Autonomic Symptom Burden and Neuroendocrine Stress Signatures in Chronic Cerebral Ischemia: A Retrospective Study

Background: Autonomic symptoms and affective distress often accompany chronic cerebrovascular pathology, yet theirconnection with hypothalamic-pituitary-adrenal and endogenous opioid systems is poorly understood. We compared theburden of autonomic symptoms, perception of stress, anxiety levels, morning cortisol and β-endorphin levels between patientswith Chronic Cerebral Ischemia (CCI) with and without somatoform autonomic dysfunction and healthy controls.Methods: This retrospective, single-centre, three-group study involved 118 subjects: CCI with somatoform autonomicdysfunction (n=48), CCI without somatoform autonomic dysfunction (n=40) and healthy controls (n=30). Autonomic symptomswere assessed by the Composite Autonomic Symptom Score-31 (COMPASS-31). The PSS-10 and HADS-A scales were usedto evaluate perceived stress and anxiety. Morning serum cortisol and plasma β-endorphin levels were determined by meansof chemiluminescence immunoassay and enzyme-linked immunosorbent assay, respectively. Differences between all groupswere assessed by analysis of variance for a general linear model. Welch t test was applied for pairwise comparisons with Holmadjustment for all outcomes.Results: Group effects were observed for COMPASS-31 (F=82.42; η²=0.589), PSS-10 (F=37.51; η²=0.395), β-endorphin(F=22.65; η²=0.283), age (F=13.85; η²=0.194), cortisol (F=13.23; η²=0.187) and HADS-A (F=11.86; η²=0.171; all omnibusp<0.001). Compared with CCI without somatoform autonomic dysfunction, the comorbid group had higher COMPASS-31(mean difference 15.34), PSS-10 (8.96), HADS-A (1.90) and cortisol (216.52 nmol/L), but lower β-endorphin (−53.89 pg/mL;all Holm-adjusted p≤0.0031). Compared with controls, the comorbid group showed the same directional pattern. CCI withoutsomatoform autonomic dysfunction had higher PSS-10, COMPASS-31 and β-endorphin than controls after within-outcomeHolm adjustment, whereas cortisol and HADS-A did not differ.Conclusion: The presence of CCI together with somatoform autonomic dysfunction is marked by greater psychological andautonomic symptoms, higher cortisol levels in the morning and lower β-endorphins. These unadjusted associations indicate adistinct clinical picture, yet causation cannot be determined from the associations alone.

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