Cognitive Impairment in Patients With Advanced Heart Failure and Its Implications on Decision-Making Capacity

Abstract

Cognitive impairment (CI) is a multifaceted entity that entails more than just memory loss. Deficits in other domains, most importantly executive function, can have profound effects on health outcomes in afflicted patients. The prevalence of CI among the heart failure population is exceedingly high, and even higher so among patients with advanced heart failure (AHF). These patients display consistent declines in memory, attention, psychomotor abilities, and executive function. Such deficits interfere with patients' abilities to recognize worsening symptoms, adhere to complex medication regimens, and make sound decisions pertaining to medical care. Regular evaluation of cognitive status using instruments such as the Montreal Cognitive Assessment is a fast, reliable method that allows physicians who treat patients with AHF to anticipate these obstacles to treatment and act accordingly. Referral for more comprehensive neuropsychological evaluation should be considered for patients with unexplained declines from baseline, legal determination of competence, and for heart transplant or ventricular assist device placement candidates.

Neurocognitive Changes after Lung Transplantation

“…Neurocognitive deficits after transplantation are important because intact neurocognitive functioning is critical for decision-making capacity and for the ability to manage a complex medical regimen, both of which are essential elements of post-transplant care (28). Moreover, studies of other medical patients have suggested that neurocognitive deficits in executive function, memory, and working memory are associated with poorer medication adherence (5,(29)(30)(31), including patients with HIV (31-33) and cardiovascular disease (5) and healthy older adults (29).…”

Disparities in Heart Failure and other Cardiovascular Diseases among Women

“…Impaired cognition contributes to factors that lead to poor outcomes of older women with HF by reducing decision-making capacity and complicating HF self-management in this group. Specifically, cognitive deficits interfere with the ability to recognize and respond to worsening symptoms, follow complex medication regimens and adhere to diet and fluid restrictions [92,93]. Older women report more functional limitations, anxiety and depression than men at older ages [102], thus contributing to double jeopardy situations associated with poor outcomes in those with HF [11,90,92].…”

Cost-effectiveness analysis of ferric carboxymaltose in iron-deficient patients with chronic heart failure in Sweden

“…Uncommon in persons aged younger than 50 years, CHF becomes more prevalent with increasing age and affects 6-10% of the population aged 65 years and older (2). CHF impairs patients' quality of life, physical health and functioning, as well as cognitive health (3)(4)(5). Besides hypertension, ischemic heart disease and atrial fibrillation, a frequent comorbidity in CHF is anemia (6).…”