Objective Treatment recommendation and guidelines for patients with heart failure (HF) can be complex, and past work has shown HF patients to demonstrate low rates of adherence to recommended health behaviors. While previous work has identified several medical, demographic, and psychosocial predictors of HF persons’ capacity to adhere to treatment recommendations, little is known about the contribution of cognitive impairment to reported treatment adherence in this population. Methods 149 persons with HF (68.08 years; SD = 10.74) completed a brief fitness assessment and neuropsychological testing. Treatment adherence was assessed using the Heart Failure Compliance Questionnaire, a brief measure that asks participants to report their adherence to a variety of recommended health behaviors (i.e., medication management, diet, exercise, among others). Results 16.1% of participants reported poor overall adherence, with particularly high rates of non-adherence to dietary and exercise recommendations. Hierarchical regression analyses adjusting for possible confounds revealed reduced performance on attention (β = .26, p = .01), executive function (β = .18, p = .04), and language (β = .22, p = .01) were associated with poorer overall adherence. Follow-up analyses showed these cognitive domains were associated with behaviors such as keeping doctor appointments, medication management, and dietary recommendations (p < .05 for all). Conclusion The current findings demonstrate that cognitive function is an independent contributor to adherence in older adults with HF. Prospective studies that objectively measure treatment adherence are needed to clarify these findings and identify possible strategies to improve outcomes in this population.

Cognitive impairment is common in heart failure (HF) and believed to be the result of cerebral hypoperfusion and subsequent brain changes including white matter hyperintensities (WMH). The current study examined the association between cerebral blood flow and WMH in HF patients and the relationship of WMH to cognitive impairment. Sixty-nine patients with HF completed the mini mental state examination (MMSE), echocardiogram, transcranial Doppler sonography (TCD) for cerebral blood flow velocity of the middle cerebral artery and brain magnetic resonance imaging (MRI). Multivariable hierarchical regression analyses controlling for medical and demographic characteristics as well as intracranial volume showed reduced cerebral blood flow velocity of the middle cerebral artery was associated with greater WMH (β = −.34, p = .02). Follow up regression analyses adjusting for the same medical and demographic factors in addition to cerebral perfusion also revealed marginal significance between increased WMH and poorer performance on the MMSE (β = −.26, p = .05). This study suggests that reduced cerebral perfusion is associated with greater WMH in older adults with HF. Our findings support the widely proposed mechanism of cognitive impairment in HF patients and prospective studies are needed to confirm our findings.

Background Heart failure (HF) is a disabling disease that often affects instrumental activities of daily living (instrumental ADLs). Despite high rates of disability in this population, little is known about the effects of cognitive impairment on instrumental ADLs in this population. Objective The current study examined whether cognitive functioning predicts instrumental ADL performance in persons with HF. Participants and Methods Persons with HF (N = 122; 68.49±9.43 years; 35.2% female) completed neuropsychological testing, fitness assessment, and self-reported instrumental and basic ADL function as part of a larger protocol. Neuropsychological tests included the Mini Mental State Examination and Trail Making Test A and B. The 2-minute step test estimated fitness. Instrumental and basic ADL function was based on self-report on the Lawton-Brody Activities of Daily Living Scale. Hierarchical regression analyses were used to determine the independent contribution of cognitive function to ADLs in HF. Results HF patients reported high rates of impairments in instrumental ADLs, though indicated requiring little or no assistance with basic ADLs. Cognitive function showed incremental predictive validity for driving (R2 change = .07, p = .03) and medication management (R2 change = .14, p<.001). In each case, poorer neuropsychological test performance was associated with poorer instrumental ADL function. Conclusion In persons with HF, cognitive performance is an independent predictor of independence in driving and medication management. Strategies to maintain or improve cognitive functioning in HF may help patients remain functionally independent in their daily living.