Study links poor blood flow in the brain to POTS

In what is believed to be a world-first study, researchers from the University of Adelaide’s Australian Dysautonomia and Arrhythmia Research Collaborative (ADARC) have used brain scans to identify blood flow problems in people with postural orthostatic tachycardia syndrome (POTS).

POTS is a complex condition affecting the autonomic nervous system, which controls unconscious bodily functions like breathing, blood circulation and digestion.

The syndrome more commonly affects younger women, and symptoms are made worse when standing, often leading to dizziness, brain fog, rapid heart rate, and fatigue.

In collaboration with the South Australian Health and Medical Research Institute (SAHMRI), academics from the ADARC analysed nuclear medicine brain scans (SPECT) from 56 patients with POTS who were experiencing severe issues with brain fog to examine problems with blood flow.

A brain SPECT creates a detailed, 3D picture of the blood flow in the brain, showing which areas may not be getting enough blood. The results of the study have been published in Scientific Reports.

“We found 61 per cent of participants had reduced blood flow in key brain areas, even when lying down.Lead author, Dr Marie-Claire Seeley, The University of Adelaide's Australian Dysautonomia and Arrhythmia Research Collaborative

“This is the first clear evidence of poor brain circulation in POTS even while patients are lying down using an imaging technique which is widely accessible to doctors," said Dr Seeley.

“These findings could help explain brain fog in POTS and similar conditions like long-COVID, where many people struggle with fatigue and trouble thinking clearly.”

On average in Australia, a diagnosis of POTS can take seven years due to the under-recognition of the condition and challenges in accessing diagnostic testing.

The brain areas responsible for executive function, sensation, and movement were the most affected in participants. This can lead to difficulties with planning, decision-making, concentration, and processing sensory information, impacting daily life and overall well-being

POTS most often develops after a viral infection but can also happen after events such as a concussion, surgery or pregnancy. ADARC researchers were the first to show a link between long-COVID and POTS, with 79 per cent of those in the study meeting the criteria for POTS.

“Considering the young age of our POTS cohort, predominantly comprising females, and the concerning implications of blood flow on cognitive function and sensory function, our findings raise questions about the potential impact on educational progression, workforce engagement, and overall social and economic well-being,” Dr Seeley said.

“We have seen POTS impact people from all walks of life, leaving people who were once able to function well in society now with a much-reduced quality of life.

“These results highlight the need for further research to understand the pathways underlying brain blood flow issues in post-viral and autonomic syndromes.

“Future prospective studies may explore the role of therapies and interventions on management on brain blood flow.”’