{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,1]],"date-time":"2026-10-01T13:57:32Z","timestamp":1790863052493,"version":"4.1.0"},"reference-count":26,"publisher":"Frontiers Media SA","license":[{"start":{"date-parts":[[2026,9,14]],"date-time":"2026-09-14T00:00:00Z","timestamp":1789344000000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":["frontiersin.org"],"crossmark-restriction":true},"short-container-title":["Front. Neurol."],"abstract":"<jats:sec>\n                    <jats:title>Introduction<\/jats:title>\n                    <jats:p>This study aimed to identify the distribution of orthostatic hypotension (OH) according to changes in internal carotid artery (ICA) blood flow in patients with cervical spinal cord injury (SCI), and to determine whether cognitive impairment is more prominent among patients with a certain level of ICA blood flow reduction.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Methods<\/jats:title>\n                    <jats:p>\n                      Forty-one patients diagnosed with cervical SCI were retrospectively analyzed and classified into two groups based on the results of a head-up tilt test and carotid duplex ultrasonography to measure ICA blood flow: those with a reduction of 21% or more (\n                      <jats:italic>n<\/jats:italic>\n                      \u202f=\u202f26) and those without such a reduction (\n                      <jats:italic>n<\/jats:italic>\n                      \u202f=\u202f15). Cognitive function tests were compared between the two groups.\n                    <\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>\n                      Patients with an ICA blood flow reduction of 21% or greater demonstrated significantly lower cognitive scores than those without such a reduction (K-MMSE\n                      <jats:italic>p<\/jats:italic>\n                      \u202f=\u202f0.028, MoCA-K\n                      <jats:italic>p<\/jats:italic>\n                      \u202f=\u202f0.048; Hedges\u2019\n                      <jats:italic>g<\/jats:italic>\n                      \u202f=\u202f\u22120.65 for both). In multivariable regression adjusted for age, sex, and education, greater ICA blood flow reduction remained associated with lower scores on both instruments (\n                      <jats:italic>p<\/jats:italic>\n                      \u202f=\u202f0.038 and\n                      <jats:italic>p<\/jats:italic>\n                      \u202f=\u202f0.033). Among 13 cognitive subdomains, only language and visuospatial construction remained significantly lower after correction for multiple comparisons.\n                    <\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Discussion<\/jats:title>\n                    <jats:p>This study suggests that the early assessment of ICA blood flow and cognitive function may be informative in the rehabilitation process for patients with cervical SCI. Whether such assessment can help identify patients who should be prioritized for formal cognitive assessment requires prospective evaluation.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.3389\/fneur.2026.1915120","type":"journal-article","created":{"date-parts":[[2026,9,14]],"date-time":"2026-09-14T04:37:21Z","timestamp":1789360641000},"update-policy":"https:\/\/doi.org\/10.3389\/crossmark-policy","source":"Crossref","is-referenced-by-count":1,"title":["Relationship between orthostatic hypotension, internal carotid artery blood flow, and cognition in patients with cervical spinal cord injury"],"prefix":"10.3389","volume":"17","author":[{"given":"Jong-Joon","family":"Lee","sequence":"first","affiliation":[{"name":"Department of Rehabilitation Medicine, Wonkwang University School of Medicine","place":["Iksan, Republic of Korea"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Min-Cheol","family":"Joo","sequence":"additional","affiliation":[{"name":"Department of Rehabilitation Medicine, Institute of Wonkwang Medical Science, Wonkwang University School of Medicine","place":["Iksan, Republic of Korea"]}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"1965","published-online":{"date-parts":[[2026,9,14]]},"reference":[{"key":"ref1","doi-asserted-by":"publisher","first-page":"51","DOI":"10.1016\/j.autneu.2017.04.004","article-title":"Implication of altered autonomic control for orthostatic tolerance in SCI","volume":"209","author":"Wecht","year":"2018","journal-title":"Auton Neurosci"},{"key":"ref2","doi-asserted-by":"publisher","first-page":"69","DOI":"10.1007\/s10286-011-0119-5","article-title":"Consensus statement on the definition of orthostatic hypotension, neurally mediated syncope and the postural tachycardia syndrome","volume":"21","author":"Freeman","year":"2011","journal-title":"Clin Auton Res"},{"key":"ref3","doi-asserted-by":"publisher","first-page":"65","DOI":"10.1038\/sj.sc.3102064","article-title":"Orthostatic hypotension in the first month following acute spinal cord injury","volume":"46","author":"Sidorov","year":"2008","journal-title":"Spinal Cord"},{"key":"ref4","doi-asserted-by":"publisher","first-page":"341","DOI":"10.1038\/sj.sc.3101855","article-title":"Orthostatic hypotension following spinal cord injury: understanding clinical pathophysiology","volume":"44","author":"Claydon","year":"2006","journal-title":"Spinal Cord"},{"key":"ref5","doi-asserted-by":"publisher","first-page":"611","DOI":"10.1212\/WNL.0000000000006244","article-title":"Cognitive function after spinal cord injury: a systematic review","volume":"91","author":"Sachdeva","year":"2018","journal-title":"Neurology"},{"key":"ref6","doi-asserted-by":"publisher","first-page":"1551","DOI":"10.1089\/neu.2013.2972","article-title":"Regulation of cerebral blood flow after spinal cord injury","volume":"30","author":"Phillips","year":"2013","journal-title":"J Neurotrauma"},{"key":"ref7","doi-asserted-by":"publisher","first-page":"794","DOI":"10.1038\/jcbfm.2014.3","article-title":"Regional neurovascular coupling and cognitive performance in those with low blood pressure secondary to high-level spinal cord injury: improved by alpha-1 agonist midodrine hydrochloride","volume":"34","author":"Phillips","year":"2014","journal-title":"J Cereb Blood Flow Metab"},{"key":"ref8","doi-asserted-by":"publisher","first-page":"R707","DOI":"10.1152\/ajpregu.00211.2015","article-title":"Technical recommendations for the use of carotid duplex ultrasound for the assessment of extracranial blood flow","volume":"309","author":"Thomas","year":"2015","journal-title":"Am J Physiol Regul Integr Comp Physiol"},{"key":"ref9","doi-asserted-by":"publisher","first-page":"1321","DOI":"10.3390\/diagnostics11081321","article-title":"Cerebral autoregulation during postural change in patients with cervical spinal cord injury\u2014a carotid duplex ultrasonography study","volume":"11","author":"Kee","year":"2021","journal-title":"Diagnostics"},{"key":"ref10","doi-asserted-by":"publisher","first-page":"369","DOI":"10.1007\/s10286-020-00738-6","article-title":"Recommendations for tilt table testing and other provocative cardiovascular autonomic tests in conditions that may cause transient loss of consciousness","volume":"31","author":"Thijs","year":"2021","journal-title":"Clin Auton Res"},{"key":"ref11","doi-asserted-by":"publisher","first-page":"47","DOI":"10.31728\/jnn.2018.00023","article-title":"Extracranial carotid duplex ultrasonography. 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