Cognitive Function in Heart Failure Is Associated With Nonsomatic Symptoms of Depression But Not Somatic Symptoms

Abstract

Background Patients with heart failure (HF) have high rates of cognitive impairment and depressive symptoms. Depressive symptoms have been associated with greater cognitive impairments in HF; however, it is not known whether particular clusters of depressive symptoms are more detrimental to cognition than others. Objective To identify whether somatic and/or nonsomatic depressive symptom clusters were associated with cognitive function in persons with HF. Methods Participants were 326 HF patients (40.5% female, 26.7% race-ethnicity, aged 68.6±9.7 years). Depressive symptoms were measured using a depression questionnaire commonly used in medical populations: the Patient Health Questionnatire-9 (PHQ-9). Somatic and Nonsomatic subscales scores were created using previous factor analytic results. A neuropsychological battery tested attention, executive function, and memory. Composites were created using averages of age-adjusted scaled scores. Regressions adjusting for demographic and clinical factors were conducted. Results Regressions revealed that PHQ-9 Total was associated with Attention (β=−.14, p=.008) and Executive Function (β=−.17, p=.001). When analyzed separately, the Nonsomatic subscale – but not the Somatic symptoms subscale (ps ≥.092) – was associated with Attention scores (β=−.15, p=.004) and Memory (β=−.11, p=.044). Both Nonsomatic (β=−.18, p<.001) and Somatic symptoms (β=−.11, p=.048) were related to Executive Function. When included together, only the Nonsomatic symptom cluster was associated with Attention (β=−.15, p=.020) and Executive Function (β=−.19, p=.003). Conclusions Greater overall depressive symptom severity was associated with poorer performance on multiple cognitive domains, an effect driven primarily by the nonsomatic symptoms of depression. Clinical Implications These findings suggest that screening explicitly for nonsomatic depressive symptoms may be warranted and that the mechanisms underlying the depression-cognitive function relationship HF are not solely related to sleep or appetite disturbance. Thus, interventions which target patients’ somatic symptoms only (e.g., poor appetite or fatigue) may not yield maximum cognitive benefit compared to a comprehensive treatment which targets depressed mood, anhedonia, and other nonsomatic symptoms.

Cognitive function and health literacy are independently associated with heart failure knowledge

“…The broad aims of the parent Heart ABC study were to examine cognitive function, psychosocial, and physical factors as predictors of adherence in patients with HF. Other reports from this study have been published examining cognitive screening methods in HF 20 and the relationship between cognition and other variables (e.g., body mass index, 21 depression, 22 quality of life, 23 and adherence behaviors 24 ).…”

Heart failure as a predictor of functional dependence in hospitalized elderly

“…Studies have been conducted to assess the impact of the association between HF and depression symptoms. A survey of 348 participants with a mean age of 68 years, recruited from urban medical centers, revealed that the Body Mass Index (BMI) is closely related to depressive symptoms in patients with HF, especially among women (21) . In patients with HF, depression can represent an independent risk factor for mortality and hospitalization, and is associated with higher cognitive impairment (21)(22) .…”

Construct validity of the Heart Failure Screening Tool (Heart‐FaST) to identify heart failure patients at risk of poor self‐care: Rasch analysis

“…In other words, the items have a common function, as indicators of risk, though each domain assesses a distinct aspect of functioning as it pertains to self‐care (Cameron et al., ). Second, physical, cognitive and emotional limitations may be interdependent in the context of HF, with physical limitations affecting the cognitive and emotional well‐being of patients (Alosco, Spitznagel, Cohen, et al., ; Alosco, Spitznagel, Sweet, et al., ; Hawkins et al., ). For example, the physiological changes induced by HF can compound pre‐existing issues with memory and concentration and even precipitate cognitive impairment (Cannon, McMurray, & Quinn, ).…”