Integrating assessment of cognitive status in elderly cardiovascular care

Abstract

Cardiovascular clinicians tend to pay little attention to issues related to cognition, and yet those caring for older adults will encounter a variety of conditions that may lead to cognitive impairment. Most commonly, these include cardiovascular disease‐specific conditions such as cerebrovascular disease or heart failure, but may also include neurodegenerative conditions, mood disorders, medication side effects and polypharmacy, and nutritional deficiencies and metabolic derangements among others. This review presents evidence supporting the importance of assessing cognitive status in older adults with cardiovascular disease, and suggests a practical approach to assessment and management of cognitive impairment in this population when it is found. Special attention is paid to the importance of collaboration between cardiovascular and geriatric specialists, and the value it may bring to patients.

The interaction and pathogenesis between cognitive impairment and common cardiovascular diseases in the elderly

“…51 The cognitive domains most commonly impaired in patients with heart failure are complex attention, executive function, learning, and memory. 52…”

“…51 The cognitive domains most commonly impaired in patients with heart failure are complex attention, executive function, learning, and memory. 52 Arrhythmias and CI Atrial fibrillation is one of the most common arrhythmias in the elderly. It was demonstrated by several researches that atrial fibrillation may increase the risk of CI through multiple mechanisms.…”

Heart failure and cognitive impairment: Complexity that requires a new approach

“…A positive screen would also serve as a trigger for more formal neurocognitive testing and assessment. 7 Cognitive impairment also has important implications for optimizing prescribing patterns. Medication regimens should include agents whose potential benefits outweigh the risk, and should not include agents whose risk outweigh potential benefits.…”

“…If challenges are identified, clinicians could implement strategies to accommodate these deficiencies, such as simplifying medication regimens and/or explicitly involving caregivers in decision‐making and self‐care behaviors. A positive screen would also serve as a trigger for more formal neurocognitive testing and assessment 7 …”