Depressive Symptomatology, Exercise Adherence, and Fitness Are Associated With Reduced Cognitive Performance in Heart Failure

Abstract

Objectives Depression is common in heart failure (HF) and associated with reduced cognitive function. The current study used Structrual Equation Modeling to examine whether depression adversely impacts cognitive function in HF through its adverse affects on exercise adherence and cardiovascular fitness. Methods 158 HF patients completed neuropsychological testing, physical fitness test, Beck Depression Inventory-II (BDI-II), and measures assessing exercise adherence, and physical exertion. Results The model demonstrated excellent model fit and increased scores on the BDI-II negatively affected exercise adherence and cardiovascular fitness. There was a strong inverse association between cardiovascular fitness and cognitive function. Sobel test showed a significant indirect pathway between the BDI-II and cognitive function through cardiovascular fitness. Discussion This study suggests depression in HF may adversely impact cognitive function through reduced cardiovascular fitness. Prospective studies are needed to determine whether treatment of depression can lead to better lifestyle behaviors and ultimately improve neurocognitive outcomes in HF.

Psychological Determinants of Heart Failure Self-Care

“…Depression was also associated with increased delay (36,43) between HF symptom onset and hospital admission, but not with self-reported consultation behavior in another large high-quality study (n = 958) (36). Considering the remaining cross-sectional studies, an association with poor exercise adherence was reported as well (35,44), whereas evidence from other studies was mostly weak, inconsistent, or lacking (16,(45)(46)(47)(48)(49)(50)(51)(52)(53)(54). Most associations disappeared when other explaining variables were taken into account, for example, disease severity, social support, or self-efficacy, or when it was assessed with a more objective method (46).…”

The role of gratitude in spiritual well-being in asymptomatic heart failure patients.

“…This is clinically significant since the presence of depressive symptoms in cardiovascular diseases such as HF is associated with increased risk of cardiovascular hospitalization and mortality (Johnson et al, 2012; Kato et al, 2012; Rutledge, Reis, Linke, Greenberg, & Mills, 2006). Typical risk factors associated with depression in HF include increasing age, poor physical fitness, poor sleep, fatigue, and inflammation (Alosco et al, 2013; Jimenez & Mills, 2012; Mills et al, 2009; Shimizu, Suzuki, Okumura, & Yamada, 2013; Sin, 2012) (Kupper, Widdershoven, & Pedersen, 2012; Tang, Yu, & Yeh, 2010). For stage B HF patients, finding correlates of depressive symptoms is particularly important as an avenue for potentially forestalling development of symptomatic Stage C disease, which is significantly associated with poorer quality of life and increased morbidity and mortality (Ammar et al, 2007).…”

Depressive symptoms and spiritual wellbeing in asymptomatic heart failure patients

“…Typical risk factors associated with depression in heart failure include increasing age, poor physical fitness, poor sleep, fatigue, and inflammation (Alosco et al, 2013; Jimenez & Mills, 2012; Kupper, Widdershoven, & Pedersen, 2012; Mills et al, 2009; Shimizu et al, 2013; Sin, 2012), factors that were controlled for in this study. For ACC/AHA Stage B heart failure patients, finding correlates of depressive symptoms is particularly important as an avenue for potentially forestalling development of symptomatic Stage C disease, which is significantly associated with reduced quality of life and increased morbidity and mortality (Ammar et al, 2007).…”

“…Moreover, symptoms of depression among symptomatic heart failure patients are associated with significantly increased risk of cardiovascular hospitalization and mortality after controlling for heart failure severity and left ventricular ejection fraction (Johnson et al, 2012; Kato et al, 2012). Risk factors associated with depression in heart failure include increasing age, poor social support, poor physical fitness, poor sleep, fatigue, and inflammation (Alosco et al, 2013; Jimenez & Mills, 2012; Mills et al, 2009; Shimizu, Suzuki, Okumura, & Yamada, 2013; Sin, 2012; Tang, Yu, & Yeh, 2010) .…”