Relationship between Cognitive Function, Depression/Anxiety and Functional Parameters in Patients Admitted for Congestive Heart Failure

Abstract

Cognitive impairment, anxiety and depression have been described in patients with congestive heart failure (CHF). We analyzed in-hospital CHF patients before discharge with neuropsychological tests attempting to correlate with prognostic parameters.Methods: All subjects underwent a mini mental state examination (MMSE), geriatric depression scale (GDS), anxiety and depression scale test (HADS). We evaluated NYHA class, brain natriuretic peptide (BNP), left ventricular ejection fraction (LVEF) and non-invasive cardiac output (CO). Results: Three-hundred and three CHF patients (age 71.6 ys) were analysed. The mean NYHA class was 2.9±0.8, LVEF was 43.4±15.8%; BNP plasma level and CO were calculated as 579.8±688.4 pg/ml and 3.9±1.1 l/min, respectively. In 9.6% a pathological MMSE score emerged; a depression of mood in 18.2% and anxiety in 23.4% of patients were observed. A significant correlation between MMSE and age (r=0.11 p=0.001), BNP (r=0.64 p=0.03) but not between MMSE and NYHA class and LVEF was observed. GDS and HADS were inversely correlated with NYHA class (r=0.38 p=0.04) and six-minute walking test (r=0.18 p=0.01) without an association with objective parameters in CHF (BNP, LVEF and cardiac output). At multivariate analysis only MMSE and BNP are inversely correlated significantly (p=0.019 OR=-0.64, CI=-042-0.86). Conclusions: in-hospital CHF patients may manifest a reduction of MMSE and important anxiety/depression disorders. The results of the study suggest that the presence of cognitive impairment in older CHF patients with higher BNP plasma level should be considered. In admitted CHF patients anxiety and depression of mood are commonly reported and influenced the perception of the severity of illness.

Evaluation of a provocative dyspnea severity score in acute heart failure

“…Other studies reporting feasibility of exercise in AHF have excluded patients with non-HF conditions affecting mobility(12–14) and generally enrolled younger patients with less severe renal dysfunction(13, 14). A study without exclusion for limited mobility and with a mean age similar to RED-ROSE, reported that 69% of patients could perform a walk test at discharge,(15) similar to our findings where 70% of eligible patients could perform the step test at 72 hours after enrollment. Thus, while exercise provocation did induce more severe dyspnea in 29% of patients, feasibility was too low to allow incorporation into a clinical trial endpoint.…”

Self-care confidence may be the key: A cross-sectional study on the association between cognition and self-care behaviors in adults with heart failure

“…Scores ranging from 27 to 30 are considered normal in the general population; scores between 21 and 26 reflect mild cognitive impairment; scores between 10 and 19 are considered moderate impairment; a score below 10 is considered severe impairment (Tombaugh and McIntyre, 1992). The MMSE has been used extensively in heart failure patients (Caminiti et al, 2012;Feola et al, 2013). Cronbach's alpha of the MMSE was 0.83 in this study.…”

Aspects of diastolic dysfunction in patients with new and recurrent depression

“…Recently, Feola et al analyzed the connection between MDD, cognitive impairment and specific objective parameters characterizing heart failure (BNP, ejection fraction, cardiac output, etc.) in a group of 303 patients hospitalized for congestive heart failure [24]. Other authors debated the influence of MDD on the occurrence and evolution of heart failure.…”