pressure (SBP) + 50 mmHg (G2) or 250 mmHg (G3). Maximum, minimum and reoxygenation rate values were assessed after each occlusion phase, using a Portamon device placed on the left brachioradialis. Reliability was assessed with intraclass correlation coefficient (ICC) value and ICC 95% confidence interval (CI-95%), coefficient of variation (CV) and standard error of measurement (SEM) (3) Results: Our results showed a good to excellent reliability for maximums and minimums within-session. However, the reoxygenation rate within sessions as well as measurements between sessions cannot predominantly show good reliability. (4) Conclusions: Multiple measurements of maximums and minimums within a single session appeared to be reliable which shows that only one measurement is necessary to assess these parameters. However, it is necessary to be cautious with a comparison of maximum, minimum and reoxygenation rate values between sessions.
Collapse
Affiliation(s)
- Julien Desanlis
- CIAMS, Université Paris-Saclay, CEDEX, 91405 Orsay, France; (C.C.); (F.C.); (M.G.)
- CIAMS, Université d’Orléans, 45067 Orléans, France
- Anglia Ruskin University, Cambridge CB1 1PT, UK;
| | - Dan Gordon
- Anglia Ruskin University, Cambridge CB1 1PT, UK;
| | - Camille Calveyrac
- CIAMS, Université Paris-Saclay, CEDEX, 91405 Orsay, France; (C.C.); (F.C.); (M.G.)
- CIAMS, Université d’Orléans, 45067 Orléans, France
| | - François Cottin
- CIAMS, Université Paris-Saclay, CEDEX, 91405 Orsay, France; (C.C.); (F.C.); (M.G.)
- CIAMS, Université d’Orléans, 45067 Orléans, France
| | - Marie Gernigon
- CIAMS, Université Paris-Saclay, CEDEX, 91405 Orsay, France; (C.C.); (F.C.); (M.G.)
- CIAMS, Université d’Orléans, 45067 Orléans, France
| |
Collapse
|
12
|
St-Amant G, Salzman T, Michaud L, Polskaia N, Fraser S, Lajoie Y. Hemodynamic responses of quiet standing simultaneously performed with different cognitive loads in older adults. Hum Mov Sci 2022; 82:102931. [DOI: 10.1016/j.humov.2022.102931] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/19/2021] [Revised: 01/12/2022] [Accepted: 01/26/2022] [Indexed: 11/04/2022]
|
13
|
Zhu Y, Sun F, Li C, Huang J, Hu M, Wang K, He S, Wu J. Acute effects of mindfulness-based intervention on athlete cognitive function: An fNIRS investigation. J Exerc Sci Fit 2022; 20:90-99. [PMID: 35154333 PMCID: PMC8804186 DOI: 10.1016/j.jesf.2022.01.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/26/2021] [Revised: 01/17/2022] [Accepted: 01/18/2022] [Indexed: 11/22/2022] Open
Abstract
BACKGROUND Mindfulness-based intervention (MBI) as a psychological treatment is adopted in the sports field, but its effect during competition has not been explored. This study investigated the acute effect of a brief MBI on athletes' cognitive function after a 45-min, lab-based soccer protocol. METHODS In a single-blind randomized counter-balanced crossover design, 17 male soccer players completed two main trials-an MBI trial and a control trial. The MBI trial was provided with a brief MBI after 45-min exercise; the control trial was instead assigned a travel-related audio to listen to at that time. In each main trial, cognitive function (i.e., Stroop task for inhibition; Corsi-block tapping task for working memory), salivary cortisol, blood lactate and mental fatigue were measured at baseline (pretest) and after the intervention (posttest). The cerebral oxygenation status was recorded using functional near-infrared spectroscopy during the cognitive function test. RESULTS The brief MBI improved working memory performance in terms of both reaction time (pre vs. post, P = 0.02, d = 0.71) and accuracy (pre vs. post, P = 0.009, d = 0.58), supported by eliciting increased oxyhemoglobin concentration in the prefrontal cortex of the brain. Whereas a slightly better cognitive performance for MBI trial than control trial at posttest (P = 0.37, d = 0.32) accompanied by a lower oxyhemoglobin concentration. A lower mental fatigue level (P = 0.05, d = 0.6) and lower cortisol concentration (P = 0.04, d = 0.65) were observed in the MBI trial than in the control trial after the intervention at posttest. The decreased cortisol concentration correlated with increased inhibition performance in the MBI trial. CONCLUSION The acute effect of MBI on athletes' mental fatigue and cortisol concentration was detected, and the beneficial effect on working memory was preliminarily supported. In general, MBI is recommended to be adopted at half-time of a soccer game.
Collapse
Affiliation(s)
- Yuxin Zhu
- Department of Health and Physical Education, The Education University of Hong Kong, Hong Kong SAR, China
| | - Fenghua Sun
- Department of Health and Physical Education, The Education University of Hong Kong, Hong Kong SAR, China
| | - Chunxiao Li
- School of Physical Education and Sports Science, South China Normal University, Guangzhou, China
| | - Junhao Huang
- Guangdong Provincial Key Laboratory of Sports and Health Promotion, Scientific Research Center, Guangzhou Sport University, Guangzhou, China
| | - Min Hu
- Guangdong Provincial Key Laboratory of Sports and Health Promotion, Scientific Research Center, Guangzhou Sport University, Guangzhou, China
| | - Kangle Wang
- Department of Health and Physical Education, The Education University of Hong Kong, Hong Kong SAR, China
| | - Shan He
- Department of Health and Physical Education, The Education University of Hong Kong, Hong Kong SAR, China
| | - Jiarui Wu
- Guangdong Provincial Key Laboratory of Sports and Health Promotion, Scientific Research Center, Guangzhou Sport University, Guangzhou, China
| |
Collapse
|
14
|
Mol A, Claassen JAHR, Maier AB, van Wezel RJA, Meskers CGM. Determinants of orthostatic cerebral oxygenation assessed using near-infrared spectroscopy. Auton Neurosci 2022; 238:102942. [PMID: 35124323 DOI: 10.1016/j.autneu.2022.102942] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/30/2021] [Revised: 11/18/2021] [Accepted: 01/16/2022] [Indexed: 11/26/2022]
Abstract
BACKGROUND To understand the relationship between blood pressure changes during standing up and clinical outcome, cerebral oxygenation needs to be measured, which may be performed using near-infrared spectroscopy (NIRS). However, the role of potential determinants of NIRS-derived orthostatic cerebral oxygenation, i.e., age, sex, type of postural change (i.e., standing up from sitting versus supine position), blood pressure (BP) and baroreflex sensitivity (BRS) is still unknown and needed to better interpret findings from studies using orthostatic NIRS measurements. METHODS 34 younger (median age 25 years, inter quartile range (IQR) 22-45) and 31 older adults (median age 77 years, IQR 72-81) underwent BP, BRS and NIRS measurements during standing up from sitting and supine position. Linear regression models were used to assess the potential determinant role of age, sex, type of postural change, BP and BRS in orthostatic cerebral oxygenation drop and recovery. Orthostatic cerebral oxygenation test-retest reliability was assessed using intra class correlations. RESULTS Younger age, male sex and standing up from supine compared to sitting position were positively associated with cerebral oxygenation drop; older age and standing up from sitting compared to supine position were associated with higher cerebral oxygenation recovery. Test-retest reliability was highest (ICC > 0.83) during standing up from supine position. CONCLUSION Based on the findings of this study, age, sex and type of postural change are significant determinants of NIRS-derived orthostatic cerebral oxygenation and should be taken into account in the interpretation of NIRS measurements. In the design of new studies, standing up from supine position is preferable (higher reliability) over standing up from sitting position.
Collapse
Affiliation(s)
- Arjen Mol
- Department of Human Movement Sciences, @AgeAmsterdam, Amsterdam Movement Sciences, Vrije Universiteit Amsterdam, Van der Boechorstraat 9, 1081 BT Amsterdam, the Netherlands; Department of Biophysics, Donders Institute for Brain, Cognition and Behaviour, Radboud University, Heijendaalseweg 135, 6525 AJ Nijmegen, the Netherlands.
| | - Jurgen A H R Claassen
- Department of Geriatric Medicine, Radboud University Medical Center, Reinier Postlaan 4, 6525 GC Nijmegen, the Netherlands
| | - Andrea B Maier
- Department of Human Movement Sciences, @AgeAmsterdam, Amsterdam Movement Sciences, Vrije Universiteit Amsterdam, Van der Boechorstraat 9, 1081 BT Amsterdam, the Netherlands; Department of Medicine and Aged Care, @AgeMelbourne, The University of Melbourne, The Royal Melbourne Hospital, City Campus, Level 6 North, 300 Grattan Street, Parkville, Victoria 3050, Australia; Yong Loo Lin School of Medicine, National University of Singapore, Centre for Healthy Longevity, National University Health System, 10 Medical Dr, Singapore 117597, Singapore
| | - Richard J A van Wezel
- Department of Biophysics, Donders Institute for Brain, Cognition and Behaviour, Radboud University, Heijendaalseweg 135, 6525 AJ Nijmegen, the Netherlands; Department of Biomedical Signals and Systems, Technical Medical Centre, University of Twente, Zuidhorst Building, P.O. Box 217, 7500 AE Enschede, the Netherlands
| | - Carel G M Meskers
- Department of Rehabilitation Medicine, Amsterdam UMC, Vrije Universiteit, Amsterdam Movement Sciences, P.O. Box 7057, 1007 MB Amsterdam, the Netherlands
| |
Collapse
|
15
|
Diagnostic criteria for initial orthostatic hypotension: a narrative review. Clin Auton Res 2021; 31:685-698. [PMID: 34677720 DOI: 10.1007/s10286-021-00833-2] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/30/2021] [Accepted: 10/13/2021] [Indexed: 12/20/2022]
Abstract
Abnormalities in orthostatic blood pressure changes upon active standing are associated with morbidity, mortality, and reduced quality of life. However, over the last decade, several population-based cohort studies have reported a remarkably high prevalence (between 25 and 70%) of initial orthostatic hypotension (IOH) among elderly individuals. This has raised the question as to whether the orthostatic blood pressure patterns in these community-dwelling elderly should truly be considered as pathological. If not, redefining of the systolic cutoff values for IOH (i.e., a value ≥ 40 mmHg in systolic blood pressure in the first 15 s after standing up) might be necessary to differ between normal aging and true pathology. Therefore, in this narrative review, we provide a critical analysis of the current reference values for the changes in systolic BP in the first 60 s after standing up and discuss how these values should be applied to large population studies. We will address factors that influence the magnitude of the systolic blood pressure changes following active standing and the importance of standardization of the stand-up test, which is a prerequisite for quantitative, between-subject comparisons of the postural hemodynamic response.
Collapse
|
16
|
Rezende C, Oliveira GVD, Volino-Souza M, Castro P, Murias JM, Alvares TS. Turmeric root extract supplementation improves pre-frontal cortex oxygenation and blood volume in older males and females: a randomised cross-over, placebo-controlled study. Int J Food Sci Nutr 2021; 73:274-283. [PMID: 34551650 DOI: 10.1080/09637486.2021.1972411] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
Abstract
Ageing is associated with endothelial dysfunction and reduced cerebral blood flow and oxygenation. The present study aimed to investigate whether turmeric supplementation could improve cerebral oxygenation and blood volume during brain activation via dynamic handgrip exercise in older males and females. Twelve older males and females were studied using a double-blind, placebo-controlled, cross-over design. Participants ingested turmeric root extract or placebo. Heart rate and blood pressure were measured before and 2 hours after supplementation. Afterward, the exercise protocol was started, and cerebral oxygenation and blood volume were evaluated. During exercise, changes in cerebral oxygenation were higher after turmeric extract supplementation, as was blood volume compared to placebo. Changes in heart rate, systolic blood pressure, and diastolic blood pressure were not significant. The current findings indicate the potential for curcumin as an intervention for improving cerebral oxygenation and blood volume changes in older males and females. Clinical trial registry: NCT04119752.
Collapse
Affiliation(s)
- Cristina Rezende
- Nutrition and Exercise Metabolism Research Group, Federal University of Rio de Janeiro Campus Macaé, Rio de Janeiro, Brazil
| | - Gustavo Vieira de Oliveira
- Nutrition and Exercise Metabolism Research Group, Federal University of Rio de Janeiro Campus Macaé, Rio de Janeiro, Brazil
| | - Mônica Volino-Souza
- Nutrition and Exercise Metabolism Research Group, Federal University of Rio de Janeiro Campus Macaé, Rio de Janeiro, Brazil
| | - Patrícia Castro
- Nutrition and Exercise Metabolism Research Group, Federal University of Rio de Janeiro Campus Macaé, Rio de Janeiro, Brazil
| | | | - Thiago Silveira Alvares
- Nutrition and Exercise Metabolism Research Group, Federal University of Rio de Janeiro Campus Macaé, Rio de Janeiro, Brazil
| |
Collapse
|
17
|
O'Connor JD, O'Connell MDL, Knight SP, Newman L, Donoghue OA, Kenny RA. Impaired Stabilisation of Orthostatic Cerebral Oxygenation is Associated with Slower Gait Speed: Evidence from The Irish Longitudinal Study on Ageing. J Gerontol A Biol Sci Med Sci 2021; 77:1216-1221. [PMID: 34331759 PMCID: PMC9159662 DOI: 10.1093/gerona/glab219] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/02/2021] [Indexed: 11/25/2022] Open
Abstract
Background Cerebral autoregulation (CAR) systems maintain blood flow to the brain across a wide range of blood pressures. Deficits in CAR have been linked to gait speed (GS) but previous studies had small sample sizes and used specialized equipment which impede clinical translation. The purpose of this work was to assess the association between GS and orthostatic cerebral oxygenation in a large, community-dwelling sample of older adults. Method Data for this study came from the Irish Longitudinal Study on Ageing. A near-infrared spectroscopy (NIRS) device attached to the forehead of each participant (n = 2 708) was used to track tissue saturation index (TSI; the ratio of oxygenated to total hemoglobin) during standing. GS was assessed using a portable walkway. Results Recovery was impaired in slower GS participants with a TSI value at 20 seconds (after standing) of −0.55% (95% CI: −0.67, −0.42) below baseline in the slowest GS quartile versus −0.14% (95% CI: −0.25, −0.04) in the fastest quartile. Slower GS predicted a lower TSI throughout the 3-minute monitoring period. Results were not substantially altered by adjusting for orthostatic hypotension. Adjustment for clinical and demographic covariates attenuated the association between but differences remained between GS quartiles from 20 seconds to 3 minutes after standing. Conclusion This study reported evidence for impaired recovery of orthostatic cerebral oxygenation depending on GS in community-dwelling older adults. Future work assessing NIRS as a clinical tool for monitoring the relationship between GS and cerebral regulation is warranted.
Collapse
Affiliation(s)
- John D O'Connor
- The Irish Longitudinal Study on Ageing, University of Dublin, Trinity College, Ireland.,The Patrick G. Johnston Centre for Cancer Research, Queen's University Belfast, UK
| | - Matthew D L O'Connell
- Department of Population Health Sciences, School of Population Health and Environmental Sciences, King's College London, UK
| | - Silvin P Knight
- The Irish Longitudinal Study on Ageing, University of Dublin, Trinity College, Ireland
| | - Louise Newman
- The Irish Longitudinal Study on Ageing, University of Dublin, Trinity College, Ireland
| | - Orna A Donoghue
- The Irish Longitudinal Study on Ageing, University of Dublin, Trinity College, Ireland
| | - Rose Anne Kenny
- The Irish Longitudinal Study on Ageing, University of Dublin, Trinity College, Ireland
| |
Collapse
|
18
|
Whitson HE, Crabtree D, Pieper CF, Ha C, Au S, Berger M, Cohen HJ, Feld J, Smith P, Hall K, Parker D, Kraus VB, Kraus WE, Schmader K, Colón-Emeric C. A template for physical resilience research in older adults: Methods of the PRIME-KNEE study. J Am Geriatr Soc 2021; 69:3232-3241. [PMID: 34325481 DOI: 10.1111/jgs.17384] [Citation(s) in RCA: 11] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/15/2021] [Revised: 06/14/2021] [Accepted: 07/07/2021] [Indexed: 12/19/2022]
Abstract
BACKGROUND Older adults with similar health conditions often experience widely divergent outcomes following health stressors. Variable recovery after a health stressor may be due in part to differences in biological mechanisms at the molecular, cellular, or system level, that are elicited in response to stressors. We describe the PRIME-KNEE study as an example of ongoing research to validate provocative clinical tests and biomarkers that predict resilience to specific health stressors. METHODS PRIME-KNEE is an ongoing, prospective cohort study that will enroll 250 adults ≥60 years undergoing total knee arthroplasty. Data are collected at baseline (pre-surgery), during surgery, daily for 7 days after surgery, and at 1, 2, 4, and 6 months post-surgery. Provocative tests include a cognition-motor dual-task walking test, cerebrovascular reactivity assessed by functional near-infrared spectroscopy, peripheral blood mononuclear cell reactivity ex vivo to lipopolysaccharide toxin and influenza vaccine, and heart rate variability during surgery. Cognitive, psychological, and physical performance batteries are collected at baseline to estimate prestressor reserve. Demographics, medications, comorbidities, and stressor characteristics are abstracted from the electronic medical record and via participant interview. Blood-based biomarkers are collected at baseline and postoperative day 1. Repeated measures after surgery include items from a delirium assessment tool and pain scales administered daily by telephone for 7 days and cognitive change index (participant and informant), lower extremity activities of daily living, pain scales, and step counts assessed by Garmin actigraphy at 1, 2, 4, and 6 months after surgery. Statistical models use these measures to characterize resilience phenotypes and evaluate prestressor clinical indicators associated with poststressor resilience. CONCLUSION If PRIME-KNEE validates feasible clinical tests and biomarkers that predict recovery trajectories in older surgical patients, these tools may inform surgical decision-making, guide pre-habilitation efforts, and elucidate mechanisms underlying resilience. This study design could motivate future geriatric research on resilience.
Collapse
Affiliation(s)
- Heather E Whitson
- Duke University School of Medicine, Durham, North Carolina, USA.,Geriatric Research Education and Clinical Center, Durham VA Health System, Durham, North Carolina, USA
| | - Donna Crabtree
- Duke University School of Medicine, Durham, North Carolina, USA
| | - Carl F Pieper
- Duke University School of Medicine, Durham, North Carolina, USA.,Geriatric Research Education and Clinical Center, Durham VA Health System, Durham, North Carolina, USA
| | - Christine Ha
- Duke University School of Medicine, Durham, North Carolina, USA
| | - Sandra Au
- Duke University School of Medicine, Durham, North Carolina, USA
| | - Miles Berger
- Duke University School of Medicine, Durham, North Carolina, USA
| | - Harvey J Cohen
- Duke University School of Medicine, Durham, North Carolina, USA.,Geriatric Research Education and Clinical Center, Durham VA Health System, Durham, North Carolina, USA
| | - Jody Feld
- Duke University School of Medicine, Durham, North Carolina, USA
| | - Patrick Smith
- Duke University School of Medicine, Durham, North Carolina, USA
| | - Katherine Hall
- Duke University School of Medicine, Durham, North Carolina, USA.,Geriatric Research Education and Clinical Center, Durham VA Health System, Durham, North Carolina, USA
| | - Daniel Parker
- Duke University School of Medicine, Durham, North Carolina, USA
| | | | - William E Kraus
- Duke University School of Medicine, Durham, North Carolina, USA
| | - Kenneth Schmader
- Duke University School of Medicine, Durham, North Carolina, USA.,Geriatric Research Education and Clinical Center, Durham VA Health System, Durham, North Carolina, USA
| | - Cathleen Colón-Emeric
- Duke University School of Medicine, Durham, North Carolina, USA.,Geriatric Research Education and Clinical Center, Durham VA Health System, Durham, North Carolina, USA
| |
Collapse
|
19
|
Laursen JC, Clemmensen KKB, Hansen CS, Diaz LJ, Bordino M, Groop PH, Frimodt-Moller M, Bernardi L, Rossing P. Persons with type 1 diabetes have low blood oxygen levels in the supine and standing body positions. BMJ Open Diabetes Res Care 2021; 9:9/1/e001944. [PMID: 34059524 PMCID: PMC8169468 DOI: 10.1136/bmjdrc-2020-001944] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/12/2020] [Accepted: 05/09/2021] [Indexed: 12/30/2022] Open
Abstract
INTRODUCTION Blood oxygen saturation is low compared with healthy controls (CONs) in the supine body position in individuals with type 1 diabetes (T1D) and has been associated with complications. Since most of daily life occurs in the upright position, it is of interest if this also applies in the standing body position. In addition, tissue oxygenation in other anatomical sites could show different patterns in T1D. Therefore, we investigated blood, arm and forehead oxygen levels in the supine and standing body positions in individuals with T1D (n=129) and CONs (n=55). RESEARCH DESIGN AND METHODS Blood oxygen saturation was measured with pulse oximetry. Arm and forehead mixed tissue oxygen levels were measured with near-infrared spectroscopy sensors applied on the skin. RESULTS Data are presented as least squares means±SEM and differences (95% CIs). Overall blood oxygen saturation was lower in T1D (CON: 97.6%±0.2%; T1D: 97.0%±0.1%; difference: -0.5% (95% CI -0.9% to -0.0%); p=0.034). In all participants, blood oxygen saturation increased after standing up (supine: 97.1%±0.1%; standing: 97.6%±0.2%; difference: +0.6% (95% CI 0.4% to 0.8%); p<0.001). However, the increase was smaller in T1D compared with CON (CON supine: 97.3%±0.2%; CON standing: 98.0%±0.2%; T1D supine: 96.9%±0.2%; T1D standing: 97.2%±0.1%; difference between groups in the change: -0.4% (95% CI -0.6% to -0.2%); p<0.001). Arm oxygen saturation decreased in both groups after standing and more in those with T1D. Forehead oxygen saturation decreased in both groups after standing and there were no differences between the changes when comparing the groups. CONCLUSION Compared with CON, individuals with T1D exhibit possible detrimental patterns of tissue oxygen adaptation to standing, with preserved adaptation of forehead oxygenation. Further studies are needed to explore the consequences of these differences.
Collapse
Affiliation(s)
- Jens Christian Laursen
- Complications Research, Steno Diabetes Center Copenhagen, Copenhagen, Denmark
- Department of Clinical Medicine, University of Copenhagen, Copenhagen, Denmark
| | | | | | - Lars Jorge Diaz
- Clinical Epidemiology Research, Steno Diabetes Center Copenhagen, Copenhagen, Denmark
| | - Marco Bordino
- Complications Research, Steno Diabetes Center Copenhagen, Copenhagen, Denmark
| | - Per-Henrik Groop
- Department of Medicine, Division of Nephrology, Helsinki University Central Hospital, Helsinki, Finland
- Folkhälsan Institute of Genetics, Folkhälsan Research Center, University of Helsinki, Helsinki, Finland
- Research Program for Clinical and Molecular Medicine, Faculty of Medicine, University of Helsinki, Helsinki, Finland
- Department of Diabetes, Central Clinical School, Monash University, Melbourne, Victoria, Australia
| | | | - Luciano Bernardi
- Complications Research, Steno Diabetes Center Copenhagen, Copenhagen, Denmark
| | - Peter Rossing
- Complications Research, Steno Diabetes Center Copenhagen, Copenhagen, Denmark
- Department of Clinical Medicine, University of Copenhagen, Copenhagen, Denmark
| |
Collapse
|
20
|
Cerebral autoregulation assessed by near-infrared spectroscopy: validation using transcranial Doppler in patients with controlled hypertension, cognitive impairment and controls. Eur J Appl Physiol 2021; 121:2165-2176. [PMID: 33860383 PMCID: PMC8260523 DOI: 10.1007/s00421-021-04681-w] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/12/2020] [Accepted: 04/02/2021] [Indexed: 01/05/2023]
Abstract
PURPOSE Cerebral autoregulation (CA) aims to attenuate the effects of blood pressure variation on cerebral blood flow. This study assessed the criterion validity of CA derived from near-infrared spectroscopy (NIRS) as an alternative for Transcranial Doppler (TCD). METHODS Measurements of continuous blood pressure (BP), oxygenated hemoglobin (O2Hb) using NIRS and cerebral blood flow velocity (CBFV) using TCD (gold standard) were performed in 82 controls, 27 patients with hypertension and 94 cognitively impaired patients during supine rest (all individuals) and repeated sit to stand transitions (cognitively impaired patients). The BP-CBFV and BP-O2Hb transfer function phase shifts (TFφ) were computed as CA measures. Spearman correlations (ρ) and Bland Altman limits of agreement (BAloa) between NIRS- and TCD-derived CA measures were computed. BAloa separation < 50° was considered a high absolute agreement. RESULTS NIRS- and TCD-derived CA estimates were significantly correlated during supine rest (ρ = 0.22-0.30, N = 111-120) and repeated sit-to-stand transitions (ρ = 0.46-0.61, N = 19-32). BAloa separation ranged between 87° and 112° (supine rest) and 65°-77° (repeated sit to stand transitions). CONCLUSION Criterion validity of NIRS-derived CA measures allows for comparison between groups but was insufficient for clinical application in individuals.
Collapse
|
21
|
Harms MPM, Finucane C, Pérez-Denia L, Juraschek SP, van Wijnen VK, Lipsitz LA, van Lieshout JJ, Wieling W. Systemic and cerebral circulatory adjustment within the first 60 s after active standing: An integrative physiological view. Auton Neurosci 2021; 231:102756. [PMID: 33385733 PMCID: PMC8103784 DOI: 10.1016/j.autneu.2020.102756] [Citation(s) in RCA: 18] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/30/2020] [Revised: 10/30/2020] [Accepted: 11/22/2020] [Indexed: 02/07/2023]
Abstract
Transient cardiovascular and cerebrovascular responses within the first minute of active standing provide the means to assess autonomic, cardiovascular and cerebrovascular regulation using a real-world everyday stimulus. Traditionally, these responses have been used to detect autonomic dysfunction, and to identify the hemodynamic correlates of patient symptoms and attributable causes of (pre)syncope and falls. This review addresses the physiology of systemic and cerebrovascular adjustment within the first 60 s after active standing. Mechanical factors induced by standing up cause a temporal mismatch between cardiac output and vascular conductance which leads to an initial blood pressure drops with a nadir around 10 s. The arterial baroreflex counteracts these initial blood pressure drops, but needs 2-3 s to be initiated with a maximal effect occurring at 10 s after standing while, in parallel, cerebral autoregulation buffers these changes within 10 s to maintain adequate cerebral perfusion. Interestingly, both the magnitude of the initial drop and these compensatory mechanisms are thought to be quite well-preserved in healthy aging. It is hoped that the present review serves as a reference for future pathophysiological investigations and epidemiological studies. Further experimental research is needed to unravel the causal mechanisms underlying the emergence of symptoms and relationship with aging and adverse outcomes in variants of orthostatic hypotension.
Collapse
Affiliation(s)
- Mark P M Harms
- Department of Internal Medicine, University Medical Center Groningen, University of Groningen, Groningen, the Netherlands
| | - Ciáran Finucane
- Department of Medical Physics & Bioengineering, Mercer's Institute for Successful Ageing, St James's Hospital, Dublin 8, Ireland; Department of Medical Gerontology, School of Medicine, Trinity College Dublin, Ireland
| | - Laura Pérez-Denia
- Department of Medical Physics & Bioengineering, Mercer's Institute for Successful Ageing, St James's Hospital, Dublin 8, Ireland; Department of Medical Gerontology, School of Medicine, Trinity College Dublin, Ireland
| | - Stephen P Juraschek
- Beth Israel Deaconess Medical Center and Harvard Medical School, Boston, MA, USA
| | - Veera K van Wijnen
- Department of Internal Medicine, University Medical Center Groningen, University of Groningen, Groningen, the Netherlands
| | - Lewis A Lipsitz
- Beth Israel Deaconess Medical Center and Harvard Medical School, Boston, MA, USA; Hinda and Arthur Marcus Institute for Aging Research, Hebrew Senior Life, Boston, MA, USA
| | - Johannes J van Lieshout
- Department of Internal Medicine, Academic Medical Center, University of Amsterdam, Amsterdam, the Netherlands; School of Life Sciences, The Medical School, MRC/Arthritis Research UK Centre for Musculoskeletal Ageing Research, Queen's Medical Centre, Nottingham, United Kingdom
| | - Wouter Wieling
- Department of Internal Medicine, Academic Medical Center, University of Amsterdam, Amsterdam, the Netherlands.
| |
Collapse
|
22
|
Orthostatic blood pressure recovery associates with physical performance, frailty and number of falls in geriatric outpatients. J Hypertens 2020; 39:101-106. [PMID: 32773650 PMCID: PMC7752240 DOI: 10.1097/hjh.0000000000002617] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/03/2022]
Abstract
Blood pressure (BP) recovery after orthostatic hypotension might be important to prevent cerebral hypoperfusion episodes in older adults, and be related to better clinical outcome. The objective was to study the relationship between BP recovery and clinical outcome, that is physical and cognitive performance, frailty and falls, in geriatric outpatients.
Collapse
|
23
|
O'Connor JD, O'Connell MDL, Romero-Ortuno R, Hernández B, Newman L, Reilly RB, Kenny RA, Knight SP. Functional Analysis of Continuous, High-Resolution Measures in Aging Research: A Demonstration Using Cerebral Oxygenation Data From the Irish Longitudinal Study on Aging. Front Hum Neurosci 2020; 14:261. [PMID: 32765238 PMCID: PMC7379867 DOI: 10.3389/fnhum.2020.00261] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/18/2020] [Accepted: 06/12/2020] [Indexed: 12/16/2022] Open
Abstract
Background: A shift towards the dynamic measurement of physiologic resilience and improved technology incorporated into experimental paradigms in aging research is producing high-resolution data. Identifying the most appropriate analysis method for this type of data is a challenge. In this work, the functional principal component analysis (fPCA) was employed to demonstrate a data-driven approach to the analysis of high-resolution data in aging research. Methods: Cerebral oxygenation during standing was measured in a large cohort [The Irish Longitudinal Study on Aging (TILDA)]. FPCA was performed on tissue saturation index (TSI) data. A regression analysis was then conducted with the functional principal component (fPC) scores as the explanatory variables and transition time as the response. Results: The mean ± SD age of the analysis sample was 64 ± 8 years. Females made up 54% of the sample and overall, 43% had tertiary education. The first PC explained 96% of the variance in cerebral oxygenation upon standing and was related to a baseline shift. Subsequent components described the recovery to before-stand levels (fPC2), drop magnitude and initial recovery (fPC3 and fPC4) as well as a temporal shift in the location of the minimum TSI value (fPC5). Transition time was associated with components describing the magnitude and timing of the nadir. Conclusions: Application of fPCA showed utility in reducing a large amount of data to a small number of parameters which summarize the inter-participant variation in TSI upon standing. A demonstration of principal component regression was provided to allow for continued use and development of data-driven approaches to high-resolution data analysis in aging research.
Collapse
Affiliation(s)
- John D O'Connor
- The Irish Longitudinal Study on Aging, Trinity College, The University of Dublin, Dublin, Ireland
| | - Matthew D L O'Connell
- The Irish Longitudinal Study on Aging, Trinity College, The University of Dublin, Dublin, Ireland.,Department of Population Health Sciences, King's College London, London, United Kingdom
| | - Roman Romero-Ortuno
- The Irish Longitudinal Study on Aging, Trinity College, The University of Dublin, Dublin, Ireland.,The Global Brain Health Institute, Trinity College, The University of Dublin, Dublin, Ireland
| | - Belinda Hernández
- The Irish Longitudinal Study on Aging, Trinity College, The University of Dublin, Dublin, Ireland
| | - Louise Newman
- The Irish Longitudinal Study on Aging, Trinity College, The University of Dublin, Dublin, Ireland
| | - Richard B Reilly
- Trinity Centre for Biomedical Engineering, Trinity College, The University of Dublin, Dublin, Ireland
| | - Rose Anne Kenny
- The Irish Longitudinal Study on Aging, Trinity College, The University of Dublin, Dublin, Ireland
| | - Silvin P Knight
- The Irish Longitudinal Study on Aging, Trinity College, The University of Dublin, Dublin, Ireland
| |
Collapse
|
24
|
Mol A, Maier AB, van Wezel RJA, Meskers CGM. Multimodal Monitoring of Cardiovascular Responses to Postural Changes. Front Physiol 2020; 11:168. [PMID: 32194438 PMCID: PMC7063121 DOI: 10.3389/fphys.2020.00168] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/07/2019] [Accepted: 02/13/2020] [Indexed: 12/13/2022] Open
Abstract
Background In the poorly understood relationship between orthostatic hypotension and falls, next to blood pressure (BP), baroreflex sensitivity (BRS) and cerebral autoregulation (CAR) may be key measures. The posture- and movement dependency of orthostatic hypotension requires continuous and unobtrusive monitoring. This may be possible using simultaneous photoplethysmography (PPG), electrocardiography (ECG), and near-infrared spectroscopy (NIRS) signal recordings, from which pulse wave velocity (PWV; potentially useful for BP estimation), BRS and CAR can be derived. The PPG, NIRS and PWV signal correlation with BP and BRS/CAR reliability and validity need to be addressed. Methods In 34 healthy adults (mean age 25 years, inter quartile range 22–45; 10 female), wrist and finger PPG, ECG, bifrontal NIRS (oxygenated and deoxygenated hemoglobin) and continuous BP were recorded during sit to stand and supine to stand movements. Sixteen participants performed slow and rapid supine to stand movements; eighteen other participants performed a 1-min squat movement. Pulse wave velocity (PWV) was defined as the inverse of the ECG R-peak to PPG pulse delay; PPG, NIRS and PWV signal correlation with BP as their Pearson correlations with mean arterial pressure (MAP) within 30 s after the postural changes; BRS as inter beat interval drop divided by systolic BP (SBP) drop during the postural changes; CAR as oxygenated hemoglobin drop divided by MAP drop. BRS and CAR were separately computed using measured and estimated (linear regression) BP. BRS/CAR reliability was defined by the intra class correlation between repeats of the same postural change; validity as the Pearson correlation between BRS/CAR values based on measured and estimated BP. Results The highest correlation with MAP was found for finger PPG and oxygenated hemoglobin, ranging from 0.75–0.79 (sit to stand), 0.66–0.88 (supine to stand), and 0.82–0.94 (1-min squat). BRS and CAR reliability was highest during the different supine to stand movements, ranging from 0.17 – 0.49 (BRS) and 0.42-0.75 (CAR); validity was highest during rapid supine to stand movements, 0.54 and 0.79 respectively. Conclusion PPG-ECG-NIRS recordings showed high correlation with BP and enabled computation of reliable and valid BRS and CAR estimates, suggesting their potential for continuous unobtrusive monitoring of orthostatic hypotension key measures.
Collapse
Affiliation(s)
- Arjen Mol
- Department of Human Movement Sciences @AgeAmsterdam, Amsterdam Movement Sciences, Vrije Universiteit Amsterdam, Amsterdam, Netherlands.,Department of Biophysics, Donders Institute for Brain, Cognition and Behaviour, Radboud University, Nijmegen, Netherlands
| | - Andrea B Maier
- Department of Human Movement Sciences @AgeAmsterdam, Amsterdam Movement Sciences, Vrije Universiteit Amsterdam, Amsterdam, Netherlands.,Department of Medicine and Aged Care @AgeMelbourne, The Royal Melbourne Hospital, The University of Melbourne, Parkville, VIC, Australia
| | - Richard J A van Wezel
- Department of Biophysics, Donders Institute for Brain, Cognition and Behaviour, Radboud University, Nijmegen, Netherlands.,Department of Biomedical Signals and Systems, Technical Medical Centre, University of Twente, Enschede, Netherlands
| | - Carel G M Meskers
- Department of Human Movement Sciences @AgeAmsterdam, Amsterdam Movement Sciences, Vrije Universiteit Amsterdam, Amsterdam, Netherlands.,Department of Rehabilitation Medicine, Amsterdam UMC, Amsterdam Movement Sciences, Vrije Universiteit, Amsterdam, Netherlands
| |
Collapse
|
25
|
Ramstrand N, Rusaw DF, Möller SF. Transitioning to a microprocessor-controlled prosthetic knee: Executive functioning during single and dual-task gait. Prosthet Orthot Int 2020; 44:27-35. [PMID: 31826702 DOI: 10.1177/0309364619892773] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/03/2023]
Abstract
BACKGROUND Walking with a prosthesis requires substantial concentration on behalf of the user and places increased demands on executive functions. Little is known of the effects that prosthetic knee joint prescription may have on executive functioning. OBJECTIVES Evaluate executive functioning in trans-femoral prosthesis users during single and dual-task walking, before and after they transition to a Microprocessor-controlled prosthetic knee unit. STUDY DESIGN Multiple case-study design. METHODS Single and dual task gait was evaluated while recording cortical brain activity. Testing occasion 1 occurred prior to participants receiving their microprocessor-controlled prosthetic knee, while testing occasion 2 was conducted a minimum of 8 months after they had been fitted with an microprocessor-controlled prosthetic knee. RESULTS During single-task level walking and walking while performing a dual-task key finding test, executive functions, measured as the relative haemodynamic response in the frontal cortex, reduced for most, but not all participants after transitioning to an Microprocessor-controlled prosthetic knee. There did not appear to be any difference when participants performed a trail walk test. CONCLUSIONS Results suggest Microprocessor-controlled prosthetic knee prosthetic knees may have a positive effect on executive functioning for some individuals who have undergone a lower-limb amputation. A larger, longitudinal study with careful control of extraneous variables (e.g. age, training) is needed to confirm results and determine causality. CLINICAL RELEVANCE This article provides some evidence to suggest that prosthetic prescription may influence executive functioning and that microprocessor-controlled prosthetic knee mechanisms may reduce cognitive effort when walking.
Collapse
Affiliation(s)
| | - David F Rusaw
- Department of Rehabilitation, Jönköping University, Jönköping, Sweden
| | | |
Collapse
|
26
|
O'Connor JD, O'Connell MDL, Nolan H, Newman L, Knight SP, Kenny RA. Impact of Standing Speed on the Peripheral and Central Hemodynamic Response to Orthostasis: Evidence From the Irish Longitudinal Study on Ageing. Hypertension 2019; 75:524-531. [PMID: 31838912 DOI: 10.1161/hypertensionaha.119.14040] [Citation(s) in RCA: 19] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/28/2023]
Abstract
Assessment of the cerebrovascular and cardiovascular response to standing has prognostic value for a range of outcomes in the older adult population. Studies generally attempt to control for standing speed differences by asking participants to stand in a specified time but little is known about the range of transition times observed. This study aimed to characterize how standing speed associates with cardiovascular and cerebrovascular measures following transition from supine to standing. Continuous cerebral oxygenation, heart rate, systolic and diastolic blood pressure were monitored for 3 minutes after transitioning from supine to standing. An algorithm was used to calculate the time taken to transition from existing Finometer data (from the height correction unit). Linear mixed-effects models were used to assess the influence of transition time on each of the signals while adjusting for covariates. Transition time ranged from 2 to 27 s with 17% of participants taking >10 s to stand. Faster transition was associated with a more extreme decrease 10 s after standing but improved recovery at 20 s for cerebral oxygenation and blood pressure. Standing faster was associated with an elevated heart rate on initiation of stand and a quicker recovery 10 to 20 s after standing. The speed of transitioning from supine to standing position is associated with cardiovascular and cerebrovascular response in the early period after standing (<40 s). Care should be taken in the interpretation of findings which may be confounded by standing speed and statistical adjustment for standing time should be applied where appropriate.
Collapse
Affiliation(s)
- John D O'Connor
- From Department of Medical Gerontology, The Irish Longitudinal Study on Ageing, Trinity College, University of Dublin, Ireland (J.D.O., H.N., L.N., S.P.K., R.A.K.)
| | | | - Hugh Nolan
- From Department of Medical Gerontology, The Irish Longitudinal Study on Ageing, Trinity College, University of Dublin, Ireland (J.D.O., H.N., L.N., S.P.K., R.A.K.)
| | - Louise Newman
- From Department of Medical Gerontology, The Irish Longitudinal Study on Ageing, Trinity College, University of Dublin, Ireland (J.D.O., H.N., L.N., S.P.K., R.A.K.)
| | - Silvin P Knight
- From Department of Medical Gerontology, The Irish Longitudinal Study on Ageing, Trinity College, University of Dublin, Ireland (J.D.O., H.N., L.N., S.P.K., R.A.K.)
| | - Rose Anne Kenny
- From Department of Medical Gerontology, The Irish Longitudinal Study on Ageing, Trinity College, University of Dublin, Ireland (J.D.O., H.N., L.N., S.P.K., R.A.K.)
| |
Collapse
|