Cognition and Frailty in Patients With Heart Failure: A Systematic Review of the Association Between Frailty and Cognitive Impairment

Abstract

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 >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.

One‐year trajectories of self‐care behaviours and unplanned hospital readmissions among patients with heart failure: A prospective longitudinal study

“…Furthermore, our findings were consistent in that cognitive impairment and frailty were related to poor adherence to self‐care behaviours and a higher risk of hospital readmissions (Faulkner et al, 2021; Li et al, 2022; Zhang, Jie, et al, 2022). This might be explained by that these two conditions effect poor self‐care behaviours, such as omitting taking medications, poor physical activities and difficulties in HF symptom management, which can lead to unplanned hospital readmissions due to deterioration of cardiac function (Faulkner et al, 2021). Nonetheless, HF conditions can aggravate cognitive decline and frailty, especially in the older HF population due to the reduced blood supply to the brain and metabolic dysfunction (Naderi et al, 2022).…”

“…Namely, HF is prevalent among older people who are likely to have multimorbidity and to experience an age‐related decline in cognitive function (Zhang, Jie, et al, 2022; Zhang, Koirala, et al, 2022). In addition, cerebrovascular haemodynamics changes, including reduced blood supply to the brain, have been postulated to contribute to the cognitive decline in HF patients (Faulkner et al, 2021). Two recent reviews emphasised that regular screening tests and multifactorial approach are required to improve self‐care abilities and clinical outcomes in individuals with HF and cognitive impairment (Faulkner et al, 2021; Zhang, Jie, et al, 2022).…”

“…In addition, cerebrovascular haemodynamics changes, including reduced blood supply to the brain, have been postulated to contribute to the cognitive decline in HF patients (Faulkner et al, 2021). Two recent reviews emphasised that regular screening tests and multifactorial approach are required to improve self‐care abilities and clinical outcomes in individuals with HF and cognitive impairment (Faulkner et al, 2021; Zhang, Jie, et al, 2022). According to the previous studies, health literacy and frailty were significantly associated with self‐care behaviours and hospital readmissions in patients with HF (Li et al, 2022; Tay et al, 2021).…”

Prevalence of cognitive frailty among older adults in China: a systematic review and meta-analysis

“… 4 Physical frailty refers to the cumulative decline of multiple physiological systems over time, leading to decreased physiological reserves and resistance to stressors in older adults. 5 It is associated with a significant increase in various adverse outcomes, such as falls, 6 dementia 7 and death. 8 Cognitive impairment is a pre-dementia stage in which age-related cognitive decline is insufficiently severe to cause significant impairment in daily functioning.…”

Neural Dysconnectivity in the Hippocampus Correlates With White Matter Lesions and Cognitive Measures in Patients With Coronary Artery Disease

“…CAD patients tend to present with reduced gray matter and white matter microstructure compared with controls ( Almeida et al, 2012 ; Vuorinen et al, 2014 ; Anazodo et al, 2015 ); it is also suggested that CAD patients showed cortical thickness in multiple regions of the brain ( Almeida et al, 2012 ; Vuorinen et al, 2014 ). Importantly, reports ( Deckers et al, 2017 ; Elman et al, 2019 ; Faulkner et al, 2021 ; Liang et al, 2021 ) have shown the association between CAD and the risk for cognitive impairment or dementia but very little is known about the association between this link. However, it is suggested that the association between cognitive impairment and CAD may be linked with underlying risk factors (such as hypertension, diabetes mellitus which have been suggested to be linked with cognitive dysfunction), atherosclerosis, and hypoperfusion.…”