All right, I found the article. Unfortunately, I found it somewhat disappointing, and I suspect many of you will concur. I will summarize it at some length. First, it is quite a brief article--only about eight pages, one containing a bibliography and several others taken up by tables and ancillary matter. The author, judging from her other publications, is not primarily a POTS researcher, but a neuropsychologist. The description of POTS is drawn from standard sources dating from the early 1990's. POTS is defined as "a mild form of orthostatic palpitations." Considering that this appeared in a journal (a relatively marginal one) targeted at neuropsychologists, the few paragraphs that actually describe the condition are probably insufficient to inform a clinician not already familiar with it. On the other hand, the article does not seem to be targeted at a broad audience; judging by the view count, I was the second person to download it. So, on to the meat of it, which is where the problems appear. The article is structured as a case study of two sisters, 19 and 22, who both have POTS. While this case study may be interesting from a neuropsychological standpoint, it is, I think, almost entirely irrelevant as applied to POTS. The problem is that both of these patients have a number of comorbidities and complicating factors. Sister A has been diagnosed with bipolar disorder, severe depression, agoraphobia, social anxiety, and obsessive-compulsive tendencies. Both sisters have been previously diagnosed with ADHD (though, as the authors point out, it is possible that the attention deficits were caused by then-undiagnosed POTS). Both have a chronic pain syndrome; one of them uses narcotic analgesics daily. Sister B also has a complicated psychological history, including suicidal ideation, self-multilation, panic attacks, anorexia, and post-traumatic stress syndrome related to a sexual assault. As the abstract suggests, the full-scale IQ score is preserved in both sisters. One has quite a high score of 132, and the other has a very good score of 118. Each, however, shows a number of deficits in certain specific subtests. For the purposes of the article, a significant deficit was a subtest score more than 1.5 standard deviations (23 points or so) below the general FSIQ. By this measure, Ms. A had 16 scores significantly below FSIQ, and Ms. B had 10. The impairments were related to working memory, processing speed, visual memory and recognition, category fluency, and inhibition. The authors contend that this pattern is "suggestive of prefrontal cortical cerebral dysfunction." The immediate concern is the large number of comorbidities, and the associated psychiatric conditions. Not only does this create the impression that psychiatric conditions are regularly compresent with, or worse, inseparable from, POTS (which studies like Raj 2009 have shown is not the case), it means that the case studies chosen for the article are not representative of the general patient population. The specific cognitive problems that these sisters are experiencing could have other causes from POTS. Cognitive deficits, of course, are also associated with some of their psychiatric conditions and some of the medications they are taking. Again, this doesn't invalidate the case study by any means, but it does seem to limit its usefulness for commenting on POTS in general. In addition, the article does not spend much time describing the cognitive symptoms these women are experiencing. I had hoped for a fairly robust phenomenological account of what those cognitive symptoms are like, subjectively; this does not occur. One sister left college because she found it "too stressful"; the other left for the same reason, though she elaborates, "stressing about getting things done on time, being late with assignments, and then getting more stressed." These are understandable responses to cognitive difficulties, as far as it goes, but these are the only sentences in the article that actually describe the sisters' subjective and functional sense of their cognitive problems. And given the psychiatric components, this concern with stress could just as easily be attributed to anxiety. It seems extremely dangerous to equate cognitive dysfunction with stress. The authors are aware of these limitations. The conclusion notes that "the two individuals have comorbidities that complicate test interpretations." Specifically, the diagnosis of ADHD, the presence of treated hypothyroidism, and the anxiety and affective disorders really muddy the waters in these cases. It is impossible to say which deficits are attributable to other causes and which arise from the POTS. In fact, the specific cases of POTS are not discussed at all: it is not mentioned what form of POTS the sisters have, how they were diagnosed, how severe their symptoms are, etc. Some of this seems like extremely basic footwork, and I can't help but thinking that the authors should have covered these bases more thoroughly. It is an interesting article, but these problems make it unsuitable for drawing any conclusions. Anyone looking for enlightenment regarding their own cognitive symptoms (which was my hope) will probably be disappointed. At worst, the article will suggest to uninformed readers that POTS is intimately bound up with psychological problems. On the bright side, I think Vanderbilt is working on an extended study of cognitive dysfunction in a more homogeneous set of patients, and their results ought to be a little more meaningful.