Dynamic cerebral autoregulation during cognitive task: effect of hypoxia

Sensitivity of cognitive function tests to acute hypoxia in healthy subjects: a systematic literature review

Acute exposure to hypoxia can lead to cognitive impairment. Therefore, hypoxia may become a safety concern for occupational or recreational settings at altitude. Cognitive tests are used as a tool to assess the degree to which hypoxia affects cognitive performance. However, so many different cognitive tests are used that comparing studies is challenging. This structured literature evaluation provides an overview of the different cognitive tests used to assess the effects of acute hypoxia on cognitive performance in healthy volunteers. Less frequently used similar cognitive tests were clustered and classified into domains. Subsequently, the different cognitive test clusters were compared for sensitivity to different levels of oxygen saturation. A total of 38 articles complied with the selection criteria, covering 86 different cognitive tests. The tests and clusters showed that the most consistent effects of acute hypoxia were found with the Stroop test (where 42% of studies demonstrated significant abnormalities). The most sensitive clusters were auditory/verbal memory: delayed recognition (83%); evoked potentials (60%); visual/spatial delayed recognition (50%); and sustained attention (47%). Attention tasks were not particularly sensitive to acute hypoxia (impairments in 0%-47% of studies). A significant hypoxia level-response relationship was found for the Stroop test (p = 0.001), as well as three clusters in the executive domain: inhibition (p = 0.034), reasoning/association (p = 0.019), and working memory (p = 0.024). This relationship shows a higher test sensitivity at more severe levels of hypoxia, predominantly below 80% saturation. No significant influence of barometric pressure could be identified in the limited number of studies where this was varied. This review suggests that complex and executive functions are particularly sensitive to hypoxia. Moreover, this literature evaluation provides the first step towards standardization of cognitive testing, which is crucial for a better understanding of the effects of acute hypoxia on cognition.

Respiratory training in older women: Unravelling central and peripheral hemodynamic slow oscillatory patterns

We hypothesized that inspiratory muscle training (IMT) increases the respiratory-induced low-frequency oscillations of mean blood pressure (MBP) and middle cerebral artery blood velocity (MCAv), upregulating cerebrovascular function in older women. Firstly, participants were recorded with free-breathing (FB) and then breathed at a slow-paced frequency (0.1 Hz; DB test) supported by sonorous metronome feedback. Blood pressure was recorded using finger photoplethysmography method, ECG, and respiration using a thoracic belt. To obtain the MCAv a transcranial ultrasound Doppler device was used. Spectral analysis of MBP, R-R intervals, and mean MCAv time series was obtained by an autoregressive model. The transfer function analysis (TFA) was employed to calculate the coherence, gain, and phase. After that, older women were enrolled in a randomized controlled protocol, the IMT-group (n = 8; 64 ± 3 years-old) performed IMT at 50 % of maximal inspiratory pressure (MIP), and Sham-group, a placebo training at 5 % MIP (Sham-group; n = 6; 66 ± 3 years-old). Participants breathed against an inspiratory resistance twice a day for 4-weeks. DB test is repeated post IMT and Sham interventions. IMT-group, compared to Sham-group, augmented tidal volume responses to DB (Sham-group 1.03 ± 0.41 vs. IMT-group 1.61 ± 0.56 L; p = 0.04), increased respiratory-induced MBP (Sham-group 26.37 ± 4.46 vs. IMT-group 48.21 ± 3.15 mmHg²; p = 0.04) and MCAv (Sham-group 14.16 ± 31.26 vs. IMT-group 79.90 ± 21.76 cm²s^-2; p = 0.03) slow oscillations, and reduced TFA gain (Sham-group 2.46 ± 1.32 vs. IMT-group 1.78 ± 1.30 cm·s^-1.mmHg^-1; p = 0.01). Our findings suggest that IMT increases the respiratory-induced oscillations in MBP and MCAv signals and reduces TFA gain. It seems compatible with an improved dynamic cerebrovascular regulation following IMT in older women.

Executive function during exercise is diminished by prolonged cognitive effort in men

The speed and accuracy of decision-making (i.e., executive function (EF) domains) is an integral factor in many sports. At rest, prolonged cognitive load (pCL) impairs reaction time (RT). In contrast, exercise improves RT and EF. We hypothesized that RT and EF during exercise would be diminished by prolonged 'dual tasking' as a consequence of pCL. To test the hypothesis, twenty healthy male participants performed four conditions [resting control (Rest), pCL only (pCL_Rest), exercise only (EX), and pCL + exercise (pCL_EX)] in a randomized-crossover design. Both exercise conditions utilized a 50-min cycling exercise protocol (60% VO₂ peak) and the pCL was achieved via a 50-min colour-word Stroop task (CWST). Compared with Rest, pCL_Rest caused a slowed CWST RT (P < 0.05) and a large SD (i.e., intraindividual variability) of CWST RT (P < 0.01). Similarly, compared with EX, the slowed CWST RT (P < 0.05) and large SD of CWST RT (P < 0.01) were also observed in pCL_EX. Whereas the reverse-Stroop interference was not affected in pCL_Rest (P = 0.46), it was larger (i.e., declined EF) in pCL_EX than EX condition (P < 0.05). These observations provide evidence that the effort of pCL impairs RT and EF even during exercise.

Validity of transcranial Doppler ultrasonography-determined dynamic cerebral autoregulation estimated using transfer function analysis

Transcranial Doppler ultrasonography (TCD) is used widely to evaluate dynamic cerebral autoregulation (dCA). However, the validity of TCD-determined dCA remains unknown because TCD is only capable of measuring blood velocity and thus only provides an index as opposed to true blood flow. To test the validity of TCD-determined dCA, in nine healthy subjects, dCA was evaluated by transfer function analysis (TFA) using cerebral blood flow (CBF) or TCD-measured cerebral blood velocity during a perturbation that induces reductions in TCD-determined dCA, lower body negative pressure (LBNP) at two different stages: LBNP - 15 mmHg and - 50 mmHg. Internal carotid artery blood flow (ICA Q) was assessed as an index of CBF using duplex Doppler ultrasound. The TFA low frequency (LF) normalized gain (ngain) calculated using ICA Q increased during LBNP at - 50 mmHg (LBNP50) from rest (P = 0.005) and LBNP at - 15 mmHg (LBNP15) (P = 0.015), indicating an impaired dCA. These responses were the same as those obtained using TCD-measured cerebral blood velocity (from rest and LBNP15; P = 0.001 and P = 0.015). In addition, the ICA Q-determined TFA LF ngain from rest to LBNP50 was significantly correlated with TCD-determined TFA LF ngain (r = 0.460, P = 0.016) despite a low intraclass correlation coefficient. Moreover, in the Bland-Altman analysis, the difference in the TFA LF ngains determined by blood flow and velocity was within the margin of error, indicating that the two measurement methods can be interpreted as equivalent. These findings suggest that TCD-determined dCA can be representative of actual dCA evaluated with CBF.

Orthostatic Resiliency During Successive Hypoxic, Hypoxic Orthostatic Challenge: Successful vs. Unsuccessful Cardiovascular and Oxygenation Strategies

Introduction: Rapid environmental changes, such as successive hypoxic-hypoxic orthostatic challenges (SHHOC) occur in the aerospace environment, and the ability to remain orthostatically resilient (OR) relies upon orchestration of physiological counter-responses. Counter-responses adjusting for hypoxia may conflict with orthostatic responses, and a misorchestration can lead to orthostatic intolerance (OI). The goal of this study was to pinpoint specific cardiovascular and oxygenation factors associated with OR during a simulated SHHOC.

Methods: Thirty one men underwent a simulated SHHOC consisting of baseline (P0), normobaric hypoxia (Fi02 = 12%, P1), and max 60 s of hypoxic lower body negative pressure (LBNP, P2). Alongside anthropometric variables, non-invasive cardiovascular, central and peripheral tissue oxygenation parameters, were recorded. OI was defined as hemodynamic collapse during SHHOC. Comparison of anthropometric, cardiovascular, and oxygenation parameters between OR and OI was performed via Student’s t-test. Within groups, a repeated measures ANOVA test with Holm-Sidak post hoc test was performed. Performance diagnostics were performed to assess factors associated with OR/OI (sensitivity, specificity, positive predictive value PPV, and odd’s ratio OR).

Results: Only 9/31 were OR, and 22/31 were OI. OR had significantly greater body mass index (BMI), weight, peripheral Sp02, longer R-R Interval (RRI) and lower heart rate (HR) at P0. During P1 OR exhibited significantly higher cardiac index (CI), stroke volume index (SVI), and lower systemic vascular resistance index (SVRI) than OI. Both groups exhibited a significant decrease in cerebral oxygenation (TOIc) with an increase in cerebral deoxygenated hemoglobin (dHbc), while the OI group showed a significant decrease in cerebral oxygenated hemoglobin (02Hbc) and peripheral oxygenation (TOIp) with an increase in peripheral deoxygenated hemoglobin (dHbp). During P2, OR maintained significantly greater CI, systolic, mean, and diastolic pressure (SAP, MAP, DAP), with a shortened RRI compared to the OI group, while central and peripheral oxygenation were not different. Body weight and BMI both showed high sensitivity (0.95), low specificity (0.33), a PPV of 0.78, with an OR of 0.92, and 0.61. P0 RRI showed a sensitivity of 0.95, specificity of 0.22, PPV 0.75, and OR of 0.99. Delta SVI had the highest performance diagnostics during P1 (sensitivity 0.91, specificity 0.44, PPV 0.79, and OR 0.8). Delta SAP had the highest overall performance diagnostics for P2 (sensitivity 0.95, specificity 0.67, PPV 0.87, and OR 0.9).

Discussion: Maintaining OR during SHHOC is reliant upon greater BMI, body weight, longer RRI, and lower HR at baseline, while increasing CI and SVI, minimizing peripheral 02 utilization and decreasing SVRI during hypoxia. During hypoxic LBNP, the ability to remain OR is dependent upon maintaining SAP, via CI increases rather than SVRI. Cerebral oxygenation parameters, beyond 02Hbc during P1 did not differ between groups, suggesting that the during acute hypoxia, an increase in cerebral 02 consumption, coupled with increased peripheral 02 utilization does seem to play a role in OI risk during SHHOC. However, cardiovascular factors such as SVI are of more value in assessing OR/OI risk. The results can be used to implement effective aerospace crew physiological monitoring strategies.

The interactive effects of acute exercise and hypoxia on cognitive performance: A narrative review

Acute moderate intensity exercise has been shown to improve cognitive performance. In contrast, hypoxia is believed to impair cognitive performance. The detrimental effects of hypoxia on cognitive performance are primarily dependent on the severity and duration of exposure. In this review, we describe how acute exercise under hypoxia alters cognitive performance, and propose that the combined effects of acute exercise and hypoxia on cognitive performance are mainly determined by interaction among exercise intensity and duration, the severity of hypoxia, and duration of exposure to hypoxia. We discuss the physiological mechanism(s) of the interaction and suggest that alterations in neurotransmitter function, cerebral blood flow, and possibly cerebral metabolism are the primary candidates that determine cognitive performance when acute exercise is combined with hypoxia. Furthermore, acclimatization appears to counteract impaired cognitive performance during prolonged exposure to hypoxia although the precise physiological mechanism(s) responsible for this amelioration remain to be elucidated. This review has implications for sporting, occupational, and recreational activities at terrestrial high altitude where cognitive performance is essential. Further studies are required to understand physiological mechanisms that determine cognitive performance when acute exercise is performed in hypoxia.

Cerebrovascular regulation is not blunted during mental stress

NEW FINDINGS

What is the central question of the study? What are the effects of acute mental stress on the mechanisms regulating cerebral blood flow? What is the main finding and its importance? The major new findings are as follows: (i) high mental stress and hypercapnia had an interactive effect on mean middle cerebral artery blood velocity; (ii) high mental stress altered the regulation of cerebral blood flow; (iii) the increased cerebrovascular hypercapnic reactivity was not driven by changes in mean arterial pressure alone; and (iv) this increased perfusion with mental stress appeared not to be justified functionally by an increase in oxygen demand (as determined by near-infrared spectroscopy-derived measures).

ABSTRACT

In this study, we examined the effects of acute mental stress on cerebrovascular function. Sixteen participants (aged 23 ± 4 years; five female) were exposed to low and high mental stress using simple arithmetic (counting backwards from 1000) and more complex arithmetic (serial subtraction of 13 from a rapidly changing four-digit number), respectively. During consecutive conditions of baseline, low stress and high stress, end-tidal partial pressure of CO₂ ( P ET , C O 2 ) was recorded at normocapnia (37 ± 3 mmHg) and clamped at two elevated levels (P < 0.01): 41 ± 1 and 46 ± 1 mmHg. Mean right middle cerebral artery blood velocity (MCAv_mean ; transcranial Doppler ultrasound), right prefrontal cortex haemodynamics (near-infrared spectroscopy) and mean arterial blood pressure (MAP; finger photoplethysmography) were measured continuously. Cerebrovascular hypercapnic reactivity (ΔMCAv_mean /Δ P ET , C O 2 ), cerebrovascular conductance (CVC; MCAv_mean /MAP), CVC CO₂ reactivity (ΔCVC/Δ P ET , C O 2 ) and total peripheral resistance (MAP/cardiac output) were calculated. Acute high mental stress increased MCAv_mean by 7 ± 7%, and more so at higher P ET , C O 2 (32 ± 10%; interaction, P = 0.03), illustrating increased sensitivity to CO₂ (i.e. its major regulator). High mental stress also increased MAP (17 ± 9%; P ≤ 0.01), coinciding with increased near-infrared spectroscopy-derived prefrontal haemoglobin volume and saturation measures. High mental stress elevated both cerebrovascular hypercapnic and conductance reactivities (main effect of stress, P ≤ 0.04). These findings indicate that the cerebrovascular response to acute high mental stress results in a coordinated regulation between multiple processes.

Cerebral blood flow regulation and cognitive function in women with posttraumatic stress disorder

Posttraumatic stress disorder (PTSD) is associated with structural and functional alterations in a number of interacting brain regions, but the physiological mechanism for the high risk of cerebrovascular disease or impairment in brain function remains unknown. Women are more likely to develop PTSD after a trauma than men. We hypothesized that cerebral blood flow (CBF) regulation is impaired in women with PTSD, and it is associated with impairment in cognitive function. To test our hypothesis, we examined dynamic cerebral autoregulation (CA) and cognitive function by using a transfer function analysis between arterial pressure and middle cerebral artery blood velocity and the Stroop Color and Word test (SCWT), respectively. We did not observe any different responses in these hemodynamic variables between women with PTSD ( n = 15) and healthy counterparts (all women; n = 8). Cognitive function was impaired in women with PTSD; specifically, reaction time for the neutral task of SCWT was longer in women with PTSD compared with healthy counterparts ( P = 0.011), but this cognitive dysfunction was not affected by orthostatic stress. On the other hand, transfer function phase, gain, and coherence were not different between groups in either the supine or head-up tilt (60°) position, or even during the cognitive challenge, indicating that dynamic CA was well maintained in women with PTSD. In addition, there was no relationship between cognitive function and dynamic CA. These findings suggest that PTSD-related cognitive dysfunction may not be due to compromised CBF regulation.

NEW & NOTEWORTHY Cognitive function was impaired; however, dynamic cerebral autoregulation (CA) as an index of cerebral blood flow regulation was not impaired during supine and 60° head-up tilt in women with PTSD compared with healthy females. In addition, there was no relationship between cognitive function and dynamic CA. These findings suggest that the mechanism of PTSD-related cognitive dysfunction may not be due to CBF regulation.