Cognitive Deficit in Heart Failure and the Benefits of Aerobic Physical Activit

Abstract

Heart Failure is a clinical syndrome prevalent throughout the world and a major contribution to mortality of cardiac patients in Brazil. In addition, this pathology is strongly related to cerebral dysfunction, with a high prevalence of cognitive impairment. Many mechanisms may be related to cognitive loss, such as cerebral hypoperfusion, atrophy and loss of gray matter of the brain, and dysfunction of the autonomic nervous system. The literature is clear regarding the benefits of aerobic physical activity in healthy populations in the modulation of the autonomic nervous system and in brain functions. Studies have shown that in the population of patients with heart failure, exercise is associated with an improvement in cognitive function, as well as in cardiac autonomic regulation. However, little emphasis has been given to the mechanisms by which aerobic physical activity can benefit brain functioning, the autonomic nervous system and result in better cognitive performance, particularly in patients with heart failure. Therefore, the present work presents the ways in which brain areas responsible for cognition also act in the modulation of the autonomic nervous system, and emphasizes its importance for the understanding of cognitive impairment in relation to the pathophysiology of heart failure. It is also described the way in which aerobic physical activity can promote benefits when it is integrated into the therapy, associated to a better prognosis of the clinical picture of these patients.

Cognitive Dysfunction after Heart Disease: A Manifestation of the Heart‐Brain Axis

“…Regular aerobic physical activity can increase the blood flow in the prefrontal cortex, promote the formation of blood vessels in the frontal cortex, and increase the concentration of the vascular endothelial growth factor [ 59 ]. Moreover, long-term continuous aerobic exercise can promote cardiovascular health by increasing vagal tone and reducing sinus node sympathetic nerve activity [ 60 ]. Tanne et al reported that HF patients with the New York Heart Association (NYHA) functional class III status and an ejection fraction of 35% demonstrated improved selective attention and mental exercise speed after long-term aerobic exercise [ 15 ].…”

Physical Exercise for Individuals with Hypertension: It Is Time to Emphasize its Benefits on the Brain and Cognition

“…These negative changes lead to a reduced ability to perform daily functions, decreased self-care levels and quality of life, and also increased risk of morbidity and mortality. 37…”

Heart Failure and Cognitive Impairment: Clinical Relevance and Therapeutic Considerations

“…The benefits of aerobic physical activity among healthy individuals on cognitive function are well established in the literature [ 96 , 97 ]. Evidence shows that when aerobic physical activity is performed consistently over a long period of time, it has the potential to promote beneficial effects on cardiovascular health, mediated by increased vagal tone and decreased sympathetic activity in the sinus node [ 96 , 97 ]. This consequently leads to improved vascular function, cardiac remodeling, and improved renal-adrenal functions [ 96 , 97 ].…”

“…Evidence shows that when aerobic physical activity is performed consistently over a long period of time, it has the potential to promote beneficial effects on cardiovascular health, mediated by increased vagal tone and decreased sympathetic activity in the sinus node [ 96 , 97 ]. This consequently leads to improved vascular function, cardiac remodeling, and improved renal-adrenal functions [ 96 , 97 ]. Regular aerobic physical activity also has an important role in the modulation of some regions of the brain related to cognitive functioning, through the increase of cerebral blood flow in the prefrontal cortex [ 98 , 99 ] increased volume in the hippocampus [ 100 ], increased concentrations of vascular endothelial growth factors (VEGF) and brain-derived neurotrophic factor (BDNF) (strengthening of synaptic connections) [ 101 ], as well as angiogenesis in lobofrontal regions [ 102 ].…”