No abstract

There is abundant evidence on inflammatory mechanisms in heart failure (HF) that are used for prognostication of the disease; however, data are lacking regarding the association between elevated cytokines, C-reactive protein (CRP), and cognition in HF. A cross-sectional pilot study of 38 patients with HF, aged 62 years (standard deviation± 9 years), predominantly men (68%) and Cau casian (79%) were screened for cognitive function using the Montreal Cognitive Assessment (MoCA). The study aimed to examine cognitive scores on MoCA with cytokines, interleukin 6 [IL-6] and tumor necrosis factor α [TNF-α], and CRP as indicators of early cognitive changes in HF. The result showed no direct correlation between cardiac variables and the MoCA score. The MoCA score, however, was inversely associated with IL-6 (r=−0.53, P=.001) and CRP (r=−0.34, P=.04), with no association to TNF-α. Regression analysis on the MoCA score and log-transformed IL-6 accounted for an additional 11% variation and remained statistically significant (P=.008) after controlling for covariates of education, living arrangements, and loneliness. The large effect size (R2=0.87) found in this pilot study provides rationale for a larger exploratory study to examine associations between cognitive function, cytokines, and CRP levels and help design future intervention studies.

Persons with heart failure (HF) have four times the risk of having cognitive impairment compared with the general population and display different patterns of cognitive impairment. This secondary analysis of a published cross-sectional study of 90 community-dwelling adults examined the Montreal Cognitive Assessment (MoCA) scores and HF differentiated as systolic and diastolic HF. Mean MoCA score was 22.9 (standard deviation±2.31) in persons with systolic HF (n=69) and 24.8 (standard deviation±2.76) in persons with diastolic HF (n=21) with statistically significant mean difference between groups (t=-2.025, P=.030). Independent t test on the eight MoCA domain scores and systolic and diastolic HF indicated significance on visuo-spatial/executive function (P=.026), attention (P=.049), abstraction (P=.014), and delayed recall (P=.048). Findings from this study support the need for including persons with systolic and diastolic HF in future researches on identifying varying cognitive profiles to plan tailored cognitive intervention.

Both caregivers' affect and perceived burden are strongly related to depressive symptoms, so healthcare practitioners need to frequently assess both so as to provide timely interventions.

The results from this pilot study suggest there is a significant relationship between FM and the psychological symptoms of depression and PTSD. Nearly two-thirds of these women screened positive for depressive symptoms and just over one-quarter of participants had symptoms indicative of PTSD. Only a small proportion of women veterans in this study were deployed (14.42%) and this suggests that a trigger or risk factor other than deployment or combat may contribute to the development of FM and mental health symptomology. To focus on the complex interrelationships between pain, fatigue, sleep, and depression, a follow-up study with a larger sample powered for more complex statistical analyses is warranted. Additional analyses in this study reveal that over half of women veterans who reported military sexual trauma (MST) while in the military, screened positive for FM. Although our analyses did not reveal there to be a significant effect between FM and MST, it should be considered as a potential risk factor for FM as MST can be a precursor for PTSD. Women veterans who present with FM should be screened for MST as sexual trauma may not be disclosed. Understanding how many women veterans are affected with FM and the relationship with PTSD, MST, stress, depression, and sleep can improve screening and treatment to improve quality of life. This will also inform decision-making about how best to design and implement interventions, programs, and policies.