Congestive heart failure and cognitive functioning amongst older adults

Abstract

BACKGROUND: Congestive heart failure is associated with decline in quality of life and, possibly, cognitive functions such as memory and attention. AIMS: The present study was designed to investigate the presence of cognitive impairment amongst patients with congestive heart failure (CHF). We hypothesised that CHF patients would have lower scores than elderly controls on general measures of cognitive functioning. METHODS AND RESULTS: We examined a sample of 50 consecutive patients admitted to hospital with CHF functional class III/IV and a convenience sample of 30 older adults assessed at the outpatient service of geriatric medicine of a teaching hospital in São Paulo, Brazil. All subjects were interviewed with the Cambridge Examination for Mental Disorders of the Elderly (CAMDEX), as well as the neuropsychological battery of the CAMDEX (CAMCOG), Mini-Mental State Examination (MMSE), Trail Making A and B, Digit Span, Digit Symbol, and Letter Cancellation Test. All CHF patients had left ventricular ejection fraction (EF) below 45% and all controls above 65%. The cognitive performance of CHF patients was significantly worse than controls for all cognitive assessments. Twenty-seven of 50 CHF patients had a MMSE total score lower than 24, compared with only 10/30 controls (p=0.073). Similarly, 36/49 and 9/30 CHF subjects and controls respectively had CAMCOG scores below 80 (p<0.001). Cognitive scores were significantly associated with EF, which was the most robust predictor of cognitive impairment according to the CAMCOG in a logistic regression model. CONCLUSION: Our results indicate that CHF is associated with significant levels of cognitive impairment and show that mental performance is, at least partly, a consequence of EF. Physicians should be prepared to assess the mental state of patients, as poor cognitive functioning may interfere with treatment compliance and management plan.

Proximal Cerebral Arteries Develop Myogenic Responsiveness in Heart Failure via Tumor Necrosis Factor-α–Dependent Activation of Sphingosine-1-Phosphate Signaling

“…[1][2][3][4] Reduced perfusion of the brain would be expected to cause wideranging neurological effects; indeed, cognitive symptoms, including impairment of memory, attention, mental flexibility, and global cognitive functions, are clinically observed in 40% to 60% of patients with late-stage HF. 1,2,31,32 The 25% CBF reduction observed in the present investigation, however, is below the reported threshold [33][34][35][36] necessary to cause cognitive deficits or gross morphological changes and explains their absence in the present model.…”

Relationship between cognitive function and 6-minute walking test in older outpatients with chronic heart failure

“…Another mechanism which may contribute to cerebral damage is cardio-embolism, frequently detected in heart failure patients with atrial fibrillation (15) or apical ventricular thrombosis (16). Putzke et al demonstrated the existence of an association between cognitive impairment and depressed left ventricular function in patients with CHF (17), not confirmed by others (18).…”

Cognitive dysfunction in congestive heart failure: transcranial Doppler evidence of microembolic etiology

“…Most data on CHF show a d i rect relationship between the degree of card i a c dysfunction (measured by the ejection fraction) and cognitive changes 1 2 -1 4 . However, at least one pre v ious study did not show a correlation between ejection fraction and MMSE score 3 , which suggests that, in some populations, microemboli may surpass low c e rebral perfusion as the predominant mechanism of cognitive dysfunction. One such unique characteristic of our population was the high prevalence of Chagas disease the etiology of CHF, which is known to be a highly embolic condition 15 .…”

“…The most widely accepted is that decreased pump function directly impacts cerebral perfusion. However, at least one study was not able to demonstrate a direct correlation between the d e g ree of ventricular dysfunction and cognitive sympt o m s 3 . The other mechanism that could lead to imp a i red cognition is microembolism from the heart causing multiple, small strokes.…”