Cognitive test results are associated with mortality and rehospitalization in heart failure: Swedish prospective cohort study

Abstract

Aims We aimed to search for associations between cognitive test results with mortality and rehospitalization in a Swedish prospective heart failure (HF) patient cohort. Methods and results Two hundred and eighty-one patients hospitalized for HF (mean age, 74 years; 32% women) were assessed using cognitive tests: Montreal Cognitive Assessment (MoCA), A Quick Test of Cognitive speed, Trail Making Test A, and Symbol Digit Modalities Test. The mean follow-up time censored at rehospitalization or death was 13 months (interquartile range, 14) and 28 months (interquartile range, 29), respectively. Relations between cognitive test results, mortality, and rehospitalization risk were analysed using multivariable Cox regression model adjusted for age, sex, body mass index, systolic blood pressure, atrial fibrillation, diabetes, smoking, educational level, New York Heart Association class, and prior cardiovascular disease. A total of 80 patients (29%) had signs of cognitive impairment (MoCA score < 23 points). In the fully adjusted Cox regression model using standardized values per 1 SD change of each cognitive test, lower score on MoCA [hazard ratio (HR), 0.75; confidence interval (CI), 0.60-0.95; P = 0.016] and Symbol Digit Modalities Test (HR, 0.66; CI, 0.48-0.90; P = 0.008) yielded significant associations with increased mortality. Rehospitalization risk (n = 173; 62%) was significantly associated with lower MoCA score (HR, 0.84; CI, 0.71-0.99; P = 0.033). Conclusions Two included cognitive tests were associated with mortality in hospitalized HF patients, independently of traditional risk factors. In addition, worse cognitive test scores on MoCA heralded increased risk of rehospitalization.

Cognitive function assessment for personalized heart failure disease management programmes

“…At the time of study enrolment (before hospital discharge) the patients were screened for cognitive impairment using the Montreal Cognitive Assessment (MoCA) and during the 1-year follow-up hospital readmissions, deaths and days at home were recorded. Confirming prior studies, 6 poorer cognitive function was prevalent and independently associated with worse outcomes. On the other hand, the HF-DMP was independently associated with better outcomes, a finding that had also been previously documented.…”

The Impact of Cognitive Function on the Effectiveness and Safety of Intensive Blood Pressure Control for Patients With Hypertension: A post-hoc Analysis of SPRINT

“…This might be mainly attributed to the vulnerability and frailty of patients with lower cognitive function. Several studies have reported that poor cognitive function is associated with a significantly increased risk of mortality (14,(28)(29)(30)(31). Patients with poor cognitive function tended to have poor health literacy and less healthy lifestyles (32,33).…”

Network Physiology in Aging and Frailty: The Grand Challenge of Physiological Reserve in Older Adults

“…In the field of brain health, the concept of "cognitive reserve" refers to the capacity of the brain to buffer age-related changes or even neurodegenerative pathology, thereby minimizing clinical manifestations (e.g., cognitive failures) that would be otherwise more apparent during cognitively demanding tasks (i.e., "brain stressors") (Kraal et al, 2021). For instance, cognitive tests have been demonstrated to predict outcome in older patients with heart failure (Holm et al, 2020). It has been hypothesized that this reserve capacity may not only derive from an individual's "anatomic" neural profile (e.g., cell count, synaptic connections, brain volume), but also in the effective physiological recruitment of neural networks and cognitive processes that are also supported by non-neural systems.…”