Neuropsychological Patterns Differ by Type of Left Ventricle Dysfunction in Heart Failure

Abstract

Cognitive impairment is common among individuals with heart failure. The purpose of this study was to compare cognitive profiles of individuals with systolic and diastolic dysfunction. Eighty individuals with heart failure completed the Repeatable Battery for the Assessment of Neuropsychological Status (RBANS), Mini-Mental State Examination, Trail Making Test, and letter fluency. Approximately 25% of individuals with systolic dysfunction were impaired on the RBANS Total Scale score, compared with only 3% in the diastolic group. Additionally, individuals with systolic dysfunction scored lower than those with diastolic dysfunction on tests of immediate and delayed memory. The groups did not differ on tests of visuospatial skills, but there were mixed results on the RBANS Attention and Language subtests. Overall, the results of this study suggest that individuals with different types of cardiac dysfunction (systolic and diastolic dysfunction) demonstrate differential patterns of performance on neuropsychological tests. These findings have important clinical implications.

‘Hearts and minds’: association, causation and implication of cognitive impairment in heart failure

“…Previous diagnosis of CILVEFMultidomain neuropsychiatric batteryHF pts scored lower than the healthy control group in domains of immediate/long-term memory and psychomotor speed56 CAD controlsCAD controls: 67 (10)CAD controls: previous MI, English speaking, EF ≥60%, no clinical HFNYHANo difference between the HF group and IHD control group in cognition64 healthy controlsHealthy controls: 69 (11)Healthy controls: English speaking, no previous MI/angina, EF ≥60%Hawkins 2012 [28]251 HF ptsAmbulatory outpatients only66 (10)Cross-sectionalEnglish speakingCo-morbid psychiatric illness. Previous diagnosis of CILVEF ≤40%Multidomain neuropsychiatric battery58% of HF pts had CI with poor scores in the domains of verbal learning and verbal memoryBratzke-Bauer 2013 [29]47 HF-REFAge >50 years and ambulatory outpatients onlyHF-REF: 75 (9)Cross-sectionalHistory of HF >6 monthsCo-morbid psychiatric, neurological or physical illness. Previous diagnosis of CILVEFMultidomain neuropsychiatric battery23% of the HF-REF cohort showed evidence of CI33 HF-PEFHF-PEF: 68 (15)Stable on medication ≥4 weeksNYHA3% of the HF-PEF cohort showed evidence of CIHF-PEF based on AHA criteriaHuijts 2013 [30]491 HF-REFAge >60 years and ambulatory outpatients only77 (8)ProspectiveHF-REF: hospitalization within past yearCo-morbid physical illnessHF-REF: LVEF <45%, NYHA II-IV, NT-proBNP >400 pg/mlAMT8% of HF-REF group showed evidence of severe CI (AMT ≤7)120 HF-PEFHF-PEF: NT-proBNP ≥400 pg/ml if pt <75 years or ≥800 pg/ml if pt ≥75 yearsHF-PEF: LVEF ≥45%13% of HF-PEF group showed evidence of severe CI (AMT ≤7)Kindermann 2012 [31]20 decompensated HF ptsDecompensated HF: non-consecutive admissions to hospitalDecompensated HF: 60 (16)ProspectiveDecompensated HF: caused by ischaemic or DCM, symptomatic HF for ≥6 months, clinical signs of decompensation, for example, raised JVPCo-morbid psychiatric, neurological or physical illness.…”

Patient preferences for heart failure education and perceptions of patient–provider communication

“…Moving from inadequate to adequate health literacy levels is inherently dependent on cognitive skills15, which is also problematic in HF. Prevalence of cognitive impairment in HF varies from 25%18 to 80%19 depending on cognition assessment8. Memory, attention and problem‐solving are areas of concern in patients with HF and have been shown to have direct negative consequences on self‐management capacity20,21.…”

The MoCA and MMSE as screeners for cognitive impairment in a heart failure population: A study with comprehensive neuropsychological testing

“…In addition to the extensive somatic symptoms of HF, such as shortness of breath, fatigue, and edema [2], neurocognitive symptoms are also highly prevalent [3-7]. Observable deficits across multiple cognitive domains, including attention, executive function, and memory, have been detected in up to 80% of persons with HF [5], with higher rates typically reported among older and inpatient samples compared to community-dwelling samples [3-7]. Persons with HF are also nearly twice as likely to develop neurodegenerative diseases, such as Alzheimer's [8].…”