Heart Failure and Cognitive Impairment: Clinical Relevance and Therapeutic Considerations

Abstract

: Heart failure (HF) is a devastating condition characterized by poor quality of life, numerous complications, high rate of readmission and increased mortality. HF is the most common cause of hospitalization in the United States especially among people over the age of 64 years. The number of people grappling with the ill effects of HF is on the rise as the number of people living to an old age is also on the increase. : Several factors have been attributed to these high readmission and mortality rates among which are; poor adherence with therapy, inability to keep up with clinic appointments and even failure to recognize early symptoms of HF deterioration which may be a result of cognitive impairment. : Therefore, this review seeks to compile the most recent information about the links between HF and dementia or cognitive impairment. We also assessed the prognostic consequences of cognitive impairment complicating HF, therapeutic strategies among patients with HF and focus on future areas of research that would reduce the prevalence of cognitive impairment, reduce its severity and also ameliorate the effect of cognitive impairment coexisting with HF.

Cognitive Dysfunction after Heart Disease: A Manifestation of the Heart-Brain Axis

“…On the basis of the mechanism discussed above, aerobic exercise is beneficial for cardiac disease patients with cognitive impairment. Regular aerobic physical activity can increase the blood flow in the prefrontal cortex, promote the formation of blood vessels in the frontal cortex, and increase the concentration of the vascular endothelial growth factor [ 59 ]. Moreover, long-term continuous aerobic exercise can promote cardiovascular health by increasing vagal tone and reducing sinus node sympathetic nerve activity [ 60 ].…”

“…ACEI drugs pose similar risks, as they are involved in the process of converting amyloid- β 1-42 into A β 1-40. ACEIs block this process and increase the deposition of A β 1-42 in the brain [ 59 ]. However, the specific role of these drugs in the process of cognitive dysfunction remains to be further elucidated.…”

Psychomotor speed as a predictor of functional status in older chronic heart failure (CHF) patients attending cardiac rehabilitation

“…Indeed, in a recent systematic review and meta-analysis, the odds ratio for cognitive impairment in the CHF population in case-control studies was 1.67 [95% confidence interval (CI) 1.15–2.42] and the prevalence of cognitive impairment in CHF cohorts (n = 26 studies, 4176 participants) was 43% (95% CI 30–55) [ 8 ]. The presence of cognitive impairment has a great impact on CHF patients’ health status as it contributes to low self-care, poor adherence to clinical prescriptions, increased re-hospitalizations and higher risk of mortality [ 9 – 11 ]. In particular, poorer global cognitive score and working memory, psychomotor speed, and executive function dysfunctions are significant predictors of mortality [ 12 ].…”

Cognitive Impairment, Chronic Kidney Disease, and 1-Year Mortality in Older Patients Discharged from Acute Care Hospital

“…Additionally, cognitive dysfunction may alter the ability to recognize the clinical manifestations of kidney function deterioration, with a consequent increased risk of cardiovascular complications and death [ 49 ]. Additionally, the management of selected CKD comorbidities (e.g., diabetes and heart failure) may become very challenging among cognitively impaired patients [ 50 , 51 ], with relevant consequences in terms of mortality risk. Cognitive impairment may worsen adherence to antidiabetic medications [ 52 ] and reduce the awareness of hypoglycemic warning symptoms, thus increasing the risk of silent hypoglycemia further contributing to cognitive deterioration [ 53 ].…”