Cognitive Impairment in Heart Failure—A Review

Abstract

Cognitive impairment (CI) is common in heart failure (HF). Patients with HF demonstrate reduced global cognition as well as deficits in multiple cognitive domains compared to controls. Degree of CI may be related to HF severity. HF has also been associated with an increased risk of dementia. Anatomical brain changes have been observed in patients with HF, including grey matter atrophy and increased white matter lesions. Patients with HF and CI have poorer functional independence and self-care, more frequent rehospitalisations as well as increased mortality. Pathophysiological pathways linking HF and CI have been proposed, including cerebral hypoperfusion and impaired cerebrovascular autoregulation, systemic inflammation, proteotoxicity and thromboembolic disease. However, these mechanisms are poorly understood. We conducted a search on MEDLINE, Embase and Scopus for original research exploring the connection between HF and CI. We then reviewed the relevant literature and discuss the associations between HF and CI, the patterns of brain injury in HF and their potential mechanisms, as well as the recognition and management of CI in patients with HF.

Cognitive transitions based on functional status in older adults with heart failure: a population‐based study

“…In addition to its overwhelming prevalence of cognitive impairment in HF, mounting evidence suggests concerning risks of cognitive impairment in HF 4 . Additionally, transitions of cognitive status in HF have been extensively studied.…”

“…The determinants of cognitive impairment in HF and their impact on further deterioration are keys to limiting cognitive decline. Established clinical factors of cognitive impairment in HF include hypertension, atrial fibrillation, and stroke 4,11,17 . Previous studies suggest that impaired functional status, for example, advanced New York Heart Association class and reduced 6 min walk distance, is associated with cognitive impairment in HF 11,24–26 .…”

Internal carotid artery blood flow and pulsatility index in cognitively impaired people with chronic heart failure

“…Although the mechanisms behind cognitive impairment in HF are not fully understood, an association with cerebral blood flow has long been suspected. Previous experiments did either not compare BF with cognitive function or used different parameters such as blood flow velocity or measures of cerebral autoregulation 12–14 . A recent study assessed frontal brain perfusion by near‐infrared spectroscopy and reported significantly lower frontal brain activity and cognitive function in patients with HF 15 .…”

Association of sleep duration and physical frailty with cognitive function in older patients with coexisting atrial fibrillation and heart failure

“…Hence, there is a need for better understanding factors related to a higher risk of cognitive impairment so that individualized care plan can be designed to reduce cognitive decline in older patients with AF and HF. Regarding possible risk factors of cognitive decline, many studies have mainly focused on biological factors such as chronic inflammation, silent cerebral ischaemia and genetic factors (Goh et al, 2022 ; Tangestani Fard & Stough, 2019 ). Recently, sleep duration and physical frailty have emerged as modifiable risk factors of cognitive impairment among older people.…”

“…As ageing increases physical frailty and cognitive impairment (Tamura et al, 2018 ), it is meaningful to examine the extent of the influence of physical frailty on cognitive impairment in older people with multimorbidity. Although there are several studies on the relationship between physical frailty and cognitive impairment in older people with AF or HF (Goh et al, 2022 ; Lee et al, 2018 ; Mailhot et al, 2020 ; Marino et al, 2019 ), studies on older patients with concomitant AF and HF are scarce.…”