Attention, cognitive issues tied to pain, body regulation problems in hEDS
Study: Executive function abilities appeared to depend on body position
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People with hypermobile Ehlers-Danlos syndrome (hEDS) may have impaired cognitive function, including lower attention and executive function abilities, a new study in Germany shows.
Among hEDS patients, executive functioning — the set of cognitive processes used to solve problems, make plans, and manage emotions — appeared to depend on body position. Particularly, performance was worse when standing with legs crossed than when lying down.
The study further demonstrated that attention and cognitive issues were associated with pain and autonomic symptoms, which affect the autonomic nervous system that regulates involuntary body functions such as blood pressure and heart rate.
The study, “Impaired attention and cognitive deficits associated with pain and autonomic symptoms in hypermobile Ehlers‑Danlos syndrome: a pilot study,” was published in Clinical Autonomic Research.
hEDS patients often report cognitive issues that may lead to disability
Hypermobile EDS is the most common type of EDS, a group of connective tissue disorders caused by defects in the production and function of collagen, a structural protein. This leads to symptoms such as stretchy and fragile skin, hypermobile joints, and frequent joint dislocations.
People with hEDS often report cognitive issues that may lead to significant disability and functional limitations in daily living. Possible mechanisms associated with cognitive impairment include pain and orthostatic intolerance — dizziness, fatigue, and a fast heart rate upon standing. However, “few studies have examined attention, and concentration and associated conditions in hEDS,” the researchers wrote.
To learn more, researchers in Germany used a test battery to assess cognitive performance in individuals with hEDS and to determine whether this performance depends on body position. The study enrolled 29 individuals with EDS and 29 healthy controls. Patients had a mean age of 36.7 years; most were women and had more than 12 years of school education.
Additionally, the majority (55%) were diagnosed with orthostatic intolerance, including postural orthostatic tachycardia syndrome, or rapid heart rate increase upon standing, and orthostatic hypotension, or a sudden drop in blood pressure upon standing.
Pain correlated with increased symptoms
Compared with healthy controls, hEDS patients reported more orthostatic issues while standing and autonomic symptom burden, as well as more pain, mental health issues (anxiety and depression), and daytime sleepiness.
At the beginning of the study, participants with hEDS showed significantly lower reaction times in the Test of Attentional Performance, which evaluates attention, than healthy controls. On the contrary, they performed better in the Performance Scale of an intelligence test.
“These results highlighted lower attention capacity in patients with hEDS, although their intelligence was higher,” the researchers wrote.
Cognitive performance in different body positions — lying on the back (supine), standing, or standing with legs crossed — was assessed using tests for selective and visual attention, as well as tests for memory and executive functions.
The hEDS group showed significantly lower (poorer) performance in the Stroop selective attention test while standing with legs crossed, compared with healthy controls (54.1 vs. 61.6).
Patients with hEDS showed indications of impaired cognitive performance compared to [healthy controls], particularly in selected domains such as executive function and attention. This occurred despite patients with hEDS displaying a higher intelligence profile.
When hEDS patients were standing with legs crossed, their attention levels were lower than in the supine position, indicating that body position affected executive function. However, the effect was no longer present after adjusting for orthostatic intolerance.
In participants with hEDS, higher levels of pain correlated with increased orthostatic intolerance symptoms and more severe autonomic dysfunction. Additionally, pain was associated with worse performance in attention, intelligence, and memory tests.
Overall, “patients with hEDS showed indications of impaired cognitive performance compared to [healthy controls], particularly in selected domains such as executive function and attention. This occurred despite patients with hEDS displaying a higher intelligence profile,” the researchers wrote.
They also noted that “future studies should investigate whether interventions such as wearing compression garments and physiotherapy could improve not only [position perception] but also cognition.”
“In addition, symptoms such as pain, depression, and fatigue should be treated appropriately to stabilize cognitive functioning,” they added.
