Association Between Orthostatic Intolerance Symptoms and Cognitive Complaints in Hypermobile Ehlers-Danlos Syndrome (hEDS) and Joint Hypermobility Spectrum Disorder (JHSD): A Cross-Sectional Analysis.

BACKGROUND

Many people with hypermobile Ehlers-Danlos syndrome (hEDS) and joint hypermobility spectrum disorder (JHSD) often experience both orthostatic intolerance (OI) and brain fog. They are both clinically significant, even though their direct link has rarely been studied. This research examines whether there is a link between OI symptoms and complaints of poor concentration in patients with hEDS and JHSD.

MATERIALS AND

METHODS

A study was carried out with 385 individuals who were clinically diagnosed with hEDS or JHSD in Islamabad, Pakistan. Both the Composite Autonomic Symptom Score (COMPASS-31) and the Cognitive Failure Questionnaire (CFQ) were used to collect data. To investigate the relationship between OI problems and cognitive symptoms, a statistical analysis was conducted using SPSS Statistics version 26 (IBM Corp. Released 2019. IBM SPSS Statistics for Windows, Version 26.0. Armonk, NY: IBM Corp.), including Pearson correlation, t-tests, ANOVA, and linear regression. Data were collected from November 15, 2024, to March 25, 2025.

RESULTS

Orthostatic symptoms were present in 249 (65%) of participants, and cognitive changes were reported by 282 (73%). The correlation between OI and CFQ scores was found to be moderate and statistically significant (r = 0.449, p = 0.03). Participants who experienced brain fog often (36%) scored a bit higher on CFQ than others. Although the differences between the groups were found to be significant, the effect sizes were very small (η² = 0.004), which corresponds to practically irrelevant distinctions. In a regression model, it was confirmed that the OI symptoms were significant predictors of cognitive complaints (r = 0.449, p = 0.03).

CONCLUSIONS

The researchers found a statistically significant yet low level of association between OI and cognitive complaints in individuals with hEDS and JHSD. These results suggest that autonomic dysfunction may play a role in the cognitive symptoms experienced by this group of individuals. Future objective assessment studies should be conducted to better understand the mechanisms involved and the contributions of psychological and emotional factors.