Purpose: Atrial fibrillation (AF) is the most common cardiac arrhythmia, and its incidence increases with age. The elderly population is commonly affected by frailty syndrome (FS). FS syndrome along with anxiety and depressive symptoms are prevalent among elderly patients with AF. It is unclear whether depression contributes to AF or vice versa. The purpose of this study was to assess correlations between FS and the occurrence of anxiety and depression symptoms in a group of elderly patients with AF. Patients and Methods: This cross-sectional study included 100 elderly patients (69 females, 31 males, mean age: 70.27 years) with AF. Standardized research instruments were used including the Tilburg Frailty Indicator (TFI) to assess FS, and two questionnaires to assess depression including the Geriatric Depression Scale (GDS), and the Hospital Anxiety Depression Scale (HADS). Results: Mild FS was found in 38% and moderate FS in 29% of patients. Based on GDS scores, depression symptoms were found in 51% of patients' sample. Based on HADS scores, 20% of patients were found to have anxiety symptoms, and 28% revealed depression symptoms. Single-factor analysis demonstrated a significant positive correlation between HADS anxiety symptoms (r=0.492), HADS depression symptoms (r=0.696), and GDS score (r=0.673) on the one hand, and overall TFI frailty score on the other. Multiple-factor analysis identified overall GDS score, education, and lack of bleeding as significant independent predictors of TFI scores (p<0.05). Conclusion: FS is common in the population of elderly patients with AF. We found evidence for the association between symptoms of anxiety and depression and the incidence of FS in this group of patients. Due to the risk of consequences which may in part be irreversible, screening for FS is recommended.

Background/Aim: Pathological processes associated with aging increase the risk of cognitive deficits. Frailty syndrome may significantly accelerate these pathological processes in elderly patients with heart failure. The objective of this review was to better understand the association between frailty syndrome and co-occurring cognitive decline in patients with heart failure.Methods: We conducted a systematic review based on PubMed/MEDLINE, Scopus, EMBASE, and CINAHL as databases. The search followed the method described by Webb and Roe. For inclusions, the studies were selected employing cross-sectional and longitudinal designs. The included studies had to evaluate frailty syndrome and cognitive impairments among participants with heart failure. As we were interested in older adults, the search was limited to individuals &gt;65 years of age. The search was limited to primary research articles written in English published since the year 2000.Results: Of the 1,245 studies retrieved by the systematic review, 8 relevant studies were enclosed for the full-text review. Our review revealed that most studies of patients with HF demonstrated evidence of an association between greater frailty and cognitive impairment. In particular, six studies reported evidence for the significant association between higher levels of frailty and cognitive impairment in patients with heart failure. The remaining two studies failed to find an association between frailty and cognitive impairment.Conclusions: The development of frailty and cognitive impairment in heart failure is particularly important because this cardiovascular disease is a common cause of both morbidity and mortality in the world. The results of this review fill the existing gap in the literature related to the identification of clinical factors linked with frailty syndrome that contribute to cognitive impairment in patients with a diagnosis of heart failure. The prevalence of overlapping frailty and cognitive impairment in patients with heart failure, therefore, necessitates a routine assessment of these components in the care of patients with cardiovascular disease.

Current psychopathology attempts to understand personality disorders in relation to deficits in higher cognition such as mindreading and metacognition. Deficits in mindreading are usually related to limitations in or a complete lack of the capacity to understand and attribute mental states to others, while impairments in metacognition concern dysfunctional control and monitoring of one’s own processes. The present study investigated dysfunctional higher cognition in the population of patients with borderline personality disorder (BPD) by analyzing the accuracy of metacognitive judgments in a mindreading task [reading the mind in the eyes Test (RMET)] and a subsequent metacognitive task based on self-report scales: a confidence rating scale (CR) versus a post-decision wagering scale (PDW). It turned out that people from the BPD group scored lower in the RMET. However, both groups had the same levels of confidence on the PDW scale when giving incorrect answers in the RMET test. As initially hypothesized, individuals with BPD overestimated their confidence in incorrect answers, regardless of the type of metacognitive scales used. The present findings indicate that BPD individuals show dysfunctional patterns between instances of mindreading and metacognition.

Contemporary discussions on relations between metacognition and mindreading result in several theoretical accounts allowing various combinations of both mechanisms in the process of formation of beliefs, intentions, and decisions with respect to oneself or others. In fact, various prefrontal areas of the brain are activated when individuals mentalize about themselves and about other people. Interestingly, the latest accounts of the relationship between mindreading and metacognition clearly favor arguments for interactionism between functionally different mechanisms in the formation of our social knowledge. In particular, a two-level architecture enables a mutual interaction within a complex metacognitive system that is evolutionarily structured into higher and lower level metacognition with different functions and tasks. In our opinion, cognitive architecture of such systems needs to include conscious mechanisms that incorporate information accessibility as activation through the interaction. Here, we will argue that the combination of the two-level account on mindreading and metacognition along with a global broadcasting architecture embedded in the human brain is a good starting point that explains formation of accurate social knowledge and access to such knowledge. In our opinion, it becomes clear that consciousness via the interaction activates many unconscious brain regions, including interpreter systems such as metacognition and mindreading.

Introduction: There is evidence that mindfulness-based interventions can be effective in the treatment of patients with depression, anxiety, posttraumatic distress syndrome and many other disorders. Psychological disorders are common among heart failure patients. In the management of heart failure interventions based on mindfulness are used sporadically, and there is also a need for more evidence-based data to prove the efficacy of these methods. Material, methods and results: Mind-HF is a pilot, single-centre, open-label study in which 30 adults hospitalized for heart failure (HF) are randomized to start Mindfulness-Based Heart Training (MBHT) or psychoeducational intervention. The efficacy and safety of MBHT training in comparison to psychoeducational intervention will be assessed over 3 months. Both interventions will be delivered online, therefore, additional feasibility of educational interventions through online tools will also be tested.Conclusions: Mind-HF will provide evidence of the efficacy and safety of the original, HF-tailored mindfulness program delivered online. The results will thus be relevant for introducing MBHT to clinical practice for the management of HF. It will also check the feasibility of online tools in delivering education and psychological support for this group of patients.