Cognitive impairment in patients with heart failure: an international study

Abstract

Aims Cognitive impairment (CI) in heart failure (HF) patients has mostly been studied in single countries in specific health care settings. Sociodemographic and clinical predictors of the global CI and CI dimensions are still unclear. We described CI in a diverse HF population recruited in several countries and in different health care settings and investigated sociodemographic and clinical factors associated with the global and specific CI dimensions in HF patients. Methods and results A secondary analysis from the baseline data of the Wii‐HF trial. Patients (n = 605) were enrolled in Sweden, Italy, Israel, The Netherlands, Germany, and the United States. We used the Montreal Cognitive Assessment to evaluate CI and the 6 minute walk test (6MWT) to measure exercise capacity. Patients were on average 67 years old (SD, 12), and 86% were in New York Heart Association Class II and III. The mean Montreal Cognitive Assessment score was 24 (SD, 4), and 67% of patients had at least a mild CI. The item evaluating short‐term memory had a considerable proportion of low scoring patients (28.1%). Worse CI was associated with patients' older age, lower education, and lower 6MWT scores (R2 = 0.27). CI dimension scores were differently associated with specific clinical and demographic variables, but the 6MWT scores were associated with five out of seven CI dimension scores. Conclusions CI is an important problem in HF patients, with specific challenges in regard to memory. Exercise capacity is a modifiable factor that could be improved in HF patients with the potential to improve cognition and other outcomes in this population.

Cognitive and Emotional Disturbances Due to COVID-19: An Exploratory Study in the Rehabilitation Setting

“…It assesses multiple cognitive domains including memory, language, executive functions, visuospatial skills, calculation, abstraction, attention, concentration, and orientation. As many other studies (27,28), we used the original cutoff proposed by the author of the test (25), who recommended that a total MoCA score of <26 indicates the presence of cognitive deficits; furthermore, according to the author, one point should be added to the total score in subjects with a low (<12 years) education level.…”

Living with Heart Failure during the COVID-19 Pandemic: An Interpretative Phenomenological Analysis

“…Our participants felt particularly at risk for both the frailty due to their health conditions and for the relevant changes in the healthcare systems, where routine visits, rehabilitation programs, and non-urgent care were postponed, leaving these patients to worry if they could get care in case of HF exacerbation or other health emergencies. Prior studies had already reported that patients with HF felt vulnerable on multiple levels (Hauptman, 2018;Sloan & Pressler, 2009) because of financial instability, impaired cognition, and reduced quality of life and social functioning (Sloan & Pressler, 2009;Vellone et al, 2020). Also, it is known that psychological problems such as anxiety and depression were already widespread in this population before the pandemic (Dellafiore et al, 2019), with an 11% to 63% rate of anxiety and an 11% to 51% rate of depression (Bordoni et al, 2018).…”

Cognitive Impairment in Heart Failure—A Review

“…There is also a lack of standardisation of the cognitive assessment tools used. For example, screening tests such as the Mini Mental State Examination (MMSE) [ 6 ], Montreal Cognitive Assessment (MoCA) [ 7 , 23 ] and Hodkinson Abbreviated Mental Test (AMT) [ 3 , 13 ] were used by some investigators to assess CI, while others used more comprehensive neuropsychological batteries [ 2 , 19 , 24 , 25 ]. Recognising these limitations, CI at least appears to be common in HF and is present across a wide age range.…”

“…Cognitive impairment (CI) in patients with heart failure (HF) is common, with a reported prevalence of 20–80% [ 1 , 2 , 3 , 4 , 5 , 6 , 7 , 8 ]. Patients with HF demonstrate increased cognitive deficits compared to controls in several cognitive domains [ 9 ] and have poorer self-care and treatment adherence [ 10 ].…”