Cognitive impairment measured by Mini-Cog provides additive prognostic information in elderly patients with heart failure

Abstract

Background: There has been no study elucidating whether cognitive impairment (CI) can provide additive prognostic information besides that provided by preexisting prognostic factors in elderly patients with heart failure. This study examined whether CI can provide additive prognostic information in elderly patients with heart failure. Methods: This multicenter retrospective study included 352 patients with heart failure aged !75 years. We administered the Mini-Mental State Examination (MMSE) and Mini-Cog test to assess CI. The Meta-Analysis Global Group in Chronic Heart Failure (MAGGIC) risk score was used as a model to incorporate the preexisting prognostic factors. All-cause mortality was considered the prognostic outcome. Results: The median age was 85 years old, 47.7% were male. According to MMSE and Mini-Cog, 167 (47.4%) and 159 (45.2%) patients had CI, respectively. The agreement between MMSE and Mini-Cog was fairly low (Cohen's kappa coefficient 0.37). During the follow-up period of median 346 days, 53 patients (15.1%) died. In multivariate Cox regression analysis, CI defined by MMSE and Mini-cog were individually associated with worse prognosis in older heart failure patients even after adjustment for MAGGIC risk model and log B-type natriuretic peptide levels [CI defined by MMSE, HR: 2.05 (95%CI: 1.16À3.61); and CI defined by ]. The area under the curve of receiver operator characteristics curve was numerically greater for Mini-Cog than for MMSE (0.59 vs. 0.52, p = 0.109). Moreover, significant net reclassification improvement was observed when CI defined by Mini-Cog, but not on CI defined by MMSE, was added to the MAGGIC score, and when Mini-Cog, instead of MMSE, was used as a CI assessment tool (0.41, p = 0.004).

The Utility of Cognitive Screening in Asian Patients With Heart Failure: A Systematic Review

“…Most studies were cross-sectional studies ( n = 7) ( 34 – 40 ), case–control studies ( n = 10) ( 41 – 50 ), while the remaining studies were longitudinal studies ( n = 4) ( 19 , 51 – 53 ). Tables 1 , 2 summarize the main characteristics of the 21 included studies.…”

“…Tables 1 , 2 summarize the main characteristics of the 21 included studies. Studies were conducted in Asian regions, including China ( n = 16) ( 19 , 37 – 50 , 52 ), Japan ( n = 3) ( 34 , 35 , 51 ), Korea ( n = 1) ( 36 ), and Singapore ( n = 1) ( 19 ). Nine of the 21 included studies ( 19 , 34 , 35 , 37 , 40 , 42 , 50 – 52 ) used the MMSE as a cognitive screening tool, while there were 14 studies ( 19 , 36 , 38 , 39 , 41 , 43 – 49 , 52 , 53 ) used the MoCA and 1 study ( 51 ) used the Mini-Cog.…”

“…Studies were conducted in Asian regions, including China ( n = 16) ( 19 , 37 – 50 , 52 ), Japan ( n = 3) ( 34 , 35 , 51 ), Korea ( n = 1) ( 36 ), and Singapore ( n = 1) ( 19 ). Nine of the 21 included studies ( 19 , 34 , 35 , 37 , 40 , 42 , 50 – 52 ) used the MMSE as a cognitive screening tool, while there were 14 studies ( 19 , 36 , 38 , 39 , 41 , 43 – 49 , 52 , 53 ) used the MoCA and 1 study ( 51 ) used the Mini-Cog.…”

“…There were 5 studies that applied cognitive screening tools, including the MMSE ( 19 , 34 , 35 , 51 , 52 ), the MoCA ( 19 , 52 ), and the Mini-Cog ( 51 ) ( Table 1 ). When considering the utility of cognitive tests for screening purposes, discriminant indices of the screening instruments, including sensitivity, specificity, PPV, and NPV, were examined.…”

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

“…Both tests are useful in identifying the majority of patients with and without CI with the sensitivity and specificity around 60-70%. Other tests, such as the Mini-Cog and the CAMCOG, had a moderate accuracy in populations with HF (117,118). With up and coming research investigating CI in HF, however, there is still no clear consensus regarding the optimal screening tool for the assessment of CI in HF.…”