Cognitive impairment and self-care in heart failure

Abstract

BackgroundHeart failure (HF) is a prevalent chronic disease in older adults that requires extensive self-care to prevent decompensation and hospitalization. Cognitive impairment may impact the ability to perform HF self-care activities. We examined the association between cognitive impairment and adherence to self-care in patients hospitalized for acute HF.DesignProspective cohort study.Setting and participantsA total of 577 patients (mean age = 71 years, 44% female) hospitalized for HF at five medical centers in the United States and Canada.Measurements and methodsParticipants were interviewed for information on self-reported adherence to self-care using the European Heart Failure Self-care Behaviour Scale. We assessed cognitive impairment in three domains (memory, processing speed, and executive function) using standardized measures. Patients’ demographic and clinical characteristics were obtained through medical record review. Multivariable linear regression was used to examine the association between cognitive impairment and self-care practices adjusting for demographic and clinical factors.ResultsA total of 453 patients (79%) were impaired in at least one cognitive domain. Average adherence to self-care activities among patients with global cognitive impairment did not differ significantly from those without cognitive impairment (30.5 versus 29.6; 45-point scale). However, impaired memory was associated with lower self-care scores (P = 0.006) in multivariable models.ConclusionCognitive impairment is highly prevalent among older patients hospitalized for HF. Memory impairment is associated with poorer adherence to self-care practices. Screening for memory impairment in patients with HF may help to identify patients at risk for poor self-care who may benefit from tailored disease management programs.

Cognitive Decline in Heart Failure: More Attention is Needed

“…16 Being one of the most important cognitive functions, episodic memory of specific personal events and experiences was demonstrated to slowly decline in HF patients. 5,13,14,17 Furthermore, deficits in initial learning as well as delayed information recall were reported in the literature. 17 This suggests that CI in HF patients and CI in patients with vascular dementia could share pathophysiological mechanisms.strong impact on the patient's everyday life and are common in cases of frontotemporal and vascular dementia, and are also detected in HF patients.…”

“…Reported prevalence [2][3][4][5][6][7][8] of cognitive dysfunction in the heart failure (HF) population parallels the severity of HF, being the highest in the acute decompensation settings (see Table 1). …”

“…Even mild cognitive deficits may interfere with adherence to self-care practices. 5,24 Memory and executive function impairments are independently associated with worse instrumental activity, especially with a decreased ability to manage medications. Several studies demonstrated that patients with mild CI can return to normal cognitive functioning.…”

“…5,13,14,17 Furthermore, deficits in initial learning as well as delayed information recall were reported in the literature. 17 This suggests that CI in HF patients and CI in patients with vascular dementia could share pathophysiological mechanisms.…”

Cognitive impairments in patients with heart failure of ischemic genesis.

“…Хронічна серцева недостатність (ХСН) -неминучий наслідок прогресування всіх серцево-судинних захворювань, у тому числі й ІХС [5]. Поширеність ранніх стадій когнітивних по-рушень коливається від 25% до 75% у пацієнтів із СН [4] та пов'язана з ранньою смертю, втратою функціональної незалежності, гіршим дотри-манням режиму терапії та зниженням якості життя [6]. Найбільш виражена форма дисфункції головного мозку, що розвивається в пацієнтів із тяжкою ХСН, трактується як кардіальна ен-цефалопатія і проявляється когнітивною дис-функцією з брадифренією, порушенням уваги та інших регуляторних процесів, апатико-абу-лічним синдромом.…”