Cognitive Impairment in Heart Failure: Landscape, Challenges, and Future Directions

Abstract

Heart failure (HF) is a major global healthcare problem accounting for substantial deterioration of prognosis. As a complex clinical syndrome, HF often coexists with multi-comorbidities of which cognitive impairment (CI) is particularly important. CI is increasing in prevalence among patients with HF and is present in around 40%, even up to 60%, of elderly patients with HF. As a potent and independent prognostic factor, CI significantly increases the hospitalization and mortality and decreases quality of life in patients with HF. There has been a growing awareness of the complex bidirectional interaction between HF and CI as it shares a number of common pathophysiological pathways including reduced cerebral blood flow, inflammation, and neurohumoral activations. Research that focus on the precise mechanism for CI in HF is still ever insufficient. As the tremendous adverse consequences of CI in HF, effective early diagnosis of CI in HF and interventions for these patients may halt disease progression and improve prognosis. The current clinical guidelines in HF have begun to emphasize the importance of CI. However, nearly half of CI in HF is underdiagnosed, and few recommendations are available to guide clinicians about how to approach CI in patients with HF. This review aims to synthesize knowledge about the link between HF and cognitive dysfunction, issues pertaining to screening, diagnosis and management of CI in patients with HF, and emerging therapies for prevention. Based on data from current studies, critical gaps in knowledge of CI in HF are identified, and future research directions to guide the field forward are proposed.

Chronic Neuroinflammation and Cognitive Decline in Patients with Cardiac Disease: Evidence, Relevance, and Therapeutic Implications

“…Chronic HF is a complex clinical syndrome that often coexists with multiple comorbidities. MCI appears to be a particularly important condition in HF [ 7 ], although reports on its prevalence vary between 25% and 75% across population-based studies due to variation in definitions and diagnostic criteria [ 23 , 24 , 25 , 26 , 27 ]. Patients with HF typically exhibit MCI in the domains of memory, working memory, attention, processing speed, and executive function [ 25 , 28 ].…”

“…Patients with HF typically exhibit MCI in the domains of memory, working memory, attention, processing speed, and executive function [ 25 , 28 ]. In patients with HF, MCI was shown to significantly increase the risk of hospitalization and mortality, and decrease quality of life [ 7 ]. Chronic HF is also associated with an increased risk of dementia and AD in older adults [ 29 ].…”

“…However, the pathophysiological links between cardiac disease, central nervous system (CNS) dysfunction and cognitive decline remain poorly understood. Shared risk factors such as hypertension, diabetes, obesity, arteriosclerosis, age, and genetic predisposition [ 6 ] might be involved, but there are also specific cardiac sequelae such as a decreased cerebral blood flow, neurohumoral activation, and systemic inflammation [ 7 ]. There is now compelling preclinical and clinical evidence that the latter might also induce or deteriorate chronic inflammatory responses of the central nervous tissue, which mediate pathophysiological processes leading to neurodegeneration [ 8 ].…”

The Utility of High Intensity Interval Training to Improve Cognitive Aging in Heart Disease Patients

“…Although, Hammond et al [ 10 ] found that cognitive decline was similar in HF patients with reduced versus preserved ejection fraction. In HF patients with preserved ejection fraction, the mechanisms for cognitive decline are likely related to obesity, vascular impairment, diastolic dysfunction, chronic neurohormonal activation [ 48 ].…”

Restoring myocardial infarction-induced long-term memory impairment by targeting the cystic fibrosis transmembrane regulator

“… 3 , 4 , 5 Cognitive impairment imposes a detrimental health burden on HF patients, as it negatively impacts quality of life, self-care management, treatment adherence, hospitalisation rates, and mortality. 6 Interventions that prevent, slow down, or reverse cognitive decline in HF patients are desperately needed; however, a lack of mechanistic insight has limited the number of safe and effective pharmaceutical interventions.…”